Valium

[Maria1972]

I have 2 other conditions called interstitial cystitis and pelvic floor disfunction. I was recommend to take valiun for to relax the pelvic floor and reduce the pelvic pain. I'm currently taking amytriptiline for the pain but I was wanting to go with teh valium therapy that seems to be more promising.
Is anyone on valium and does it affect dry eye?

[kitty]

I can't answer you about the Valium, but if you are concerned about the DES side effects of meds, I would find an alternative to Amitriptyline. That will make DES worse in many people.

[Dotanne]

I have started taking a form of valium called clonazepam. My face pain and dry mouth and eyes were causing me much distress and ruining my life and the eye specialist was thinking my depression was making my eyes much worse and suggested he would talk to a psychologist - facial specialist is arranging for me to get an MRI scan and said then after that I could go to a pain clinic but I couldn't wait and one desperate day took a half tablet of clonazapam (had them from when I had depression after Lasik). It gave me quite a bit of relief and my eyes are much better - lots less drops and now they are manageable. My face pain (they called it neuralgia) is much better too and the burning/dry mouth is improving now too. My GP is happy with what I am doing and gave me another script. I do know that it can be quite addictive so I am very fearful of taking any more than I have to. But I am getting a life again!!!! I have been taking it for 1 1/2 weeks - just the half tablet (0.25 mg) each morning when my face starts to hurt. I only hope that the effect doesn't weaken over time but by then maybe my symptoms will be better. It can make one sleepy but with me I am just so much happier without the pain that I have more energy! It suits me much better that Amitrip 10. That made my eyes worse. The valium derivative has improved my eyes. I have even been able to drive a little at night.
Do use it under your Drs advice. Different people are affected in different ways by these drugs.
Good luck Maria and let us know how you get on.
Cheers
Dotanne

[Dotanne]

Woops it went through twice!!

[tomgrin]

valium DES

Hi, I suffer from RCE, which by it's troubles, causes pretty severe DES. I also take Val for anxiety; I've been on different doses of val in the past, down to nearly nothing now. Just my 2 cents; check with your doctor, but in my personal experience, I have not seen ANY effect from the val on my eyes. More/less, etc. Nothing. Other things like antihistamines have had effect during bad colds, etc., but not the val. Good luck.

[bernmee]

I too suffered erosions after lasik and terrible dry eye. I took a low enough dose for the first three months as needed for my anxiety.

I am not someone who takes pills but I was such a mess I needed something to calm me down. I didn't notice any difference with my eyes on the days I took it and the days it didn't.

Bernadette

[Rojzen]

tricyclics and anticonvulsives not addicting; BENZOs are, in 3 senses

I have been on amitriptyline for lengthy periods of time (for eye pain and for back pain), and was on a benzodiazepene (lorazepam; Valium is also a benzo), for a brief period, at the onset of my severe DES.

I have had excellent results in eye pain relief from amitriptyline, with no noticeable drying of mouth, nose, or eyes.

I recall no effect on eye pain from the benzo I took, but I feel a duty to report that benzodiazepenes are well known to be addicting, in the sense that they can produce tolerance (potential reduced effect of dosage over time), withdrawal symptoms, and, most importantly, rebound. Rebound occurs when the drug wears off, and it takes the form of an exacerbation of the very symptoms one is treating.

I fervently hope that those of us finding relief in some kind of anxiolytic (like Valium) will be open to giving tricyclics like amitripyiline (or other classes of drugs) a good try before becoming too enamored of the benzo class of drugs. Very often, the occasional drying or fatiguing effects of tricyclics completely disappear after a few days or weeks of use. These drugs can be taken long term, and generally produce no rebound or withdrawal. Tolerance is possible, but there is a huge range of dosages available in the tricyclics, and so there is lots of wiggle room for upping dose over a very long period of time.

Any good pain/rehab physician will know that amitriptyline is only one of several pain-addressing tricyclics. LOTS of people get excellent pain relief from nortriptyline (not sedating for most) and/or from doxepin. Doxepin, moreover, is well known to be effective for integumentary symptoms, e.g., skin pain and/or itch, and this suggests that the epithelium of the cornea could possibly respond to this medication. Doxepin is considered to be the most sedating of the three major tricyclics, and for some, that is great in this context, since the benzos are sedating, too, and derive their effectiveness, in part, from this very feature.

A good pain doc will also know that today there are several other classes of drugs that can be used for pain and anxiety, and which are not considered to be addicting, as are the benzos. For example, Topamax, Neurontin, and tiagabene are all in major use today for the treatment of chronic pain. Each has its own profile and favored uses. I believe that all are anticonvulsive medications that work for mood stabilization, when applied in the psychiatric context. For some, these drugs reduce anxiety while addressing pain.

