Advice Needed: Complete Analgesic Polypharmacy

[S-VV]

I have recently developed a possible case of CRPS, a syndrome that if fully allowed to progress has one of the the highest pain scores (along with Trigeminal Neuralgia) and is dubbed "the suicide disease".

Fortunately its relatively mild, but it can progress. The literature agrees that aggressive analgesic/anti-inflammatory treatment to avoid central sensitization and the spread of the inflammatory process is key. Early and aggressive treatment is factor #1 for a good prognosis.

For now, Im using ibuprofen 600mg twice a day and acetaminophen 650mg three times a day for a very good analgesic effect. Im also taking pregnenolone 300mg a day. The next step in allopathic medicine for analgesia would be opioids, which for now im not going to take.

Gabapentinoids are also an option, but they can generate tolerance quickly. Corticosteroids are also an option, but im putting them off for now for obvious reasons. I may try low dose naltrexone.

My question is, what other analgesic/anti-inflammatory compounds do you know that are effective?

Thanks guys.

 

[Maljam]

Acetaminophen is a nasty drug, I would highly advise against taking nearly 2 grams a day indefinitely. Can you switch aspirin in instead?

 

[S-VV]

Yeah, I know its nasty. But CRPS is far, far worse. For now, its the lesser of two evils until I can get things stabilised.

Aspirin is an NSAID, the same as Ibuprofen. I have thought about switching from Ibuprofen to aspirin.

Also, NSAIDs and acetaminophen are synergistic.

 

[S-VV]

After some research im going to try:
-Aspirin: 1.5 grams (COX-2, prostaglandins)
-LDN taper up to 4.5 mg (TLR4, microglia)
-Pentoxyfiline 1200mg (TNFalpha, and microcirculation)

-Red light
-PEMF

I still need something good for mast cells.

 

[Diokine]

Modulation of the kynurenine pathway may be effective therapy. Subliminal infection or chronic exposure to immunogenic agents may induce a holding pattern in the metabolism of tryptophan that can lead to serious disruption of homeostasis, especially in the nerves. Have you considered melatonin? It has been demonstrated to positively modulate tryptophan metabolism and may help restore feedback in this system.


Plasma Amino Acids Changes in Complex Regional Pain Syndrome

In addition, the L-kynurenine to L-tryptophan ratio demonstrated a significant increase, whereas the global arginine bioavailability ratio (GABR) was significantly decreased in the CRPS subjects. The CRPS subjects demonstrated a significant correlation between overall pain and the plasma levels of L-glutamate and the L-kynurenine to L-tryptophan ratio. CRPS subjects also showed a correlation between the decrease in plasma L-tryptophan and disease duration.

Decrease in tryptophan could be associated with indiscriminate activation of tryptophan di-oxygenase. Peripheral activation can consume oxygen and tryptophan at a rate not compatible with immune competency.

Pyridoxal 5 phosphate might be deficient in conditions like this.

I think it would be very important to manage insulin, ie. no large blood sugar excursions especially before bed.

Insulin resistance and dysregulation of tryptophan – kynurenine and kynurenine – nicotinamide adenine dinucleotide metabolic pathways

Nicotinic acid (niacin) may act as an antagonist of quinolinic and xanthurenic acid and might help as well.

Best wishes to you.

 

[S-VV]

Modulation of the kynurenine pathway may be effective therapy. Subliminal infection or chronic exposure to immunogenic agents may induce a holding pattern in the metabolism of tryptophan that can lead to serious disruption of homeostasis, especially in the nerves. Have you considered melatonin? It has been demonstrated to positively modulate tryptophan metabolism and may help restore feedback in this system.


Plasma Amino Acids Changes in Complex Regional Pain Syndrome



Decrease in tryptophan could be associated with indiscriminate activation of tryptophan di-oxygenase. Peripheral activation can consume oxygen and tryptophan at a rate not compatible with immune competency.

Pyridoxal 5 phosphate might be deficient in conditions like this.

I think it would be very important to manage insulin, ie. no large blood sugar excursions especially before bed.

Insulin resistance and dysregulation of tryptophan – kynurenine and kynurenine – nicotinamide adenine dinucleotide metabolic pathways

Nicotinic acid (niacin) may act as an antagonist of quinolinic and xanthurenic acid and might help as well.

Best wishes to you.

Thanks bro!

Yeah, I read the plasma amino acid study. To be honest, I have never deep dived into kynurenine/quinolic acid pathways, but I know they are pretty involved in neuropathy pathogenesis.

I do believe that a low level of l-tryp means a high flux thru dioxigenase. I'll have to learn more about it. Do you know of any means to modulate l-tryp metabolism apart from melatonin? I'm already taking it:)

I also found curious that l-arginine was also low in the study. Does that mean a high NO level due to inflammatory iNOS? On the other hand, I read many accounts of crps patients improving with l-arg supplementation.

 

[S-VV]

Update: im going to target mast cells with palmitoylethanolamide

 

[S-VV]

-Aspirin: 1.5 grams (COX-2, prostaglandins)
-LDN taper up to 4.5 mg (TLR4, microglia)
-Pentoxyfiline 1200mg (TNFalpha, and microcirculation)
-PEA 400mg x 3 (mast cells)

-Red light
-PEMF

 

[S-VV]

UPDATE: PEA is a no-go. Lowered bp with compensatory tachycardia and increased overall fatigue. Still searching for a “mast cell stabiliser”.

Anybody got a lead on that?

 

[ecstatichamster]

UPDATE: PEA is a no-go. Lowered bp with compensatory tachycardia and increased overall fatigue. Still searching for a “mast cell stabiliser”.

Anybody got a lead on that?

ketotifen
And it and cypro intensify analgesic effect of nsaids

 

[S-VV]

ketotifen
And it and cypro intensify analgesic effect of nsaids

Thanks hamster!

I was thinking about ketotifen. Seems its the only alternative that actually prevents degranularization, instead of just antagonizing H1.

I may try cypro, but im wary of serotonin receptor upregulation with long term use.

On a related note, I don’t know why histamine blockers are not used more widely on (auto)inflammatory diseases. It seems that mast cells are very involved in chronic inflammation and hyperalgesia.

 

[Cloudhands]

I have recently developed a possible case of CRPS, a syndrome that if fully allowed to progress has one of the the highest pain scores (along with Trigeminal Neuralgia) and is dubbed "the suicide disease".

Fortunately its relatively mild, but it can progress. The literature agrees that aggressive analgesic/anti-inflammatory treatment to avoid central sensitization and the spread of the inflammatory process is key. Early and aggressive treatment is factor #1 for a good prognosis.

For now, Im using ibuprofen 600mg twice a day and acetaminophen 650mg three times a day for a very good analgesic effect. Im also taking pregnenolone 300mg a day. The next step in allopathic medicine for analgesia would be opioids, which for now im not going to take.

Gabapentinoids are also an option, but they can generate tolerance quickly. Corticosteroids are also an option, but im putting them off for now for obvious reasons. I may try low dose naltrexone.

My question is, what other analgesic/anti-inflammatory compounds do you know that are effective?

Thanks guys.

Try ketamine?

 

[Breadpill]

Proteolytic enzymes have been used for pain, although i think they can lower bp.

 

[Breadpill]

Any updates?