Brief Answer:
Consultation

Detailed Answer:
Hi XXXXXXX a.schroeder, thanks for asking.


I can understand your concern. It is sad that you are undergoing so much suffering. I really want to help you. I will answer your questions one by one.

First question - You are taking 6 medications on/off. Out of these 6 medications, 5 medications cause severe sedation, dizziness, confusion, memory impairment. Only Baclofen causes loss of sleep, aggression, irritability. You asked about adjustment of drugs so that Cymbalta can be safely taken. You can reduce dose of other medication to reduce sedation, like take Lyrica 75 mg only before sleep.
Citalopram (Celexa) and Duloxetine (Cymbalta), both are antidepressants. You should not take Celexa or reduce its dose.
You need to reduce dose of all medication as doses are very high. Take Cymbalta at highest effective dose and avoid rest drugs high dose.

2nd answer - Disorientation is occurring due to combined CNS suppression effective of all these centrally acting drugs high dose. As I have mentioned in above question, 5 medications are acting against your brain activity, you will feel disoriented. This much use and dose of medication can cause continuous sleep in a healthy male. You are still able to tolerate it as you are using these medications for long time and you have developed tolerance.

For pain and spasticity relief, you can also try methods other than drugs

: Physiotherapy and occupational therapy - I am sure that you must be taking it already. You can ask your therapist to use ultrasonic and infrared therapy to reduce pain. Ask him to do stretching of muscles to control spasticity.

: Meditation - It helps you in controlling your nerves and mind. Thereby you will be able to control your pain effectively. It will relieve your depression or anxiety. You must try it.

: Acupuncture can also help you getting some relief.

: Drug pump intrathecal placement - Here Baclofen pump or painkiller drug are implanted around spinal cord membranes (intrathecal) and it releases drug at constant rate for long time. It relieves pain and spasticity. Consult neurosurgeon for it.

: Spinal cord stimulation - Here any electronic device is placed near cord and nerves which blocks pain signals below it. It can reduce pain intensity. Your drug doses will reduce after it.

: Other methods like Thermoelectrical neuro stimulation (TENS) and bioelectric therapy can also reduce pain.

You should consult pain clinic to evaluate you. Based upon that, methods to control pain can be selected from above. The aim is to reduce drug numbers and amount along with significant pain relief.

I hope it will help you. Still in doubt, do let me know.

Thanks. Take care.

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