Cymbalta: Uses, Side Effects, Warnings & Withdrawal Risk

Posted by twinklev

Cymbalta is one of Eli Lilly’s top-selling drugs, used for treating depression, anxiety, and bone and muscle pain. The drug carries some serious side effects, including discontinuation syndrome with brain zaps.What is Cymbalta? Cymbalta is a popular antidepressant that helps control neurotransmitters and hormones, improving moods and alleviating pain. Eli Lilly manufactured this multi-use, billion-dollar drug, which received FDA approval for alleviating mental and physical discomfort.In 2004, the FDA also approved Cymbalta (duloxetine hydrochloride) to treat depression. Doctors soon began prescribing Cymbalta for a wide range of patients, including those with anxiety, diabetic neuropathy, muscle pain and stress urinary incontinence.In 2007, the FDA added the treatment of fibromyalgia – a type of arthritis characterized by muscle pain, trouble sleeping, and tiredness – to Cymbalta’s label.Unfortunately, patients wishing to discontinue use of the drug often suffer from side effects that impair their health, ones that can last weeks after stopping Cymbalta treatment. These withdrawal symptoms range from headaches and dizziness to suicidal ideation and blackouts.

Cymbalta and Other Antidepressants Cymbalta makes up a major share of the $11 billion-a-year antidepressant market and competes with drugs like Paxil, Lexapro and Effexor. In 2012, it accounted for 42 percent of antidepressant sales.Like Effexor, Cymbalta works as a serotonin-norepinephrine reuptake inhibitor (SNRI). The SNRI drug class deals with norepinephrine and aims to improve energy levels. Similar to SSRIs,

Cymbalta also deals with serotonin levels, which can lift moods.A Top Seller for Eli Lilly Since the drug’s approval in 2004, Eli Lilly has brought in more than $29 billion. At its peak, in 2013, it had annual sales of $5 billion.High Costs for Patients The brand-name drug sells for retail prices of more than $170 a month—making the drug more expensive than many antidepressants on the market. Cymbalta Uses and Clinical Studies Over the past decade, Cymbalta indications expanded to include anxiety, diabetic neuropathy, fibromyalgia and chronic muscle pain. Internationally, the drug is also approved for treating stress urinary incontinence.FDA Approvals The FDA initially approved the drug for treating depression, and within a year approved it for diabetic neuropathy. For diabetic neuropathy, Cymbalta treats pain and tingling from nerve damage. In 2007, generalized anxiety disorder – a condition that more than 6 million Americans suffer from every year – was put on the list.Growing Popularity Within five years of the drug hitting the market, doctors prescribed 2.8 million patients

Cymbalta, according to an FDA staff report. Of these prescriptions, 400,000 were prescribed for off-label uses like nerve pain, musculoskeletal pain and headaches. In 2008, the FDA approved its use for Fibromyalgia. Analgesic properties make the drug also suitable for osteoarthritis.Advisory Committee Meets Because of reports of serious side effects like liver damage and skin disease, an FDA advisory committee met in 2010 to review whether or not the benefits outweighed the risks in the use of Cymbalta for treating chronic pain. Despite this danger, the drug was approved months later for chronic musculoskeletal pain, including osteoarthritis.

Side Effects of Cymbalta Patients taking Cymbalta are often unaware of the potential side effects that may occur, and doctors continue to prescribe it for more uses despite these dangers.Complications for Pregnant Women Birth Defects Skin Disease Suicidal Thoughts Liver Toxicity Discontinuation Syndrome Persistent Withdrawal Symptoms (Brain Zaps)The Institute of Safe Medication Practices (ISMP) published a report describing 48 instances where Cymbalta users suffered from debilitating withdrawal side effects, including brain zaps.While a brain zap is not a precise medical term, many Cymbalta users have experienced the same type of abrupt electrical shock disrupting their mind. They describe the zaps as intense and painful sensations that cloud mental clarity and leave them with shakes, nausea and headaches. The degree of severity can impair a patient’s ability to work, socialize and carry out daily tasks.

