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chloeinoz1

Chronic Pain Causing Depression

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Hi my sons 16 today! Yes it's his birthday on NYE!about 9 months ago now my son went from completely normal in every sense of the word to being in agony overnight. When he walked as little as 10 metres he would be grabbing at his chest, breathless and just in so much pain. He was Admitted to hospital where he had a battery if tests and they came up blank saying it's some sort of neurological disorder, he missed a lot of time off school and eventually they kicked him out and said he can start back end jan and re do the year, since then instead of getting better he has gotten worse he has now developed pain in I is knees and can't walk without a cane. The school has made it clear that he return to school and do normal hours otherwise they will kick him out agaim(it's private) and he will do distance learning.

My son has been seeing a psychologist but he decided he would prefer to see someone else so were in the process of finding someone. He has expressed a desire to start anti depressants but unfortunately he is on both slow release and normal tramadol and there are no anti depressants that mix with them because they cause serotonin syndrome. My son also suffers with weekly migraines. He went to bed Christmas Day as normal and woke at midnight screaming in pain from both a migraine and chest pain, once at the hospital they tried morphine and fentynal and neither touched the pain so the gave him propononol and diazepam and finally at 6:30 he managed to fall asleep.

I'm at a loss to know what to do, do we take him off of tramadol and put him on a dual action anti depressant like endep or cymbalta.

I'm terrified of when he starts school again that he just won't be able to cope and will get kicked out and will lose contact with his school friends and his depression worsens. I myself suffer with severe depression but there's nothing worse than seeing your 16 yr old walking with a cane in agony and I'm scared of what he's holding inside.

Sorry so long, thanks for reading

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Hi Chloe,

As a mom of a daughter who started getting migraines and joint pain around puberty I can relate with how hard it is to watch your child go through it. I've just spent the last 20 minutes trying to search the web for the information I discovered a couple years ago and I can't find it. I have health issues myself that affect my memory so I can't recall it off the top of my head---it's kinda like over the top growing pains.

As for the tramadol and ADs---I can see the concern with SSRIs and SNRIs, but I was on tramadol and wellbutrin a few years ago at the same time so perhaps one of the other categories of ADs would be a possibility.

As "Detective Mom" I would have so many questions for you. Like which came first---the migraines or depression (rereading the title I guess it was the pain)? Was there something that changed 9 months ago like a triggering event or change of diet or location or something---was that when actual puberty hit? Dealing with chronic pain can cause depression because it's frustrating not being able to do what you used to and speaking with a good therapist can help with the transition. The chest pain stuff---has he described it to you---it could possibly be severe panic attacks related to the migraines---the trouble breathing and chest pain can mimic heart issues. Has he had a regular physical to make sure his bloodwork is within normal range and to rule out other conditions? We as parents barely have a clue what to ask so our kids have even less of an idea. For us it required me basically educating myself and then educating our doctor to some degree---luckily I found one while he was in residency and have worked with him for about 10 years now.

We made dietary changes and sometimes she has to wrap her knees and/or put warm compresses on them, and she finds she can minimize her migraines if she takes plain aspirin at the first hint. There's been a lot of trial and error involved. We got it down to less than once a month but now that she's away at college and not under direct care of "Doctor and Dietician Mom" she has more episodes so it's been tricky keeping her there. Her diet directly affects her but it's hard to get a teen to eat right from far away when it's so much easier to eat the wrong things.

The answers to all the detective questions can help you try to come up with a plan for where to go from here with your doctor and therapy and such. I don't know if they have "functional" doctors where you are, but that might be a place to look since functional doctors look at the whole picture rather than just symptoms from my understanding. There aren't any within a 100 mile radius of me or I'd check one out.

Best Wishes for you both on this journey.

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Hi Chloe, have you had him checked for infections such as Lyme disease? Many doctors will rule that out depending on where you live without doing a blood test, but if he does have it antibiotics should help.

Just a thought, hope you can find something that helps.

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Hi onmyown,

Firstly thank you so much for your response. Harry has been suffering with migraines since about the age of 6 but was otherwise completely healthy, his diet isn't great he is a very fussy eater so that's difficult.

Nothing happened 9 months ago to bring on the pain and to answer your questions he's had every test including bloods available including mris. They have at this point stopped looking for the cause of his symptoms and are concentrating on controlling his pain.

