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Nightmares, fatique, medication

May 3, 2006

I am a 65 year old woman presently taking Combivir, Reyataz and Norvir, and have been positive for 8 years. I have severe neuropathy and have tried several neurological type meds but now am on oxycontin and hydrocodone at certain times for breakthrough pain. The pain never totally subsides and is worst at night. I have great difficulty getting to sleep and have a history of nightmares but they have gotten much worse in the last year and a few months since I've been on my new regime of meds. So far I am doing wel with the meds otherwise. I also have very little energy, low apetite and a generally unenergetic lack luster feeling. My great love is to paint watercolors but the oomph needed to get started has gone and I fight every day to get myself to at least put brush to paper. This pursuit has been my best pain controller. Are antidepressents of any use to me?? I've had not so good reactions - feeling more depressed and less energetic- in the past from paxil and something that sounds like Celedon. Elavil makes me feel like I have a bladder infection. any suggestions???

Response from Dr. Horwath

There are other excellent medications available for peripheral neuropathy. Gabapentin (Neurontin) is an excellent treatment for peripheral neuropathy, for example.

It is well established that treating depression helps to improve pain symptoms of various types. Depression should be regarded as a medical illness that is associated with various physical symptoms, including pain. Treatment of depression also relieves the physical symptoms such as pain.

From what you describe, you are suffering from depression. Your depression and peripheral neuropathy would improve with good antidepressant treatment. One of the newest antidepressants on the market, duloxetine (Cymbalta), is both an excellent antidepressant and also is indicated for the treatment of neuropathy in people with diabetes mellitus. I have used it to treat a number of people with AIDS and severe depression with great success. In several patients who also had peripheral neuropathy, they found that it provided additional relief for pain associated with the peripheral neuropathy.

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