ISMP’s reported Cymbalta withdrawal side effects include:Dizziness Brain zaps Anger Suicidal thoughtsWeight gain Paresthesia (burning sensation)Clinical studies reveal that with abrupt discontinuation of the drug, similar symptoms occurred in nearly half of patients. Of those, 10 percent felt symptoms acutely and half continued to suffer from side effects more than one to two weeks after stopping treatment.Many of these patients required hospitalization and also reported nausea, tremors and blackouts.

Source: Cymbalta: Uses, Side Effects, Warnings & Withdrawal Risk

Catastrophizing

Posted by twinklev

Rational Expectations

Catastrophizing is an irrational thought a lot of us have in believing that something is far worse than it actually is. Catastrophizing can generally take two forms. The first of these is making a catastrophe out of a situation.

What is Catastrophizing?

Catastrophizing has two parts:

Part 1: Predicting a negative outcome.

Part 2: Jumping to the conclusion that if the negative outcome did in fact happen, it would be a catastrophe.

Three Psychological Mechanisms related to Catastrophizing

Psychology research on chronic pain and catastrophizing has uncovered three types of mechanisms related to catastrophizing

– Rumination – (overthinking. Cognitive Behavioral Therapy technique for overcoming rumination)
– Magnification
– Helplessness

Overcoming Catastrophizing

– Mindful awareness

You have to catch yourself having cognitive distortions to be able to do anything about them,

– Consider Other Possible Outcomes
Consider positive predictions, neutral predictions, and mildly negative predictions, not just very negative predictions.

– Make a Distinction Between Significantly Unpleasant and Catastrophe
Key to overcoming catastrophizing is making a distinction between something being significantly unpleasant and it being a catastrophe. Failing an important exam would be extremely distressing but it does not doom the individual to a life of failure.

– Increase your perception of your ability to cope.
If you believe you can cope with negative events, anxiety will be much less of a problem for you.

Types of Catastrophizing

The common types of catastrophes people tend to imagine include:

– Imagining yourself losing control of yourself. For example, an individual with panic disorder predicts that if they go to the mall on a weekend afternoon, they will have a panic attack. They predict that having a panic attack would be a catastrophe, rather than it just being significantly unpleasant.

– Imagining yourself spiraling into a deep depression.

– Imagining yourself never finding love, and imagining that if this happens you will be plagued by intense feelings of loneliness 24/7 from now until you die.

– Equating some type of mild to moderate social rejection with being totally shunned by all desirable people.

Sources:

https://psychcentral.com/lib/what-is-catastrophizing/

https://www.psychologytoday.com/blog/in-practice/201301/what-is-catastrophizing-cognitive-distortions

Commentary-

Excellent. And if imagination fails to exist? I bet that’s covered in the ICD 10, too.

Wait though, predict?

Hold up!

Ain’t nobody done yet.

Catastrophizing.

Recap

Catastrophizing has two parts:

Part 1: Predicting a negative outcome.

Part 2: Jumping to the conclusion that if the negative outcome did in fact happen, it would be a catastrophe.

Very few people go from jumping to a negative conclusion or outcome to being mindful enough to realize “its” just going to be a catastrophe.

Seriously?

Can I help a little more?

Show me somebody that’s like, “if that really gonna happen” I’m finna have me a catastrophe. Really?

Is that a Cognitive Distortion? And yes I’ve understood for decades that cognitive just means “thinking”. Knowing, perception, judgement, reasoning and cognitive behavior is just… the behavior of thinking in the first place.

Rational or Critical thinking?

Catastrophizing?

Just asking.

Public Apology

Posted by twinklev

I extend to each of you, any of you that I may have offended over the last year an apology. I’m not sorry because I did anything wrong, I’m sorry because I lost control of managing pain. I inclined my head to bullies, I smiled, and shrugged off any compromises. I shimmied on like I never heard, never seen it, and rarely did I admit to knowing it.

I’m really sorry that I let Facebook bring out the worse in me. I’m still trying to understand this for myself. I let it become a “I don’t care” platform to anyone who either stalked me for their own organizations or disliked me for the one I was with.

Reductions in stressers and triggers have me feeling so much better. Better able to continue on with strengthening myself, stretching, moving, healing, accomplishing.

