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Non-Opiate, Non-NSAID pain relievers
June 11, 2013 11:50 PM   Subscribe

Atypical fibromyalgia (I.E. Docs can't figure out why I have chronic pain and fatigue). Medications I've tried thus far for fibromyalgia have been bust, more or less. The only thing that works for me is tylenol 3, but I'm building a tolerance and it gives me insomnia. What haven't I tried? Special Snowflake details inside.

I really don't want to be on narcotics. The next thing my doctor prescribed is butran patches (buprenorphine). This seems like a dangerous road to addiction, though I've read in some ways it's less addictive than other narcotics.

I'm very sensitive to a lot of medications, including opiates. Tylenol 3 worked for a long time only taking 1/2 a pill. But I've either built up a tolerance or the pain is getting worse (I think it's a little of column A, a little of column B). Other opiates make me sick, and when I had surgery a couple years ago, I had to have an antiemetic to keep from barfing all over the place. And I still did, especially once the antiemetic they gave me under anesthetics wore off. The two times I've had hydrocodone I barfed all over the place. Tylenol 3 didn't make me nauseous, thankfully, but it had another problem, beside increasing tolerance - it gave me really bad insomnia so I often had to choose between staying awake from pain, or staying awake from tylenol 3 induced insomnia. Looking back, Percocet had a similar problem with insomnia after the first two days on it. (I was on it for 5 days).

I have tried other pain meds. Tramadol gave me head pain that was as intense as a migraine but different, and made my whole body feel shaky/weird/on fire. Lyrica and neurontin make the pain worse. Neurontin had also insomnia as a side effect. Cymbalta aggravated my restless leg syndrome and made me twitchy/spastic/want to tear my skin off. Generic Prozac did the same. I've been told by my sleep doctor that I should expect that from pretty much any antidepressant. He gave a longer explanation, but the short version was that however antidepressants affect the brain, they affect it in such a way that changes dopamine in a way to worsen restless leg syndrome.

Savella wasn't bad but did start to elevate my blood pressure and RLS, and may have caused or worsened some severe hand pain. I say may because I had some mild hand pain before, and after it's been on and off, though no where nearly as bad as the 12 days I was on the Savella titration pack.

Ibuprofin and Celebrix work a little, but have chewed my stomach to pieces so I can't take those anymore. Calcium Channel Blocker (taken for high blood pressure, not pain) caused a pretty big flair up of restless leg syndrome and PLMD episodes.

I'm fairly worried about the butran patches. In addition to addiction issues, I don't know if I'll be in a foggy cloud the whole time, and I saw one of the possible side effects is insomnia. I really struggle with sleep, and it seems like anything that MIGHT cause insomnia with me does. I am desperate for some good sleep, have sleep medication, but either the pain or tylenol 3 throw a wrench in sleeping most nights. Last sleep study I was getting 0 stage 4 sleep, in part due to alpha intrusions from pain, and in part due to PLM.

So, I have tried a lot of medications. But, much to my surprise, I found a small number more that aren't opiates. I'm hoping for even more suggestions. The ones I've found but haven't spoken to my doctor about are: Clonidine, Marinol, and acetamenophen at 4000mg/daily. Pot is not an option, it's not legal in the state, and I've been told I'll be kicked out of the pain program if I use it, and that I could be subject to random drug tests. I haven't yet, but that's just not something I want to deal with. I'm hoping there are some others that I haven't been able to find with a simple web search.

I'm not interested in hearing any Natural/Alternative medicines unless there is some actual evidence based proof that it works.
posted by [insert clever name here] to Health & Fitness (22 answers total) 11 users marked this as a favorite
 
I have pretty wicked nerve pain in one of my legs, I once got a prescription for nortriptyline that worked great for me. It's a tricyclic antidepressant that works pretty well for pain management when taken at a 10-fold lower dose than is used to manage depression. The only side effect that I noticed was some pretty mild drowsiness and I only stopped taking it because the physical therapy I had just started was doing the job all on its own.
posted by ltisz at 1:23 AM on June 12, 2013 [2 favorites]


FYI Marinol is THC the active ingredient in weed. Personally I wouldn't take 4g of acetominophen either as that would eventually cause liver damage. I'm not up to the state of the art with pain meds, so I can't offer any suggestions, just some tidbits for you to consider.
posted by koolkat at 1:25 AM on June 12, 2013


This falls under the alternative medicine umbrella, but have you tried turmeric? Curcumin has been shown to have anti-inflammatory properties. Here's one such research supporting this: http://www.ncbi.nlm.nih.gov/pubmed/12676044

Placebo or not, turmeric has consistently worked for me as an anti-inflammatory agent. I'm not into alternative medicine, just tried it one day on a lark, and was surprised at how effective it was for me.

