Friday, February 18, 2011

Fads in Fashion Are Fine, but in Medicine?

If you've had chronic pain for the last decade, as I have, you know exactly what the title refers to. If you haven't, you probably think that fads are limited to fashion, music and social networking, but medicine is ruled by science.

Yeah, not so much.

Medicine is ruled by fads, and no, that's not good for the patient. Yesterday, I left my doctor's office with a prescription for Sevella. I've never heard of it, so I looked it up.

Milnacipran is not used to treat depression, but it belongs to the same class of medications as many antidepressants.

Sevella is an SSRI/SNRI, putting it in the same group as Prozac and Wellbutrin (Zyban if you're quitting smoking). When my pain first sent me to doctors for relief, tricyclic antidepressants were the fad, so I took Elavil. Fifteen days after starting Elavil, I tried to kill myself. After that came the first wave of the fad of treating chronic pain with SSRI/SNRIs. "But I'm not depressed," I protested and was assured that these new antidepressants had no effect besides pain relief if you weren't depressed. I can only assume my doctor got that line from the drug rep, because it's not true. My reaction was not unique. Prozac left me despondent, crying until I literally ran out of tears. Wellbutrin turned me into an avatar of rage and I found myself screaming obscenities at some poor guy named Tim when my cable went out. (Sorry, Tim.)

My doctor knows this, I've told him these stories in great detail. My file should have "NO ANTIDEPRESSANTS" written on it in red pen.

After that was the fad for Neurontin, an anticonvulsant. The drug reps were pushing it hard for disorders other than epilepsy, and doctors treating pain patients were delighted to play along, even though there was no evidence that Neurontin did anything for chronic pain. It didn't do anything for me, and my doctor at the time told me that Neurontin was the gold standard for chronic pain and if it didn't work for me, maybe I just liked narcotics too much.

Not one fucking study, no science at all, just a drug rep's assurances, and I was a junkie.

After that came Lyrica. It was a miracle! We would all be saved! I got so dizzy I couldn't stand up. "Wait for it to pass," my doctor said, "This stuff is worth it." I did eventually learn to walk somewhat straight, but my pain didn't go away. After six months, I gave up, but to this day, I still have balance problems, and if I turn my head too fast, I fall over.

Last year, right before my doctor's visit, I saw an ad for Cymbalta. "Here we go again," I said. "He's not going to give you that," my husband said, "He knows what happens to you on antidepressants."

As soon as he walked into the exam room, my doctor was singing the praises of Cymbalta. "Angels deliver it directly from heaven!" I'm paraphrasing, but he was pushing this stuff like the manufacturer had sent an assassin to his house and was holding his family hostage until he prescribed enough of it.

I'd had enough. I refused. He threatened to stop my pain meds unless I tried it. I took the sample pack- and then went home and threw it away. I told him it didn't work, but I had tried.

This year, it's Sevella and everyone's getting a scrip! Pink is the new black, belts are the new gloves and Sevella is the new Cymbalta. Here's a look at the side effects:

Milnacipran may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • nausea

  • vomiting

  • constipation

  • stomach pain

  • weight loss

  • dry mouth

  • feeling of extreme facial warmth and/or redness

  • increased sweating

  • headache

  • dizziness

  • blurred vision

  • difficulty falling or staying asleep

  • decreased sexual desire or ability

  • pain or swelling of the testicles

  • difficulty urinating

  • rash

  • itching

Would you prescribe that to someone who just got done telling you that they can't sleep and their gallbladder is sending them to the ER every three weeks? If so, you have what it takes to be a pain doctor- a fantastic commitment to fads and a sociopathic unconcern for the wellbeing of other people!

I can't wait for next year.


  1. That is horrible. Doctors should listen to their patients. I hope that you get something that helps you.

  2. I've seen the same thing with my wife who has severe chronic pain. Every couple months she'll come home from the doctor and say they switched one or more of her medicines. They always have a similar gigantic list of major side-effects. You never know what's going to happen -- especially since the way they interact with all the other medications she's taking is highly unpredictable. We've had passing out, extreme dizziness and suicidal thoughts among other symptoms to deal with.

  3. Wellbuterin is an MAOI.

    but YES - i've had the SAME list of meds.

    just a side note - people with ANY form of Porphyria SHOULD NOT EVER, FUCKING EVER, I DON'T CARE IF DANUE HERSELF SHOWS UP AND RECOMMENDS IT, TAKE SSRIs. Porphyria+SSRI = SOMETHING HORRIBLE, because the Porphyria reacts VERY badly to SSRIs [or maybe SSRIs react VERY badly to Porphyria]

    i know you said you didn't, but DON'T take the Savella - my pain doc gave it to me for sleep - after reassuring me it was NOT an SSRI [!] and i take 25mg of phenegrin every 4 hours. it shouldn't be POSSIBLE for me to throw up after taking one.

    i threw up. copiously.
    plus - it's an SSRI. DO NOT TAKE!!! [yes, yes, i'm repeating both myself and you. but... seriously. it HURTS. it makes you not just nauseated, but triggers accute porphyrin attacks. that info, btw, is IN THE INSERT, that i got, anyway, that one should not take this if they have porphyria.]

