4 ms·

Only posting this in case it helps anyone else. I am aware it is a single point of data in my case but it is backed by research and accepted medical advice (htt

by chime 6y ago

Only posting this in case it helps anyone else. I am aware it is a single point of data in my case but it is backed by research and accepted medical advice (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412202/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412202/). I had severe chronic pain from herniated disc that was not a perfect candidate for immediate surgery. My GP prescribed Cymbalta (https://www.cochrane.org/CD007115/NEUROMUSC_duloxetine-treating-painful-neuropathy-chronic-pain-or-fibromyalgia https://www.cochrane.org/CD007115/NEUROMUSC_duloxetine-treat...) and I was surprised to find out that the depression med actually is known to help with chronic pain. It took a few days/weeks to really kick in but it absolutely worked for me. What it did was dissociate my conscious self from my in-pain self. I was always aware that my body was in pain but frankly it didn’t bother me. This allowed my body the time to properly heal itself without me consciously trying to adjust my position and movement to minimize pain. After about 9 months, I got off the meds, completely pain free. Cymbalta does have a ton of side effects and I experienced a number of them, especially when tapering off. However it was all worth it to get rid of the literal pain in my neck. Sounds like a parody to say “Ask your doctor about Cymbalta” but honestly if you are in chronic pain, don’t want to be addicted to opioids, have tried every rational thing but this, it is not a woo crystal oil gimmick. It is a risk that may be worthwhile to you.

sebmellen 6y ago
Fascinating. I gained the ability to dissociate very similarly after I had all 4 wisdom teeth removed in one surgery as a teenager. Post-surgery, I fell into a very deep depression and took a fair amount of Hydrocodone for the pain. For the next number of months, I could almost at will separate my "thinking/conscious" self from my depressed and deeply in pain self (due to a TMJ disorder from the surgery, when they had to crack my jawbone to excise the teeth). I was prescribed an antidepressant, Prozac, at the time. Prozac is only an SSRI, not an SSNRI like Cymbalta, but the mechanisms of action may be similar. I've always wondered why I was able to do that kind of dissociation — it would make sense if the Prozac prompted it. I think this same kind of dissociation can be achieved through tremendous discipline and practice at meditation. I think it was the technique used by Thích Quảng Đức when he self-immolated: https://www.youtube.com/watch?v=OxrBik16Hzg https://www.youtube.com/watch?v=OxrBik16Hzg.
xyzzy_plugh 6y ago
Funny, my wife was put on Cymbalta for a bit and the side effects were absolutely the worst. Then, she started tapering off and things got so much worse -- brain zaps, nausea, starry vision. We even got the drug compounded to a comically small dose to taper with even smaller steps, and it didn't really help. So, while your advice isn't wrong, drugs work differently for people. Great for some people, terrible for others. My wife would probably rank being on Cymbalta as the worst time of her life hands down.
- nicklaf 6y ago
  Hmm. I was prescribed Cymbalta and wrote about the reasons for that in a sister reply to yours, and your post reminds me why I have been hesitant to take it. If I may ask, did your wife's post-withdrawal symptoms eventually subside?
  - xyzzy_plugh 6y ago
    Yes, it took months to ramp off it. She had starry vision whenever the lights turned off for several months after that, which doctors were pretty dismissive of. She claims to never have been quite the same since taking it (and she only ever took what the doctors described as a baby dose) but she seems quite fine and normal now, over a year later. She's been on a lot of drugs, and the ramp down for this was by far the biggest pain. Compounding alone cost hundreds of dollars and tons of driving time to places that could actually compound it, all to get off the damn drug. She was mostly prescribed it for pain/nerve damage. Edit: that being said, her doctors did have patients who were on absolutely massive doses for the long term with basically little to no side effects, so I think it depends a lot on the person.
    - nicklaf 6y ago
      Thank you very much for sharing. I'll definitely need to give the decision to take the drug more consideration before I go through with it.
nicklaf 6y ago
Very interesting! I was recently prescribed Cymbalta as well for chronic pain in my first rib area [0], but until reading your post had some remaining skepticism about going through with it. In my case, chronic pain seems to be affecting my sympathetic nervous system and causing dysautonomia, manifesting as delayed orthostatic hypotension (blood pressure drops after a few minutes of standing) and compensatory orthostatic tachycardia (heart rate increases to compensate), similar to POTS (postural orthostatic tachycardia syndrom, which, strictly speaking, is just the heart rate symptom and not the blood pressure one). My doctor who prescribed the Cymbalta described the approach as "multi-modal", since I'll be getting a treatment of pulsed radiofrequency neuromodulation to the painful area (the first rib area) to numb the pain up. But I already have widespread chronic pain, which seems to relate to my POTS (the spine has nerves close enough to the first rib that pain signals could be spilling over and affecting the sympathetic fibers regulating the autonomic nervous system, i.e., things like heart rate and blood pressure). This gives me hope that if my doctor is right, something like Cymbalta could work in tandem with numbing up the pain locally to turn these pain signals down a notch, and hopefully do something to ease up the POTS over time. [0] https://news.ycombinator.com/item?id=24949553 https://news.ycombinator.com/item?id=24949553