I don’t want to care about what I let you see toward that end, yet I do. I don’t want to care about who you thought I was before it all. I will. I may not always understand why from your point of view but I understand from mine the persona I threw out. I think that I demonstrated fairly well by shoving everyone so far away and eventually giving people a reason to gossip with potty mouth words and pretty photos that I achieved what I wanted at the time. Disconnect.

I never wanted to get close to people, so I kept everyone at a distance. I would reply to the questions regarding CRPS/RSD, Chronic pain, SCS, legislation, depression that you asked, but I’ve not in all my years using the Facebook Platform engaged on a personal level with more than I can count on one hand. Only one person in the pain community knew me, enough.

Wow, I must have issues, right? Yes. I can’t do the gossip, drama, he said she said, did you hear what so and so did type of stuff. Why? Because I haven’t the time or concern for it.

Any relationship can be repaired enough for people to respect that agreeing or disagreeing on something isn’t what defines them, but instead that which allows them to proceed forward with an open mind. Learn from one another.

If was in an IM with only 2 or 3 people a day, exchanging 5 messages each. I’d never be able to do anything constructive, maintain pain levels, scrub my toilet. One has to always be available at some point, even if not on the spot, to reply, and then the conversation continues until it either trails off or is abandoned. For those of you who do engage all day long. Kudos to you. Friendships? Okay. Communication? Okay. Support? Understood.

Facebook; the place you can check into, but hard to check out of.

I’ve been running on empty with anxiety highs and shifting depressive moments this entire year. Trying to manage both chronic pain and narcolepsy evenly for myself. I did do it on my own. No one’s taking that from me.

I can recall pieces and parts of this year as if I was viewing an old 8MM reel of 2016. I can recall vivid moments, yet I’ve lost other memories and I really don’t know if I ever created them in memory to be able to remember.

That’s how the mind protects itself from trauma and perceived threats.

I’m not much different than all of you just uniquely challenged. Some of you the F word is in the first sentence, others, rude, opinionated babble lacking knowledge, certainty, or open mindedness to learn the facts before stating inaccuracies.

Hypothesis? Please do present with an educated guess before assumptions get the better of you.

Ad hominem;

Argue the topic. Don’t attack the person as an individual, you know, the people you judge without even a presumption because you know it all and per your perception they’ve done it all wrong, already? Attack the position, not the person.

Online is too much people at all given times.

Notice how I said “Too much?” rather than “Too many?’

Be good or be good at it! Choices.

Overcoming The Stress Response by Twinkle VanFleet 3/9/15

https://rsdadvisory.com/2015/03/09/overcoming-the-stress-response/

I don’t want to be associated with pain, chronic pain, illness, disability, any of it.

Not on a personal level.

I never did.

My denial was my acceptance all along because I’m still on my legs. I’m not incapacitated. I’m not in that corner by myself yet watching the world move and unable to move with it or be a part of it.

Today I found the wedding vows we wrote to each other when we renewed in 2012 for our 25th wedding anniversary. That was the first I ever walked down the isle to him in a Church ceremony. I’ve been his since I was 17. I got this! For us.

I’m sorry I showed you someone I’m not. I’m not sorry that it wouldn’t be beneath me to act in any type of way dependent on a situation.

I’m sorry too for those who couldn’t ever ask, but assume, and for those who knew they were inciting confrontation when they chose it. That’s where I had enough. That’s where I changed.

There’s consequences in choosing.

For all of us.

~Love and light

Words

Posted by twinklev

Diversity by Twinkle VanFleet

3 weeks solo and trying to decide whether or not to merge all of it here. All of it. The pain, the passion, all that purpose, essays, the filed away lyrics, the unpublished poems, the soft erotica, those short stories, the dances. Dances?

Words.

I’m guessing I’d have to show you, you’d have to read it for yourselves. 20 years of being out there and circulating already.

Expression, adjectives, descriptive, alluring.

Unrelated to the pain communities. Though I suppose that there would be relief, ease, laughter and a sense of distraction in what I could have been providing all along.

No worries.

It’s only just begun.