YMMV.
posted by pakoothefakoo at 1:33 AM on June 12, 2013 [1 favorite]


I'm sorry you're having a hard time. Chronic pain really wears you down mentally and physically.

I know you're asking about medications, but I'm wondering have you tried any complementary therapies (as opposed to natural medicine) alongside them? Gentle massage can be very effective in alleviating the symptoms of fibromyalgia. It can definitely help with fatigue as it promotes relaxation. Finding a good and qualified therapist is important.

This is an interesting article that suggests the fatigue and fibromyalgia may be two separate conditions so it may be worth considering as you try to find out how best to treat your symptoms.

There is also some information on the connection to fibromyalgia and anxiety. While I'm not suggesting that it's psychosomatic, it can be good not to think of the mind and the body as totally separate entities. Sometimes an underlying emotional issue can manifest in physical symptoms, so it could be good to think about what stresses and anxieties you are facing, or were facing around the time your symptoms began to appear. There may, of course, be no link at all, but it's just another part of you to consider, as therapy could be of some help. Good luck.
posted by billiebee at 2:35 AM on June 12, 2013 [6 favorites]


Just to be clear, you know acetaminophen is Tylenol, right? Technically, 4 grams per day should be able to be handled by your liver without damage, although it is the maximum dose which should never be exceeded.

Clonidine would be an unusual choice for chronic pain. Its more typical uses are to treat refractory high blood pressure and mood stabilization. It has to be used carefully (tapered to stop) because of its effects on blood pressure.

Based on my reading, buprenorphine is sleep inducing and might help with your insomnia. However, I applaud your interest in trying to avoid opiates. For chronic pain they are a dangerous road. Keep in mind the codeine in your Tylenol 3 is processed into morphine by your body, so it is not like Tylenol 3 is a non narcotic choice either, although it is less prone to abuse.
posted by treehorn+bunny at 3:01 AM on June 12, 2013


usual disclaimers: IANAD and you really need to work with the providers in your pain program. That said, you might ask about cyclobenzaprine (the muscle relaxant Flexeril). You mentioned insomnia. When I had disabling headaches that wouldn't go away for days, the lack of sleep was part of the vicious cycle. My doctor had me combine hydrocodone (Vicodin) with a half tablet of Flexeril. Knocked me out quite effectively, with the only side effect a moderate drowsiness for part of the next day. Probably not a good choice for regular use, but for occasional relief.

Wikipedia says cyclobenzaprine is being used off label for fibromyalgia.
posted by wjm at 4:08 AM on June 12, 2013


These things help me with fibromyalgia pain:

long hot showers;

slow release Paracetamol (Panadol Osteo);

75mg Lyrica (Pregabalin);

a Magnesium supplement at bedtime (helps with sleep, migraines, and muscle spasms);

wheat heatpacks that you microwave;

not overdoing it physically. Fatigue = pain;

getting enough sleep. Lack of sleep = BIG pain.
posted by Year of meteors at 4:26 AM on June 12, 2013


I know a couple of people who've found lidocaine patches helpful for different kinds of pain. They can be expensive, but they're non-narcotic and side effects are rare.
posted by songs about trains at 5:02 AM on June 12, 2013 [1 favorite]


Right now I'm taking Ambien, Lyrica, and flexerall. None of those are pain killers and allow me to get enough sleep so that I can exercise and move around. For a good long while I was just taking the Ambien and the muscle relaxer. I typically don't take painkillers because of tolerance issues and because ive found with fibro just stopping the pain isn't enough.

Work with your doctor on this one and if she's overfond of medication see about getting a new rheumatologist. The thing with fibro, unlike other types of pain there isn't something indentifiably wrong to fix. When you hurt your knee, you can take pain pills until the knee heals. For us, there is no real end in sight. We have to think about pain management differently. We need to find drugs that allow us to function, either by giving us sleep or slight relief from the pain, and then we need to move and find a balance with the pain.

For me, I am in drastically more pain when i don't work out. If I skip more than two days without any real exercise, i struggle for a week or two after. I hope you find that thing that helps you becuase this can really suck you dry. Good luck.
posted by teleri025 at 5:07 AM on June 12, 2013


I have fibromyalgia. I've also been through the gamut of treatments. My pain doctor prescribes topical pain cream. It's amazing. I get it from here; it's mail order. It's sort of like Medco; my doctor calls it in, they process my insurance and mail it out. Your doctor can prescribe different combos. I'm currently on Flurbiprofen/Baclofen/Lidocaine/Pentoxifylline. Baclofen is a muscle relaxer. You can get other combos.