by chime 6y ago

sebmellen 6y ago

Fascinating. I gained the ability to dissociate very similarly after I had all 4 wisdom teeth removed in one surgery as a teenager. Post-surgery, I fell into a very deep depression and took a fair amount of Hydrocodone for the pain. For the next number of months, I could almost at will separate my "thinking/conscious" self from my depressed and deeply in pain self (due to a TMJ disorder from the surgery, when they had to crack my jawbone to excise the teeth). I was prescribed an antidepressant, Prozac, at the time. Prozac is only an SSRI, not an SSNRI like Cymbalta, but the mechanisms of action may be similar. I've always wondered why I was able to do that kind of dissociation — it would make sense if the Prozac prompted it. I think this same kind of dissociation can be achieved through tremendous discipline and practice at meditation. I think it was the technique used by Thích Quảng Đức when he self-immolated: https://www.youtube.com/watch?v=OxrBik16Hzg https://www.youtube.com/watch?v=OxrBik16Hzg.

xyzzy_plugh 6y ago

Funny, my wife was put on Cymbalta for a bit and the side effects were absolutely the worst. Then, she started tapering off and things got so much worse -- brain zaps, nausea, starry vision. We even got the drug compounded to a comically small dose to taper with even smaller steps, and it didn't really help. So, while your advice isn't wrong, drugs work differently for people. Great for some people, terrible for others. My wife would probably rank being on Cymbalta as the worst time of her life hands down.

nicklaf 6y ago
Hmm. I was prescribed Cymbalta and wrote about the reasons for that in a sister reply to yours, and your post reminds me why I have been hesitant to take it. If I may ask, did your wife's post-withdrawal symptoms eventually subside?
- xyzzy_plugh 6y ago
  Yes, it took months to ramp off it. She had starry vision whenever the lights turned off for several months after that, which doctors were pretty dismissive of. She claims to never have been quite the same since taking it (and she only ever took what the doctors described as a baby dose) but she seems quite fine and normal now, over a year later. She's been on a lot of drugs, and the ramp down for this was by far the biggest pain. Compounding alone cost hundreds of dollars and tons of driving time to places that could actually compound it, all to get off the damn drug. She was mostly prescribed it for pain/nerve damage. Edit: that being said, her doctors did have patients who were on absolutely massive doses for the long term with basically little to no side effects, so I think it depends a lot on the person.
  - nicklaf 6y ago
    Thank you very much for sharing. I'll definitely need to give the decision to take the drug more consideration before I go through with it.

nicklaf 6y ago

Very interesting! I was recently prescribed Cymbalta as well for chronic pain in my first rib area [0], but until reading your post had some remaining skepticism about going through with it. In my case, chronic pain seems to be affecting my sympathetic nervous system and causing dysautonomia, manifesting as delayed orthostatic hypotension (blood pressure drops after a few minutes of standing) and compensatory orthostatic tachycardia (heart rate increases to compensate), similar to POTS (postural orthostatic tachycardia syndrom, which, strictly speaking, is just the heart rate symptom and not the blood pressure one). My doctor who prescribed the Cymbalta described the approach as "multi-modal", since I'll be getting a treatment of pulsed radiofrequency neuromodulation to the painful area (the first rib area) to numb the pain up. But I already have widespread chronic pain, which seems to relate to my POTS (the spine has nerves close enough to the first rib that pain signals could be spilling over and affecting the sympathetic fibers regulating the autonomic nervous system, i.e., things like heart rate and blood pressure). This gives me hope that if my doctor is right, something like Cymbalta could work in tandem with numbing up the pain locally to turn these pain signals down a notch, and hopefully do something to ease up the POTS over time. [0] https://news.ycombinator.com/item?id=24949553 https://news.ycombinator.com/item?id=24949553