GABA and Pain

[MLE]

Fellow corneal pain suffers- I wanted to post something to think about-

My background: diagnosed with DES and MGD in September 2011. No cause has been identified, but I suspect Tri-Luma cream (contains fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%, which is the active ingredient in Accutane). I was using around my eyes to get rid of melasma (sigh, vanity causing a debilitating illness. . . something for others to think about). After a VERY long journey of drops, trips to experts, allergy testing/hyposensitization, punctal cautery, probing, CCH surgery in both eyes, I was still in misery- until I got fitted for PROSE lenses. They have helped tremendously, but even with them in place I still get weird episodic corneal pain- photophobia, sometimes stinging and tearing, but mostly a cold ache. It comes and goes. I use lacosamide drops in my PROSE lenses, and i take neurontin. I also have back pain with numbness/tingling down my arms which is exacerbated by heavy computer use at my job (started long before the eyes). So in general I think I have a CNS that likes to "scream" at the littlest insult.

In any case, when the eye and back pain gets really bad I find one of two things help greatly: 1) ONE glass of wine or 2) a low dose benzodiazepine (xanax, atavan, valium etc). Now at first this makes me sound like some kind of addict, until I went on medline and did some research. . . both alcohol and benzodiazepines act on GABA pathways in the CNS, which regulate pain, among other things. At least in my case, this makes me think I have some GABA related aspect of both my corneal and my musculoskeletal pain. The only reason benzos haven't been further developed for pain are their side effects (sedation, abuse liability). I'm going to see if my doc is willing to carefully put me on xanax for those particularly bad days, which with the sclerals in place only happen about once every few weeks. Just something to explore.

Here's an abstract on the subject, at least for benzodiazepines :

http://www.ncbi.nlm.nih.gov/pubmed/17175808
-MLE

[DCRdryeye]

Hi MLE -

GABA is the most abundant inhibitory neurotransmitter in the brain. It is responsible for modulating the ‘exitatory’ nerves down that are firing the stimulating chemicals. Whilst there is research into GABA and pain relief, it is only a small drop in the ocean compared to the other substances and pathways in the body that can be influenced to reduce pain.
Firstly, I would not go on the benzodiazepines you mentioned to increase GABA. This is why, they bind to GABA receptors in your brain. But over time those receptors ‘down regulate’ or ‘decline’ in number, inducing intolerance. So you will have to take a higher dose to feel the same effects. Eventually you become addicted to high doses and it doesn’t do anything for you anymore. Stopping them can be hell, it can be worse than the symptoms that made you want to take them.

Rather, you can increase GABA naturally by taking it’s precursors such as Glutamine, Vitamin B6 and Zinc. Meditation is another way to increase GABA (and Serotonin) along with taking herbs to bind with GABA receptors such as Kava. In fact, consulting with a Naturopath could obtain you a mixture of herbs, nutrients, dietary and lifestyle advice for pain, inflammation, adrenal fatigue, anxiety and cover a whole gamet of issues.

Phenylalanine a natural amino acid is often used for pain, it increases pain relieving opioid substances such as endorphin.

Certain antidepressants are used for pain relief, in fact, amitriptyline is used for neurological pain. But since it’s anti-cholinergic, a side effect is ‘dry eyes’. So that’s out!! Another newer anti-depressant used for neuropathic pain without the ‘dry eye’ side effect is ‘Duloxetine’. This would seem a better choice than benzodiazapines. However, ‘Duloxetine’ was meant to be the ‘Effexor’ (Venlaflaxine) without the side effects, but it still does have side effects that apparently decrease over time. The point here is, antidepressants increase SEROTONIN and other neurotransmitters such as Norepenephine, Dopamine, etc depending on the type of drug.

Amitriptyline and Duloxetine both increase SEROTONIN so does this chemical that improves mood have pain relieving properties? Studies say YES. And, it can be obtained naturally. You can purchase ‘Tryptophan’ which converts to Serotonin or another natural product called 5HTP.

http://www.ncbi.nlm.nih.gov/pubmed/789821
http://www.ncbi.nlm.nih.gov/pubmed/21073405
http://www.ncbi.nlm.nih.gov/pubmed/7666830
http://www.ncbi.nlm.nih.gov/pubmed/21808193
http://www.ncbi.nlm.nih.gov/pubmed/19821395

[Cali]

I am on 20mg of Amitriptyline nightly for pain. The depression dose is between 25mg-100mg. I was told that at such a low dose, the dry eye side effect would be minimal.