To complete the picture, there are several SNRIs and SSRIs that are now being used to treat pain and anxiety, to wit Effexor and Cymbalta. These have reported side-effects, as do all drugs, with Effexor having some reputation for withdrawal problems, but responses are very individualized, and it is possible that some aspects of DES pain and anxiety could be treated successfully, in some of us, with these products.

All this is to say that before settling for a benzodiazepene that could pose problems down the road, due to dependency and the need to keep strictly on schedule in order to avoid rebound, one should check with the prescribing doctor for other, nonaddicting options that could prove at least as, or more, effective.

If anyone doubts the potentially powerful dependency that can arise from benzos, see the book "Toxic Psychiatry," by Dr. Peter Breggin. Dr. Breggin doesn't like any of the psychoactive drugs (something I find to be regrettable and overbroad), but his profile of benzo withdrawal and the difficulty of achieving freedom from benzos down the line is accurate and noteworthy.

[Dotanne]

Rozjen - What a great summary you have given us. Well put and very informative.

I am on amitriptyline at the moment for nerve pain after my operation on 25 August. (hysterectomy plus) I was given clonazapam in hospital randomly to help me sleep but didn't take any when I got home. I have been on the amitrip for nearly 2 months (10 mg daily at night at the start) and I did have a hangover for a start and then it came better but then the nerve healing pain (that is what they say I have) got worse so I have gone up to 15 mg and as long as I take the amitrip earlier in the evening I am not too hungover in the morning. My eyes seem to be a bit drier but then we are also going into summer and drier weather but I also have a dry mouth which I find not too good esp at night. Better than the pain though. I do hope I am able to go off it alright. This dose is very low as I know someone on 150mg per day.
I did suffer terrible side effects with Prozac (an SSRI) a few years ago and will never take it again (really bad agitation, constipation, dryness, couldn't sleep) so beware of side effects with SSRIs. I felt suicidal with the Prozac side effects. Other people can take it easily without bother.

As I mentioned before the clonazapam helped me substantially with my eye/face pain and I eventually was able to get off it but I did not take a high dose. I too read about the dangers of benzos and the risk of being addicted. Scary.

Dot

[eva b]

just to add another point of view...I have taken valium (diazepam) as a last resort on a couple of occasions when I have had bad flare-ups, with deep eye and also head pain that no other pain medication (including some of the stronger opiates) would tackle.

No cause for the pain was ever found, but it went away as soon as I started with the diazepam.

Rojzen is quite right to point out that this class of drug (benzodiazepines) can be addictive when taken for prolonged periods (anything in excess of 4-6 weeks can be considered to be prolonged), and great care has to be taken to taper doseage very gradually when stopping them, as it can be dangerous to just suddenly stop.

That said, I have on 2 occasions now taken the tablets for a few months, they helped enormously with the anxiety and lack of sleep which had built up with the frustration of my eye pain, symptoms and general lack of understanding by the medical community...and then slowly, but surely, tapered off the medication which - although it took a few months - meant I suffered no withdrawal symptoms at all.

Having spoken to a number of people over the years about various anxiolytics/antidepressants, I would personally always go the diazepam route - but we're all different.

My main point is that I don't think it made my dry eye symptoms any worse or adversely affected me in any way.

[Rojzen]

you are educating us; duration and patience with dosing

Dotanne, I am sending you warmest possible wishes for a steady reduction and end to your pain. I am also grateful that you brought to our attention that the benzodiazepenes are being prescribed for pain. This is something I need to learn more about, clearly.

Regarding amitriptyline, I want to share that my pain/rehab physician has told me that the full effect of this drug cannot accurately be measured before the patient has been on it for 3 months. Accordingly, I was started on 10 mg/night, most recently, and then gradually raised to 40 mg/night over a lengthy period of treatment. That said, you are so right to note that amitriptyline can be dosed in much higher ranges. In fact, as an antidepressant, it tends to be prescribed up to about 250 mg/day. The question becomes how much one can tolerate any side effects that surface in each range.

I'm with you on those SSRIs. I mentioned them, along with SNRIs, mostly to show that there are quite a few nonaddicting meds that are being used for pain today. Yesterday, I neglected, btw, to mention bupropion/Wellbutrin/Zyban. This antidepressant has also been studied for chronic pain, with interesting findings. (P.S. Bupropion is like poison to me; makes me feel sick all over; others love it, and soar with it.)

Since the benzodiazepenes should only be prescribed short-term, and not in steadily increasing doses, I would like to think that surgeons and pain doctors are carefully surveying the field before using this class of drugs for chronic pain. On the other hand, there may well be patients who just won't do well with any of the major tricyclics (like amitriptyline, its non-drowsying cousin nortriptyline, and its drowsying cousin doxepin), and/or with the anticonvulsives. Alas, there is no way to know without plunging in and taking one or the other long enough to give it a chance to do its potential magic.

