My story of the road to CPPS - MajorSky

[webslave]

Nothing springs to mind re: Remeron (mirtazapine). It's a tetracyclic, as opposed to amitriptyline, which is a tricyclic and is commonly used in CP/CPPS. I tried it a few years ago for a mild, passing depression, and I was not able to tolerate it (brain fog, lasted days even on just 7mg, and because I had episodes of involuntary eye tightening I was a little concerned, because in rare instances mirtazapine can provoke epileptic seizures). But your experience will be different, and it may suit you. I take it you've already tried Elavil, the usual drug?

[MajorSky1]

Have not tried Elavil. Psychiatrist said he thought remeron would be best for me. I could ask him about Elavil. Does it have any concerning side affects? He said Remeron drowsy wears off after a while for most people. Everyone's different.

[Caedar]

Amitriptyline (Elavil) and nortriptyline are more common in pain conditions. I'd try those before Remeron.

[MajorSky1]

Caedar,
It looks like you've tried nortriotyline. What is your opinion of it? Any side affects that you e noticed? Any that are especially annoying? I've got a call in to the psychiatrist today and will probably relay messages with him about it. Is it a tritrate up / ween off medication? Does it cause problems like SSRIs? So it helps with pain AND mood and outlook? Anxiety? How are they are your stomach? I have a very sensitive stomach, unfortunately.

Web reviews of it show mostly that Elavil gets 4 out of 5 stars, and nortriptyline gets 3. Weight gain with Elavil would be a bummer.

Thanks much!

[Caedar]

I've done quite well with nortriptyline. At 10 mg, the only side effect for me is very slightly reduced sexual sensation. I'm talking maybe 10%; nothing serious. You'd probably start at 10 mg and see if it made a difference, then go to 20 mg if needed. Doesn't really require titration or weening. At 10-20 mg dose, it probably won't affect mood majorly. It's indicated for IBS, too, so it might actually help your stomach sensitivity; it has with mine.

I had to switch off of Elavil because it had too many side effects. However, Elavil is used more often and is better established as a pain treatment, so you may want to try that first before trying nortriptyline.

[MajorSky1]

Thanks for the info. It's a tough call. I'd really rather not get on those kind of meds unless I'm in dire need of rescue. I'm looking into it, but I'm having a hard time seeing the side effects as being worth it, because they just make it seem like robbing Peter to pay Paul. And also, there's the whole rigmarole that gets caused if you take it for a while and then decide not to, and the Dr. gets frustrated with you.

I have moments (as do we all) where I feel close to needing rescue. I'm 99.9% sure that if the pain and discomfort would go below the "threshold" - the line under which there is pain but does not cause the sympathetic NS to switch on - and stay down consistently, that my anxiety, and depression would subside relatively quickly, and I could return to normal.

I've read some of your earlier posts and you have been on the same mode of thinking that I've been on lately: find a way to shut the nerves down with some sort of medication in hopes that it will break the cycle and help things return to normal by the time you finish the treatment. Even though there are cases where that may work, it's not easy to find what will work for that. Everybody's chemistry is a little different so it's no use trying to gauge how you will react. Either try something or don't. Since usually my system seems very sensitive, I try to be cautious.

[webslave]

I'd really rather not get on those kind of meds unless I'm in dire need of rescue.

Your condition seems to be having a major negative effect on your life. I suggest you take the meds.

[MajorSky1]

Yeah. I was doing ok there for a couple months until I had that injection. I have a call into the psych. So I'll try to figure something out.

Dunno, can Gabapentin 100mg/day be enough to bum you out? There's a moderate interaction with buspar as a NS depressant, but I don't know if that includes mood.

I'll try to back off posts for a while too.

[Caedar]

Gabapentin at that low a dose seems unlikely to cause depression.

[Caedar]

Also, you'd mentioned tailbone pain. Here's a good primer on that, just released: http://www.pelvicpainrehab.com/pelvic-p ... -the-butt/

[MajorSky1]

Interesting read. I relate to the 2nd half regarding muscles. My actual tailbone doesn't really hurt, it's the muscles and/or nerves around it.
The right side pain I was having close to where the levator ani attaches has been defunct now for about 3 weeks - possibly the only issue helped by the steroid injection, or possibly just resolved on its own, at least for now. I has some other weird soreness around it, but I think it was mainly nerve stuff.
Thanks for posting.

[MajorSky1]

Just a quick note. Approved for PT, and start next week. Probably be checked for TrPs including and beyond the pelvic floor, and be worked on in all the other ways for the type of pain I have. They have me under "Pudendal Neuralgia," and will be trying to use massage to help gate the pain, among other methods like stretches, pelvic alignment, and exercises. Either way it's good support.

[MajorSky1]

Has anyone who has been on this forum and had ejaculattion and post-ejaculation pain from that muscle spasm that happens in the spermatic cord or ischocavernosus or bulbospongeosus (hard to pinpoint exact location) ever report that it eventually resolved, healed, stopped for good?

[Caedar]

Yes. I had ejaculation pain that originated in the bulbo. TP release and hydroxyzine resolved it.

[MajorSky1]

Did you do the TP release by yourself, or do you have PT too? I can't find any TPs. I can't even tell if it's the bulbospongeosus or a different muscle. If I can get off this gabapentin, and maybe stop the buspar too, I'd like to try hydroxyzine for a while again. Looking back, I had most improvements while on that, even though it would intermittently knock me out.