Chronic Pain Syndrome and SNRI's

After having arthritis for over 20 years (I am 42 now) I was told I have Chronic Pain Syndrome..... after trying various medications I would like to add to my gabapentin and co-codamols a SNRI.

I was on fluoxetine, but after reading up on it want to try a SNRI like Milnacipran, Duloxetine or Venlafaxine.

Does anyone have experience of these?

Can anyone in the UK tell me if Milnacipran and Venlafaxine are available on NHS prescription or private?

Thank You for any words of wisdom you can share.​

16 Replies

  • I take venlafaxine and yes it is available on the NHS. Pescribed it for something else but sadly doesn't help with my pain issues.

  • Thanks Bevvy, was on fluoxetine for moods and it wasn't too bad and helped a bit with pain just wanted to hear others experience.

  • I have CRPS and ,amongst other meds, have been taking Duloxetine for nearly 2 years now. I have found it to be helpful. My GP wasn't too happy at my Pain Consultant having prescribed it, as she said it was expensive !

  • That is good to hear Treacs, Glad it is helping. Funnily enough when I asked to go back to gabapentin from pregabalin I tried to use the cost to the GP as one reason the others being side effects, he said cost didn't matter if it helped! LOL Thanks for replying.

  • Hi tartan tiger, I have taken venlafaxine for over 20 years without any problems, it does help with the pain stress cycle, I currently am taking 75mg in the morning and 150 mg at night. If I remember rightly I started of on 37.5mg twice daily and increased to my current dose over time

    Take care Sheryl

  • Thanks Sheryl.

  • I got persuaded to try venlafaxine and it really did a number on me. I had horrendous mental and physical side effects for days after just one dose. Never again. I'm not a good advertisement for SNRIs or even SSRIs though - they really scare me because of the immense difficulty you can have coming off them after even just being on them a short time. Also for me they put me in a bit of a dream world where I kind of just didn't care, as well as having some quite scary impulsive thoughts. Luckily I managed to keep myself grounded and not act on the impulsive thoughts. I realised these meds weren't for me when I finally did come off an SSRI after being on it for six months and suddenly felt properly alive and well (even if I did still have pain).

    Having said that, I realise they are wonder drugs for some people. I'd just warn not to underestimate the problems that you can have if you try to come off them too quickly, or the way they dull emotions. Dulling emotions may be a good thing for some people, but for me it made life pretty unbearable - the opposite effect to what it should have been.

    I can't take amitryptylline either because of the way it affects me, however I do know that amitryptylline is a proven med for helping with pain control, and is a much simpler medication than either SSRIs or SSNRIs, so I'd always start with that first and only go to the SSRIs or SSNRIs if I needed something more than amitryptylline, having given it a good try.

  • So sorry you have had such trouble with medication. I have always been lucky in that most don't cause and trouble or if they do the side effects are minor. Having said that I am always wary of them. That is why I like hear from others that have taken them.

    I am on Ami at 50mg at night, but to be honest don't really like it. have been through a lot of SSRI's so that is why looking at at SNRI this time.

    Thanks for sharing your experience.

  • Hi TT, I tried Duloxetine which I found really helpful. It didn't specifically help the pain but made me far less effected by it. It actually helped me find some joy back in my life, stopped me crying all the time and changed me from being so involved with myself. None of which I could have achieved with all the CBT, mindfulness etc... In fact, I found these things made me more self involved and miserable! I have tried SSRi in the past without any benefit so I clearly needed the Norepinephrine.... Side effects minimal really especially compared to the GABA drugs... Headache, feeling spacey but they passed in a few weeks. I weaned off them a few months back easily and am holding my own atm but if I start feeling overwhelmed again, I will defs go back to them.

    Best wishes 😃

  • Thanks Boozybird, been on a lot of SSRI's with varying results and feel the SSNI's may be a better option, I know what you mean about starting on them, most of them left me feeling a bit wonky for first week or so :)

    Can so relate to all the Mindfulness and CBT stuff too, trying to distance myself from the pain not do the "Body Scan" and focus on the pain!

    Being in pain all the time is getting me down again so I know it is time to go back on something that helps. :(

  • I feel grateful for the difference the Duloxetine made. I really was in a miserable place and angry. Cynical, joyless. I still have pain and perhaps it will wear away at me again but I know where to turn now. There wasn't a bloody word in the English dictionary that could have unwound me. Today there's a piece in the newspaper about how the hypocampus shrinks in the depressed. They've observed it on MRI. When it shrinks you can't process happy memories or emotions hence the circular nature of depression. I feel this to be true now. I do hope it helps you if you decide to try it. Has the gabapentin or pregab helped? They seem to either help or not. No point taking them if they don' wishes 😜

  • The study reported in The Guardian? It was interesting reading. Makes a lot of sense as I have had depression on and off since I was 15. At least I am thankful I recognize the signs that i need to go back on the pills.

    The Pregabalin was REALLY good for the pain but the side effects was REALLY NOT GOOD :(

    Gabapentin helps just not as good and I am still titrating up to the dose I was on before. Was on prozac as well part of the time. Everyone has such different responses to pills it is good to hear from the patients as well as reading the official reports.

    Heading to GP on Thursday so will try a SNRI. :D

  • Yes, was the Guardian... Interesting... Good all the research that is being done due to technology nowadays.. Just need it turned into clinical benefits.. 👍🏼😜

  • Thanks for the info. Didn't know that about venlafaxine.

  • I am on duloxtetine, amytriptiline and pregabalin. this combination works for me.

  • That is great you found what works, doc agreed to try venlafaxine (been on it a week now at 75mg a day will increase in another week) , so with my gabapentin up to 2700mg a day and 50mg ami at night - hoping the venlafaxine is the final one and I have found the right mix. :D

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