You have been through so, so much, dear friend. It would cheer me to know that something is providing you with relief NOW, and that you are being cared for lovingly and scientifically enough to be presented a large menu of options that will lead to the formula that keeps you comfortable and flourishing, as you continue to heal.

Bottom line: It is indeed possible for the pain eventually to disappear, and for us to be able to go for long stretches without medication help. At the moment, I'm tapering down my amitriptyline (under doctor's supervision), as I find tremendous benefit for my back pain via trigger point therapy, practiced by one of my nation's leading scholars in the field. This therapy is immensely powerful, when applied correctly. So far, I've not located a trigger point practitioner who believes he/she can treat dry eye pain, but I'm still looking. As for my own eye pain, I've already obnoxiously bragged hundreds of times here about how I kicked that with SUSTAINED, LONG-TERM use of Dwelle and FreshKote (mostly Dwelle). I cannot recommend Dwelle enough, as my transformation on it has been more than dramatic. In my case, I have had to use Dwelle exclusively, in order to keep my tear film stable. And I am not cured, be it known. If I skip a dose of Dwelle, I decline, but knowing that I can feel normal just by sticking with this uniquely benign and powerful treatment is as good as being cured, for me.

Please continue to keep us posted.

[Dotanne]

Thank you Rojzen for your kind thoughts. I do appreciate your very helpful posts. I have had a new development with the amitrip. Since last Thursday I have been having optical migraines. I see bright jazzy zigzags which get bigger and then fade away after about 20 minutes (both eyes). I do not get a headache but feel spaced out during that time. I rang my optician and he said to see my GP so I did today (I had 3 jazzy eye spells today) and his conclusion was that it is most likely to be the amitrip so I am going back to just one tablet (10mg) again. He had a suspicion that it is making my blood pressure low. Thank goodness I was not put on a higher dose. Now to see how much pain I get back.

Fortunately I am to see the surgeon on 12 December for a proper check up and some help with the pain management. I have not been given any option but amitrip at the moment as apparently that has to be tried before they will try anything else.

I will do some research here to find if anyone does that trigger point therapy. It sounds interesting.
Dot

[Dotanne]

I went back to the Dr on Friday and have now been given (as well as the amitrip) 1/2 tablet of clonazapam per day and 1/2 tablet of Celapram (Citalopram). I will not take the last one until I see how the other 2 are working together. Other SSRIs have caused me awful problems. I still wonder if having a high cortisol level is contributing to the pain? The pain eases at night when I presume I have a low cortisol level.

Dot

[Rojzen]

Cortisol! indeed a relevant issue!

Dotanne, I am so sorry that you have had those troubling spells, very possibly traceable to the amitrptyline. . .It is good news that your surgeon has branched out into another direction, at least for a trial. . .

And thank you for your interest in trigger point therapy. We have an international center for training in this therapy in Maryland, USA, but I believe that the hotbed of trigger point is the Netherlands, and that there are trained therapists in the field all over the world (but not enough). Migraines are a major focus of trigger point treatment. . .There is a great book by Clair Davies on trigger point theory/therapy that distills the science behind the work (completed by Dr. Janet Travell over a period of 30+ years), that actually describes how one can do some trigger point work on one's own body. . .

I share your sense that cortisol is a HUGE contributor to our pain. When I first developed dry eye, a smart rheumatologist sent me to an endocrinologist, and while no specific disease was picked up by the latter, she said my cortisol levels were through the roof. . .That said, there are many potential ways to reduce cortisol secretion, which is an indicator of stress, from effective meditation to drugs. . .

But just the other day, I posted a quickie about Niacin, and its apparent effect on counteracting the effects of excessive adrenal gland secretions. Some find, at least anecdotally, that Niacin at the right dose (and be careful not to over-use niacinamide and slow-acting Niacin, which can be toxic) can relieve arthritis pain and otherwise detox the body, at least partially. . .Write to me if you would like some leads on Niacin and cortisol. . .

[tomgrin]

To expand on someone else's post above, it is absolutely true that it is a known fact, (and class of drugs; the benzos) that they are/can be addictive in prolonged use, especially at higher dosages. There is a dosage difference Dr's use to use this as as mild anti-anxiety vs a sedative/muscle-relaxer. It should be noted that different dosages (for different people) can be considered either type of usage. But most importantly, DO NOT stop Val/benzodiazopam abruptly and without a Dr's help weening you off of it. I tried to stop cold turkey from what I was told was a VERY minor dosage for my body size and health, and I had very scary symptoms that terrified me. Over time, I was able to very smoothly/easily reduce off of them. But - in deed, be very careful not to stop shortly once you've been on them for more than a few weeks. You won't die or anything like that, no need to be terrified, but the physiological symptoms were pretty scary, and took a lot of patience and re-assurance from my doc to get through it. So just be careful. It's been a very helpful Rx, but just talk to you Dr for solid coaching/advice and you'll be fine.