[DCRdryeye]

I am on 20mg of Amitriptyline nightly for pain. The depression dose is between 25mg-100mg. I was told that at such a low dose, the dry eye side effect would be minimal.

Hi Cali. Yes Amitryptyline is prescribed in very low doses for pain. In fact, 10mg has been prescribed for disorders such as RSI, Fibromyalgia, etc. Let's hope at such low doses don't have a dry eye inducing affect. Monitor your eyes and you'll know if they are feeling worse or the same as before from Amitryptyline. It's been prescribed to every man and it's dog for two decades now. In fact, I had shoulder surgery a few months ago and was getting referred pain down further in the joint. My surgeon recommended Amitryptyline and I refused, I'm personally not taking any chances.

I respect your choice in using it and hope it helps. We do have little choice at this time.

[Ccoughlin]

I am on 20mg of Amitriptyline nightly for pain. The depression dose is between 25mg-100mg. I was told that at such a low dose, the dry eye side effect would be minimal.

Folks,

I have a question. I have a lot of cornea pain, and have started to slowly ramp up Gabapentin (Neurontin). I am using 200 mg 3 times daily, and I'm getting almost no relief. Mis this not nearly enough? Should I try something else,or ramp this up much higher? I'm 16 months post-Lasik, and suffering a lot of daily pain (with no visible dry eye symptoms). Also, I started blood serum drops yesterday - hoping that will give me some relief.

I'd appreciate any advice you have.

Thanks, Chandra

[MLE]

My Corneal Pain Protocol

Folks,

I have a question. I have a lot of cornea pain, and have started to slowly ramp up Gabapentin (Neurontin). I am using 200 mg 3 times daily, and I'm getting almost no relief. Mis this not nearly enough? Should I try something else,or ramp this up much higher? I'm 16 months post-Lasik, and suffering a lot of daily pain (with no visible dry eye symptoms). Also, I started blood serum drops yesterday - hoping that will give me some relief.

I'd appreciate any advice you have.

Thanks, Chandra

Hi Chandra,

That is actually a pretty low dose. I'm on 300mg 3 times daily, and I know that pain specialists will prescribe much higher. The problem with me is that I'm not sure if it works, as my pain is sporadic, and if I start to up my dose much more than 900/day I feel really fuzzy headed. I also wear PROSE lenses and put compounded lacosamide in my lenses.

Here's my protocol on really "bad" days
1) Gapapentin 600mg in the morning, then only one dose later in the day
2) Benadryl- I have an allergic component with my dry eye and allergens actually seem to trigger corneal pain in me. Weird. . .
3) Lacosamide drops in the sclerals (compounded by Leiter's pharmacy- could use them as just eye drops too) Again, I'm not sure how well these work
4) 0.5mg Xanax. I know this sounds bad but Xanax really knocks out my pain. Fortunately I only have to resort to this once weekly or less. Of all the things I use this seems to have the most definable effect.

I then spend the rest of the day functional, pain free, but feeling a little loopy. . . but it is better than corneal aching, burning, cold sensations and photophobia!

-MLE

[LaDiva]

I take lorazepam for sleep, but have noticed that when it kicks in my eyes don't hurt, AND they are not red. The red veining disappears, and the whites of my eyes are white. Once it wears off, things are back to normal. I have wondered why that might be.

[lizlou29]

When I was taking Zopiclone for sleep my eyes felt and looked much better the next day. Almost normal. Zopiclone also works on the GABA receptors. Glad to be off the tablets due to the horrible side effects but I do miss being able to make plans knowing the pain/dryness and redness wouldn't get in the way. I understand the pain connection but not why they they actually LOOK better.

[MLE]

When I was taking Zopiclone for sleep my eyes felt and looked much better the next day. Almost normal. Zopiclone also works on the GABA receptors. Glad to be off the tablets due to the horrible side effects but I do miss being able to make plans knowing the pain/dryness and redness wouldn't get in the way. I understand the pain connection but not why they they actually LOOK better.

My layman's guess-I think when your eyes hurt that triggers your eyes to tear in response. That in turn causes redness and the ugly appearance we all can't stand of dry eye. Once you get rid of the pain, your eyes stop tearing, or trying to tear, and some of this irritated look goes away. I found the same thing with my PROSE- lenses- my meibomian gland disease actually IMPROVED, probably because I was less painful, producing less irritating tears, and breaking the cycle that was further irritating the glands.

MLE