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Combining Treatments continued...
What should a patient try first? Dubinsky says that treatment must be
individualized, and that a doctor's advice -- early on -- is crucial. The most
important first step, he says, is to find out what drugs a patient is able to
take. That decision is based on the patient's health, other current
medications, and the side effects a patient has from certain drugs.
"If there are no contraindications, and the pain is debilitating, I would
start a patient with tricyclic antidepressants," Dubinsky says. "If the pain is
not that debilitating, I would try the lidocaine patch first. And if there is a
contraindication to tricyclic antidepressants, I would go with opioids. This
decision has a lot to do with what patients can tolerate."
If these individual medications don't work, Dubinsky would try a combination
of tricyclic antidepressants and opioids. Such powerful combinations have
powerful side effects, and he warns patients and doctors to plan for them in