Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: Treating acute pain flare ups
An issue that comes up sometimes is “What do you do for the worst sudden really bad flare up?” It could be the first attack ever. It could be somebody who’s established with a pain but who’s been in a relative remission and now all of a sudden, it has gotten really, really bad. There are a couple of things you can do to get up and going really quickly.
I mentioned in another episode that Tegretol is not easy to get going fast. It takes several weeks in my experience for most of them.
The one thing I do for patients who are in acute flare up, when they’re really bad off is we’ll do a combination of Lyrica and Cymbalta. Now the concept is why use two medicines when one might do. Well these people are pretty bad off and they’re really hurting and both medications work by different systems or chemical processes and both take a week to ten days to start getting into the system and being number one tolerable for their side effects and number two starting to get a benefit.
So, I’ve found that in my practice when somebody is really in pain, really uncomfortable, if I’ll start both of those medicines explain what the different side effects of each one are going to be, that’s pretty identifiable and say “Here’s what’s going to happen. Both of these are coming in. If you get doing great, we’ll take one of them out.” But to get the maximum response in the shortest amount of time, I tend to start Lyrica for instance, 50 milligrams, three times a day. They’ll get dizzy, you bet you. And then I start Cymbalta, 30 milligrams the first week, 60 milligrams the second week. By the end of the second week, these two medicines have gotten in. You’re getting some typically synergistic effects, they work in different areas. And the combination we usually give a person at least some good pain control and if they’re having side effects, okay. If they’re dizzy, we tend to reduce the Neurontin. If they’re a little bit goofy headed, not cognitively suppressed, not thinking as clearly, maybe we’ll reduce the Lyrica. If they’re having more of the just blah feeling, can’t quite get going, some people get a lot of sweating or nausea persist then it’s probably Cymbalta. So by knowing the side effects of the medication, you can say let’s get both in there, pounce on it, figure out how to get pain control, then figure out how to pull it back.