I have fibromyalgia and I'm pretty convinced that's also what's wrong with Harry but they won't listen to me due to my extensive psychiatric history. I really struggle to cope at times seeing him have to walk with a cane.

We bought him a new car for his birthday, so he has to just pass the written test and he can begin learning to drive which I'm hoping will motivate him and give him something to look forward to! I've applied for a disabled parking permit for him so fingers crossed he gets it.

Anyway thanks again, sad to meet under these circumstances but I appreciate the support.

Chloe

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Chloe,

Ah yeah, I can relate even more. I have fibro too and my daughter shows all indicators that she is developing symptoms of it much earlier than I did. The migraines from an early age are similar too, but unlike when I was young, aspirin was not an option until she was older. I wish I could remember the name of what I read about regarding excessive pain for some teenagers that's sort of related to growing pains but much worse.

I wish I had answers. I wish my mom was around so I could ask about how she felt when she was young to be able to compare the different diets from the 3 generations. Mom would have had a primarily whole foods diet where I was one of the first generation to be raised on mostly processed foods and my daughter got a mix with more whole foods as I learned more and now more junk food at college---it contributes to her anxiety and her pain. I figured out the mood stuff when she was younger and wouldn't be her usual adorable self when she got home from her dad's house---it would take about 3 days being home and eating what I served before she'd return to normal. But, yeah, doctors and the other parent can just think it's all in the parent's head with or without any psychiatric history.

I don't know if you've had any food allergy testing done, but sometimes an allergy or sensitivity can contribute to or cause some pain.

There's lots of theories on how to make fibro more livable---some say mild exercise like yoga or stretching, some say exercise, and some say exercise exacerbates fibro. Then there are people you run into in daily life who don't believe how bad you have it because they know or are related to someone who can still work full time with it. It's frustrating having it and more frustrating to think that our children have it. At this point I haven't even suggested to my daughter that she might have it as so far it's more common over 30 and usually has a trigger or series of injuries or illnesses that set it off---that may be another reason doctors automatically dismiss it even though there are young people who do develop it.. I sure wish I could remember the name or explanation for why some kids have joint pain more terrible than growing pains. Hopefully it will pop into my head in the next couple days like sometimes happens with things I'm trying to remember.

If I were in your shoes I'd try to find out if the chest pain thing might possibly be described in a way that might suggest a panic or anxiety attack---the not being able to fight or flee the migraines could very well be setting it off. I wish I had better answers for you but there's not just one path to the migraines or the pains. Even knowing the paths doesn't always result in figuring out something to do about it. I do commiserate though. It sure can cause fear and feelings of guilt in a parent even though there isn't anything to be done about the genetics---I wasn't diagnosed with fibro until after I had my daughter so had no clue.

We tried topomax for the headaches without much luck but some have success with it. I think the benzo ADs don't work with the serotonin if your son wants to try an AD, but there are others more well-versed on medications than I am.

Anyhow, we might have ideas around here but not answers, but this place is pretty good for being supportive, so welcome. I haven't really read over there, but there are forums for parents and forums for teens here that might have threads to help you with things---oh duh, just saw that this is in one of them. LOL

Best Wishes.

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Hrm... I can't reply from a parental perspective, so forgive me for that, please.

Regarding the medication, if you want to stick with Tramadol for the pain then I can see why you antidepressant options are limited. You can't use an SSRI or SNRI because of the serotonin effect, which only leaves you with tricyclics or possibly tetracyclics (although the latter also affect serotonin levels... just to a lesser degree). The benzodiazepines aren't antidepressants -- they are sedatives and they have the associated problems of both desensitisation and addiction, meaning that you need more to achieve the same effect if they are used constantly. MOAIs are an option, but they require quite strict dietary requirements.

If you feel that the chest pains and/or migraines could be more stress related due to the pain then benzodiazepines could be a solution for specific instances, provided they are not used daily, but if you are more concerned with the general depression caused by ongoing pain then tricyclic antidepressants are probably your only option without changing the pain medication.