Again.

Transition

Posted by twinklev

waterfireheart Turning pain into her greatest asset was like turning water into wine by the bitter and sweet essence of nature. She waited. Wanting to become numb and no longer feel, but she also knew she would have to feel to understand. She knew that without walking shoes of others that she could never really embrace what they’ve gone through or was heading for. She would have to go there, too.

She began to think that her heterogeneous spirit was equal to an ugly duckling swimming alone in a vast pond of siblings. She wanted to feel everything and nothing at the same time because she was the light and became darkness through the worldly conflicts of being human in the first place.

Transitioning through the elements of water and stepping barefoot through the fire of both pain and passion to uncover a balance of consciousness and self awareness that had become divided long ago.

To find out who she was…

…she would have to meet herself first.

Unicorn

Posted by twinklev

Unicorn
by Rosie Broyles Tresca

unicorn-horse-head-with-a-horn-and-wings_318-48956

I am a unicorn

People call me beautiful but never really see me

I am iridescence

changing at every blink and angle

I am newly cut glass

extremely fragile but always shining through

I am a rose

scents that lure you with thorns that prick

I am better

happy and never going back

I am a unicorn, beautiful and real

Written by my little sister and used with permission.

The Last 6 Weeks in Review

Posted by twinklev

justlive

It’s been 6 weeks since I completed the Gohl Program. This post will share progress and setbacks since returning from the healing retreat. Hard times dictate choices. A week after returning I lost 3 puppies. 2 of them, I held until they took their last breaths. One of them I held all day. Both of them I gave my own breath to to try to save them. I lost them 12 hours a part, so those 3 days were intense. My son’s car was stolen out of his driveway with important gear in the trunk. It was located abandoned the next day but without the safe.

My mom and dads home burned down.

News 3 Exclusive

Vietnam veteran, wife and granddaughter lose Harris County home in fire
@Ashley_G_WRBL
Published: December 2, 2016, 6:40 pm Updated: December 5, 2016, 9:51 am

Don Tresca Vietnam Vet house Fire (Please share)

https://www.gofundme.com/dbxzr5rw?ssid=835607202&pos=2

My daughter’s liver is still unstable and with little to do for it. She’s been a patient at the Liver Transplant center at Stanford for awhile now and is being sent to their pain management for care.

My husband was cleared for knee surgery though we’re still waiting on scheduling.

In the midst of it all, I’m trying to maintain reductions in pain with physical movement, stretching, and all those things I need to do to recover and strengthen myself further.

Right now, I’m doggie sitting and have been since Monday. Aloha and Gaia came home. They’re Ohana’s brother and sister. They were born on Valentine’s Day, hours after I was admitted to the hospital. They were named from me having just returned from Hawaii a month before. Mahalo and Cupid are no longer with us. Aloha was renamed Legend by his new family and Gaia was renamed Bella. They’ve been together all along and came home as if they never left. They knew their birth place, they knew their den. They were both also reunited with their mother, Oreo. Aloha and Gaia sleep at my head, Ohana sleeps behind my knees, Lilly flower in the crook of my neck and Independence at my feet. Yep full twin bed. Freedom, Amo, and Oreo with my husband.

My CRPS legs and feet are still doing fairly well for what they had become all the years prior and for what they’re becoming. Pain in my arm is much better than before. There really isn’t anything wrong with my arm, directly, it’s referred pain and symptoms from my back, spine. Nerve roots and all that blah blah. I can feel the tug of the curves in my spine and it’s still sort of depressing because I don’t know how to reverse the errors in my own body anymore than I know how to correct the mistakes in healthcare that could have potentially eased it if it had been addressed. The only time my back effects my legs is when those bones shift.

I don’t think most will ever realize the difference in pain levels before and after MLT. That even with these issues the impact of learning what to do for ourselves and how we can decrease additional pain and symptoms simply by a therapy rather than by medication or injections.

After the California International Marathon I was down a few days but that was because I attempted a walk I hadn’t done in 16 years. These few days however wasn’t the week + that activity, events, walking, standing, movement or even stress would have previously caused.

