Is anyone using the newer SNRI's for pain? results? papers?
Pristiq
Fetzima
Pristiq
Fetzima
Newer SNRIs? for pain?
- Thread starter macman
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Pain and psych here -- for some reason, Cymbalta seems to be the best. Effexor does help. I don't have much experience with Savella of Fetzima. Pristiq is excellent for depression/anxiety, but I haven't seen a profound difference in pain.
D
deleted875186
Never used them. I recently starting trying savella for fibro patients, typically would only do cymbalta before. But honestly nothing seems to work for fibro patients.
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O
Plus cymbalta is generic.
It is the only SNRI I use as a pain physician.
thank You.
Plus cymbalta is generic.
It is the only SNRI I use as a pain physician.
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Savella is quite nauseating, I think it was only marketed for fibromyalgia because the SNRI niche was getting full.
Have not tried due to insurance limitations/cost for patient population
Reg Pristiq: Clinical experience with desvenlafaxine in treatment of pain associated with diabetic peripheral neuropathy
Did not see data on Fetzima
I rotate through them based on side effect profiles but I don't have experience with the newer ones enough to say. I have been slipping in some low dose Abilify and Zyprexa though to augment some of the usual agents with efficacy.
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Are the agents effective because the patients clinical depression is improved and that reduces pain vs working on pain directly?
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Cymbalta more noradrenergic than Savella? I was under the impression Savella did little serotonin and mostly NE.
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Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison
The serotonin norepinephrine reuptake inhibitors are a family of antidepressants that inhibit the reuptake of both serotonin and norepinephrine. While these drugs are traditionally considered a group of inter-related antidepressants based upon reuptake ...
www.ncbi.nlm.nih.gov
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Nice Steve. I need to be as resourceful as you. I haven’t used Savella in a while but maybe I should revisit.
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I was a KOL for them. I can post my handouts when I get to my laptop.
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And a pic of your shoes. Might have been a square toe box at that time period.
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Nike Vortex. Blue with shiny gold swoosh.
D
deleted875186
Almost every savella script I’ve written has been denied by insurrance, probably going to give up even trying it.
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There should be generics based on age of drug. No one making it that I can see.
It's Euro name was Impulsor. Never available.
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Creatine supplementation in fibromyalgia: a randomized, double-blind, placebo-controlled trial - PubMed
Creatine supplementation increased intramuscular phosphorylcreatine content and improved lower- and upper-body muscle function, with minor changes in other fibromyalgia features. These findings introduce creatine supplementation as a useful dietary intervention to improve muscle function in...
pubmed.ncbi.nlm.nih.gov
This is a comparison of relative, rather than absolute, effects. The fact of the matter is venlafaxine, desvenlafaxine, and duloxetine are weak NRIs, as shown by their inefficacy in blunting the tyramine pressor response (see below). I can't comment on milnacipran, because no such study has been conducted with it.Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison
The serotonin norepinephrine reuptake inhibitors are a family of antidepressants that inhibit the reuptake of both serotonin and norepinephrine. While these drugs are traditionally considered a group of inter-related antidepressants based upon reuptake ...
Incidentally, has anyone used atomoxetine for pain?
Assessment of the Serotonin and Norepinephrine Reuptake Blocking Properties of Duloxetine in Healthy Subjects - Neuropsychopharmacology
Duloxetine is a dual inhibitor of norepinephrine (NE) and serotonin (5-HT) uptake. Initial trials conducted in depressed patients using regimens of 20 mg/day or less did not convincingly demonstrate its efficacy as an antidepressant. The aim of this study was to assess the effects of duloxetine...
www.nature.com
Effects of different doses of venlafaxine on serotonin and norepinephrine reuptake in healthy volunteers
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Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake - PubMed
The term niacin is the generic name for the two compounds nicotinic acid and nicotinamide, the major dietary precursors for two important coenzymes, nicotinamide adenine dinucleotide (NAD) and its phosphorylated form, NADP. Niacin is important for the maintenance of cellular integrity and energy...
pubmed.ncbi.nlm.nih.gov
antidepressants/ssris disrupt tryptophan catabolism, tripping out salvage NAD+ production, which body has to do to match ATP demands, so it can stay alive. Done through kyneurinine pathway. Result is psychiatric symptoms worsen the longer on these drugs.
i have patients on statins and ssris for 30+ years. cognitively, i would not label these people as sharp.
Yes, I've used Strattera off label for pain in patients with concomitant ADHD.
Some case reports but no major study when I looked
Some case reports but no major study when I looked