I'm unclear as to whether there is a definite cause for your son's physical pain. Some of the symptoms sound like they could be anxiety/panic-related or psychosomatic, in which case switching gradually to a combined antidepressant such as an SNRI (I'd recommend duloxetine over venlafaxine) or a tetracyclic might be effective alongside a different painkiller.

It would be unusual for fibromyalgia to manifest at such a young age so if it's not been specifically diagnosed I wouldn't worry too much about that.

As an example of what onmyown was talking about, in my teens I had a lot of pain in my joints because my muscles and bones were growing at different rates and they would "creak" when I bent them and I couldn't put any significant pressure on them. I found exercise that moved the joints without pressure (swimming and cycling, for example) to help.

These are just ideas I am throwing out for you to explore (my knowledge lies in neurobiology rather than general physiology, I'm afraid), but maybe some of what we've said will be of use to you. I'm sure it must be very upsetting to worry about your son's health, especially given the situation with school. I hope if nothing else that you can find support here, even if we don't have answers :hugs:

Best wishes and :hugs:

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Yay! Lioninwinter, thanks for the med part. I knew somebody around here had way more info than I did. :)

Chloe, I don't know how insurance and doctors work where you are, but aquatic therapy can really help ease the joint pain for some, especially if there's a sports medicine or pain management clinic that has actual pools for the therapy. I definitely echo Lion's swimming idea if aquatic therapy isn't available. We also do epsom salt soaks here when joint pains get intolerable---it helps some and sometimes helps a lot.

Fibromyalgia is getting diagnosed more in younger patients. Unfortunately where I live it's pretty common for it to take about 10 years to finally get a diagnosis and that's about how long it took for me. I wouldn't automatically go for that diagnosis yet though since there are other factors with teenagers. It's just not as uncommon as it used to be is all I wanted to say. There have been discussions in some medical arenas about it and about the factors that may be contributing to it. We are approximately in the 2nd or 3rd generation raised predominantly on processed foods and some researchers are positing that there is a correlation. There's not any money to be made by any corporations if research were to discover whole foods made a difference so it's doubtful we'll be seeing much research in that direction that is accredited by the mainstream medical establishment any time soon. It's kinda like celiac---avoiding gluten doesn't make big pharma any money.

I'm curious if you have tried Lyrica for the fibro? I haven't tried it since I am not in a position right now to risk side effects.

I hope that you find a combination of things that helps your son and that your fibro hasn't gotten too debilitating.

Best Wishes.

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He's actually already on lyrica, just a small dose we tried increasing it and it made him worse. I'm also on lyrica the max dose works really well for me.

Harry sees a pain management dr and is going on a pain management camp in January with other kids who also suffer with chronic pain so hoping that really helps him and he meets some friends who he can talk to when things get tough like for example Christmas Day he went to bed and woke up at midnight screaming in pain from a migraine and pain in his chest, we had to call an ambulance that's how bad he was they gave him morphine and the green whistle neither did anything .

He had 4 lots of morphine and fentanyl and he was still screaming in pain so they gave him propononol and diazepam and at 6:30 he finally fell asleep. They have now put an action plan in place in case it happens again which is good and he's been prescribed diazepam for extreme pain. I'm worried today with it being his birthday and gone and done his written test got 100%:-) and then been out for a drive then gone out for dinner that it will all be too much for him and he will pay for it tonight, ironically I'm the one stuck at home missing out on the birthday dinner because of a migraine. So I'm hoping and praying he will be ok later and part of me is feeling hopeful because I can book him some driving lessons and take him out driving they have to log 100 hrs that it might lift his spirits and I'm praying he gets the disabled parking permit because he needs it. Thanks again for the help/advice

Chloe

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Harry has now been changed onto endone slow release(oxycodeine) and also 2 normal endone a day, we have to wait a week before he can start an anti depressant that is also a pain management drug our choices are cymbalta or endep(amitriptyline) think we're going to go for cymbalta. It's just worrying because the risk of suicide when used in teens.

On a good note Harry passed his written driving test so can now learn to drive and we got him a brand new car for his 16th birthday and he's been out a few times in it!

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I've got pretty severe nerve pain. Tricyclics and SNRIS are both useful in reducing intensity, in most cases Tricyclics are more effective in test studies, but SNRIS have less side effects. You're right that tramadol already is very similar to an SNRI so transitioning to something purely opiod would allow a more controlled delivery. Take care in the use of opioids, as they are just like benzos in that they can include tolerance and dependence and social attitudes towards opioid users are very negative.