    in my case, prozac caused me to try to kill myself, elavil made me enraged, and wellbuterin didn't do much of ANYTHING except cause migrains if i missed a dose [but wellbuterin is, at least, "safe" for people with porphyria, it's just fucking useless] the dose of wellbuterin for those trying to quit smoking is 1/4 of the dose for depression and everything else. please note the thought to quit? never even crossed my mind - it doesn't help people to quit at "normal" dosage [maybe it's different at 1/4 dose, but that seems... odd]

    and i DO NOT understand the fucking obsession with neurotin! it's STILL there! i've been given neurotin EVERY YEAR since it came out! and it's done fuck all for me.

    and i LOVE doctors who say "if this med doesn't work you must be an addict" - ESPECIALLY when the doc knows you don't take all the narcotics you have TO BEGIN WITH. does. not. compute.

    assholes, all.

  4. You know, Denelian, that actually explains a lot. Back when I got Prozac, I was diagnosed with fibromyalgia, and I did get vicious stomach pain from the Prozac and was assured it was a side effect that would pass. Looking back on it, I bet it did trigger a porphyric attack.

    Don't worry, I took the sample pack of sevella, but I have no intention of trying it. As soon as I saw SSRI, I thought "crying until I run out of tears? No thanks."

    Thank you. Though if Danue shows up, I don't know that I'd get past my shock soon enough to refuse. ;)

  5. UNRR - trying to separate out which drug is causing which symptom, or if it's some combined thing between drugs is a nightmare. Heck, just getting a doctor to believe you or care is hard enough. As far as I can tell, as long as they aren't dealIng with it personally, who cares?

  6. yay i was helpful! {*shudder* on the stomach pain - the worst bit about porphyria is you never know if it's the porphyria, or an actual problem that needs fixed! i'm sorry you went thru an induced attack - it's my opinion that they're worse than the "normal" ones]

    seriously - this is an IMPORTANT FACT that people with ANY Porphyria should know - and no one tells us. it's incredibly negligent, and i don't get it [i had an AWESOME shrink tell me, because he was HORRIFIED that i was on prozac. and... yeah]

    if She shows up... well, She'd probably smack whomever was trying to give you something you shouldn't take. i'd ask for a sparkly purple unicorn, if i were you - your one chance to get one lol!

    UNNR - the person to befriend is the pharmacist. in reality, if there are drug interactions, they're SUPPOSED to tell you, but they're very often over-loaded. ASK. be nice to pharamicist all the time. it's sad and sucky that doctors won't do it, but the pharmacist? will, and SHOULD [and is required by law to advice you of any and everything, so long as you ask - that's why you have to sign a piece of paper when you get meds - there's two colomns, one for if you did talk to pharmacist, and one if you refuse - by signing under the "refuse" column, you are absolving pharmacist of all responsibility. don't do it - ask for counseling and sign the column that SAYS you're asking for counseling

  7. Denelian: Bupropion is absolutely not an MAOI, it's a norepinephrine-dopamine reuptake inhibitor (NDRI). So it's a non-tricyclic like all the 'normal' SSRIs, but works on norepinephrine as opposed to serotonin.

    If it was an MAOI, you couldn't take it with nearly anything else, because MAOIs interact with basically every other drug made. (EMT school, all the drug sheets list MAOIs as an absolute contradiction. Ok, that's a bit of an exaggeration, it's still ok to give your MAOI patients supplemental oxygen...)

    PersonalFailure: As for chronic pain... I've got arthritis, have since I was a kid. Used to take lots of ibuprofin, now I mostly just gut it out and use the ibuprofin and acetaminophen when I'm too sore for that, and have a "use as needed" bottle of percocet for when my back goes out and I actually can't stand up. (Fun fact, the distance from the driveway to your wife's bedroom down the far end of the hallway is about a million times as long on your hands and knees.)

    And now that I think about that, I probably can't use my emergency percocet now that I'm an EMT.

    Does your chronic pain have the consideration to have as definable a source as "all of your joints are missing half their cartilage"?

    BTW: Hi, I'm here from Holly's journal after your "I define everything I do as be definition feminine" comment. For the win. :)

  8. perlhaqr;

    now i am confused, as my old psychiatrist told me that Wellbuturin is an MAOI. *shrug* either way, it's NOT an SSRI. and it's specifically SSRIs that are the problem with porphyria - i've been given NDRIs, and while they do nothing for me, they do NOTHING in reaction to porphyria.

    arthritis is weird to treat, too. i have RA - all the damned opiates i'm on do almost nothing for the RA pain. but i can't take most of the Rx arthritis meds, and i'm allergic to the combo of oxycotin and asprin/tylenol/motrin. i can't take percoset or percodan, just oxycotin alone. which also sucks. i think that that's also a porphyria-reaction [as i have trouble taking them at ALL, and it's stomach pain.]

    if you have arthritis, i'm jealous of your ability to work as a paramedic with it. even before the crap with my hip/MRSA/nerve damage trifecta, i couldn't carry more than about 20 or 30 pounds - i certainly couldn't spend all day picking people up and putting them in ambulances.


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