It’s not easy my friends, but it’s getting easier. I don’t have pain medication to turn to for chronic or even an acute situation and I’ve flat out never cheated taking any even when they were in my reach. February will be a year without medication management for pain and related symptoms.

I use sublingual oil and gummies, medicinal, on occasion. I’ve also used Kratom, which has no more risk than opioids when used responsibly.

I still haven’t turned my SCS back on. Not because I didn’t need it a few times but because I’m struggling to not want to need anything. I’m still not using my ASV. I still have no plans on ever being put in a scoliosis brace and I’m still not considering corrective surgery for it.

Wanna live? Don’t rely on others to fulfill it for you.

“Do not ask the stones or the trees how to live, they can not tell you ; they do not have tongues; do not ask the wise man how to live for, if he knows , he will know he cannot tell you; if you would learn how to live , do not ask the question; its answer is not in the question but in the answer, which is not in words; do not ask how to live, but, instead, proceed to do so.”

Page 9 ~Magicians of Gor

Squirrel

Posted by twinklev

No Facebook!

I woke up early this morning. I started Netflix to find something to cuddle up with and my photo was back. It had not been there since deactivating Facebook. So I pull my own name up and WTF. I message Trudy and she’s like yeah you’re back. Even in your group.

I’m like “Nooooooooo!”. How? So I go in and deactivate again immediately.

I’ve been dealing with crap like this for years. And this year, I’ve had periods of time with no internet access whatsoever, yet I still end up logged in, or rather my accounts do.

Squirrel!

Control | Spoken Word

Posted by twinklev

Control by Twinkle VanFleet

Control it
Hold it
(Down)

Rolling the dice (Gamble) (Rambling?)

Ascendancy
Enough of
(Play off?)

Regulate
Not anymore
(Keeping score?)

Oversight
Not really, though
(As above, so below)

california-state-capital-california-international-marathon-december-4-2016

California International Marathon, California State Capital December 4, 2016.

(Everything and nothing)

(Balance)

Ascertain
Rarely exists (Remain?)

Responsibility
Owning it
(Grow)

Authority
Consider this
(Risk)

Influence
Subsist
(With…?!)

Controlled

(Dismiss it)

Throw down
(Profound?)

Broken, hoping
(Coping)
Faded, Jaded

Climb, rhyme
(Time)
Sublime, realign.

wwgrctwvf_rsdadvisory

Stress’Less

Posted by twinklev

Definitions of stress include the physical pressure, pull, or other force exerted on one thing by another; strain, mental, emotional, or physical strain or tension. In physiology, stress is defined as; a specific response by the body to a stimulus, as fear or pain, that disturbs or interferes with the normal physiological equilibrium of an organism. In medicine: A physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness. Stressless is then the opposite of the above, having no stress, without.

Image Credit by Ozra

Included in my letter of resignation to the International Pain Foundation was that “Stress is my weakness” right now. It had become my weakness since January of 2015. I had come to realize a long time ago that stress increased physical pain and uncontrolled physical pain instigated anxiety highs for me. I had struggled on and off with bouts of depression. Prior to this year diagnosed with mild recurrent major depressive disorder secondary to the injury that led to my CRPS and a psych sequela. A confirmed diagnosis of PTSD, which I’ve shared a couple of times over the years, but have not discussed much of. My PTSD isn’t a solo diagnosis for a specific event, but rather multi diagnosis’ for multiple unrelated events.

It’s been a hell of a year! It’s also been heaven! Can you imagine? The best and the worse, the worse and the best happening simultaneously over a short period of time? Next month begins a year since that first night I can’t ever erase from my existence. Valentines Day becomes a year to the day, and the 3rd week in April is the second. I’m really only 8 months forward from it all. I really have a way to go in healing.

I think I’m doing pretty darned good for pain having not been addressed until a few weeks before I tried the Gohl Program (October 24th) and the Manual Ligament Therapy performed by Arik Gohl. After transferring my primary care to the Ellison Ambulatory Care Center and choosing the teaching facility so that students could learn from me and I could learn from them, I was sent to a new pain management facility rather quickly. This though only covered my upper body, not my lower. I was now opposite of what I had endured in the many years prior. I had been covered for my bilateral CRPS and SCS, but not for my upper extremities. I had a CT, learned of what had been occurring with my spine, the several new diagnosis’s, started PT, ended PT and I had 2 cervical steroid injections and decided after the program to cancel the 3rd.