I have found long term benzodiazepine use very useful, though there is a serious moral panic about this issue akin to Reefer Madness. Getting off these medications means using liquid solution and titrating down very slowly. Doctors cold turkey patients, and then say they drugs are 'evil' and useless. I don't want to stop this medication currently, as it is highly effective for my condition (and have seen studies indicating similar results).

So even if benzos work long term, if you can find anything else that works, it will help you immensely as your son will be at risk of having his meds suddenly stopped and then being called a drug addict for taking them as instructed, whether they work. This has been done to me and really damaged my health.

The most effective medications you can find with the least 'reefer madness' attitudes from your society will help your son in the long term. Even if now, people have sympathy for a child in pain, when he become a grown man, the witch hunts can start.

Maybe at some point opioid and benzodiazepine tolerance will be solved biologically and we no longer have to worry about this, but in the meantime, get as much help as you can from the other ones, and resort to these as minimally as possible. Not because they don't work for various purposes, and cannot be responsibly taken, but because there is a risk of persecution no matter how responsibly they are taken. Persecution of people in severe pain is very dangerous and can end lives, so we don't want that for anyone.

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Hi my sons 16 today! Yes it's his birthday on NYE!about 9 months ago now my son went from completely normal in every sense of the word to being in agony overnight. When he walked as little as 10 metres he would be grabbing at his chest, breathless and just in so much pain. He was Admitted to hospital where he had a battery if tests and they came up blank saying it's some sort of neurological disorder, he missed a lot of time off school and eventually they kicked him out and said he can start back end jan and re do the year, since then instead of getting better he has gotten worse he has now developed pain in I is knees and can't walk without a cane. The school has made it clear that he return to school and do normal hours otherwise they will kick him out agaim(it's private) and he will do distance learning.

My son has been seeing a psychologist but he decided he would prefer to see someone else so were in the process of finding someone. He has expressed a desire to start anti depressants but unfortunately he is on both slow release and normal tramadol and there are no anti depressants that mix with them because they cause serotonin syndrome. My son also suffers with weekly migraines. He went to bed Christmas Day as normal and woke at midnight screaming in pain from both a migraine and chest pain, once at the hospital they tried morphine and fentynal and neither touched the pain so the gave him propononol and diazepam and finally at 6:30 he managed to fall asleep.

I'm at a loss to know what to do, do we take him off of tramadol and put him on a dual action anti depressant like endep or cymbalta.

I'm terrified of when he starts school again that he just won't be able to cope and will get kicked out and will lose contact with his school friends and his depression worsens. I myself suffer with severe depression but there's nothing worse than seeing your 16 yr old walking with a cane in agony and I'm scared of what he's holding inside.

Sorry so long, thanks for reading

I'm so sorry about what you and your family are enduring. Chronic pain coupled with depression is terrible; I know first hand. I can only imagine how much worse it is to watch your child suffer. My heart is breaking for you. Please forgive me if I have obviously missed something written above.

I don't know about teens, but many people use various combinations of SSRIs, SSNRIs, Wellbutrin, etc., with tramadol, opiates, etc., and without incident. I am one of them. I have used various combinations for over 14 years. I have checked with several pharmacists and different types of specialists about my many combos, etc., and have always been told that the risk for serotonin syndrome was extremely rare, in my case anyway.

For me, depression and anxiety are worse than my physical pain, which is severe. FWIIW, if your son's physical ailment is not degenerative, you might opt to focus on the depression, if you have to make compromises in the meds because depression is progressive.

FWIIW, I would not discount fibromyalgia just because of his age as it does occur in youth and the incidence is higher if it runs in the family, from what I've read anyway.

If you have not already done so, you might want to seek second opinions from the top pain and/or psych experts in your area; better yet, a psychiatrist who runs a pain clinic - that was one of mine. Some doctors, because of malpractice fear and/or other reasons, are not aggressive in treating conditions such as pain and depression.

BTW, Cymbalta worked great for my pain and did not seem to interfere with my Effexor or Wellbutrin.

My heart goes out to you and yours. Good luck. :hugs:

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