Leaving iPain was abrupt and perhaps shitty, deactivating my Facebook account was also abrupt and spontaneous. Heck, declining followup appointments, injections, and mental health care was also on the spot. I know each of the perceptions that can be considered. 1. I’m reckless. 2. I’m Bipolar. 3. I only considered myself. 4. I’m playing games. 5. I’m crazy. 6. Out of character.

Let me help sort these out. 1. I’m not careless of consequences nor am I irresponsible. 2. I wouldn’t care if I was, but I’m not. 3. I considered everyone in those split seconds, including myself. 4. The only games I like to play are slots. 5. I love my crazy as do many others. 6. Perhaps, though it could have been in character all along.

What does that mean? In character all along? Pain, passion, purpose. Compassion, forgiveness, devotion, appreciation, thankfulness, gratitude,and diversity are all strong traits for me as is compliance, submission, and loyalty. Those can sometimes provoke conflict. But then again, I’m a different kind of duck.

As 2013 ended and I couldn’t change what I needed to, I couldn’t make someone else want to live, take care of themselves, after being given new life, or repair someone else’s frontal lobe from damage, or make tumors disappear in another and I couldn’t change the errors of others from a 2012/2013 healthcare related failure for myself, I rose and fell, but got back up each and every time.

Until I couldn’t, until I didn’t want to anymore.

In 2012 I had my Gall Bladder removed after a painful 20 hour wait in the Emergency Department. Acute or Chronic, the wait was painful. When I was taken back, I was scheduled for surgery immediately. I hemorrhaged during both surgeries a year apart.

I had never felt judgement in healthcare prior to this second removal. I had never been treated adversely or in any judgmental way. Ever!

A month ago, I would have never considered resigning as Advocacy Director and after being apart of iPain 5 years. On the contrary my only vision was remaining indefinitely.

“Don’t cry because it’s over, smile because it happened.” — Dr. Seuss

Fighting for your own life, while already fighting for others, up close and personal others, in addition to advocacy. And not knowing, or understanding, right in the midst of the end, who to choose, what to choose. Me or them. I can still hear the words that slipped from my lips to him that night. I can see it all so vividly and I can hear my own quivering voice say it to him so powerful that..

(Maybe I’ll share the rest of that another time)

But I survived. And then I survived again. And I was pissed! I had to be who someone else wanted me to be.. still. I couldn’t be unwell, not dangling, and make sure that I didn’t disappoint anyone, pretend it never happened because such events are unbecoming of family matters, social knowledge and sometimes even friendships or that online I had to be talked about in whispers and private calls and that would have all been okay as long as the record was correct. All it takes for accuracy is to ask the question. If someone doesn’t wish to answer it still doesn’t mean to create a scenario.

I was negative for all prescribed and illicit drugs, including all those extra’s screened for. I declined pain care by first responders and I declined pain management upon arrival at the hospital.

Consider that I had not been taking pain meds, opioid related, legal or illegal, benzo’s etc, and once injected in the ambulance there would have been no way to prove I had none of these substances in my system. Not even Marijuana. Understand? I don’t regret the 200 ml bottle of Vodka I finished just minutes before those acts of “I’m done!”. Nope!

All I’ve wanted to do is fight. I won’t go looking for confrontation, but if I’m confronted, hands. It’s really not as wrong as it seems. It just means that I protect my space and my ground.

Stress is down. Leveled.

Without, in regards to the internet.

“The two most important days in your life are the day you are born and the day you find out why.” — Mark Twain

I always knew why, I just didn’t want to know to what extent.

https://rsdadvisory.com/2013/05/18/endoscopic-retrograde-cholangiopancreatography-52113-due-to-gall-bladder-removal-fiasco/

https://rsdadvisory.com/2013/07/17/gall-bladder-fiasco-continued-and-hopefully-the-final-chapter/