My doctor gave it to me because I'm tired of taking so much Tramadol and Flexeril. Flexeril works but gives me so many side effects. The pain cream gives me almost immediate pain relief and it doesn't have all the side effects. It doesn't stain your clothing; it's a little sticky, so I usually only put it on when I'm in my PJs.

My current regime is Tramadol, Flexeril, and the pain cream. I also use Tiger Balm patches if you haven't tried those. And my heated mattress pad and heating pads and ice packs.
posted by hotelechozulu at 11:06 AM on June 12, 2013 [1 favorite]


I am sure you have searched the web up and down, still my 2 cents. I am a daily visitor to Healingwell Forums but I do not have fibromyalgia. I have other condition. There are many readers there who have this condition so you may want to interact with them. Don't stick to fibromyalgia sub-forum only but search across the forum.
posted by zaxour at 12:58 PM on June 12, 2013


Thanks everyone for the input. I probably should have shared more as many things have been tried or I am already currently doing. But I'll respond to a few things to see if that doesn't bring up some new ideas.

"I have pretty wicked nerve pain in one of my legs, I once got a prescription for nortriptyline that worked great for me. It's a tricyclic antidepressant that works pretty well for pain management"

I can't take antidepressants because it aggravates my restless leg syndrome and periodic limb movement, keeping me from sleeping. I've tried a trycyclic antidepressant at a low dose for sleep already, and it made things worse. Wellbutrin supposedly is one that won't cause problems, but I have been told I can't take it due to high blood pressure and a history of palpitations.

"FYI Marinol is THC the active ingredient in weed."

Yes, I'm not against using pot other than it would get me kicked out of my pain management program. So if my doctor felt comfortable prescribing Marinol, I would be okay with that. I'm not too fond of being stoned in general, but I think it's better than opiates.

"This falls under the alternative medicine umbrella, but have you tried turmeric? Curcumin has been shown to have anti-inflammatory properties. "
Yes, as part of a night time pain supplement that was supposed to help with pain and sleep. I took it the whole month and did not notice anything. But I also don't have inflammation.

"I know you're asking about medications, but I'm wondering have you tried any complementary therapies (as opposed to natural medicine) alongside them? Gentle massage can be very effective in alleviating the symptoms of fibromyalgia. It can definitely help with fatigue as it promotes relaxation. Finding a good and qualified therapist is important."
I can't afford massages, really. I go when I can, which has been about once every 4-6 months. Before I stopped working I was going every 2-4 weeks.

"This is an interesting article that suggests the fatigue and fibromyalgia may be two separate conditions so it may be worth considering as you try to find out how best to treat your symptoms."
A few doctors have suggested the same thing to me.

"There may, of course, be no link at all, but it's just another part of you to consider, as therapy could be of some help. Good luck."
I am in therapy as part of my pain management program, for all the reasons you outlined.

"Just to be clear, you know acetaminophen is Tylenol, right? Technically, 4 grams per day should be able to be handled by your liver without damage, although it is the maximum dose which should never be exceeded."
Yup, I do realize that. I can't recall where I read it, maybe even here. The suggestion was that 4 grams a day keeps the tylenol concentration in your blood at a level that helps with more severe pain. But the liver part makes me very nervous, I'm already on way too many medications.

"Clonidine would be an unusual choice for chronic pain. Its more typical uses are to treat refractory high blood pressure and mood stabilization. It has to be used carefully (tapered to stop) because of its effects on blood pressure."
I'm reaching here, I realize, but I don't have many options and I've seen it cited as an uncommon pain medication, but of course it's use is off label.

"Based on my reading, buprenorphine is sleep inducing and might help with your insomnia."
Tylenol 3 was supposed to help with the pain and to help with sleep, but it gives me insomnia, so my fear is the same thing will happen with buprenorphine. Several internet searches suggest people do struggle with insomnia with the patches, especially the first day out of the week.

"However, I applaud your interest in trying to avoid opiates. For chronic pain they are a dangerous road. Keep in mind the codeine in your Tylenol 3 is processed into morphine by your body, so it is not like Tylenol 3 is a non narcotic choice either, although it is less prone to abuse."
Yup, I've been unhappy about using the tylenol3 for a long time, but after Celebrex did a number on my stomach, it was the only thing I had left. I'm not thrilled with the idea that since I'm gaining intolerance of it that the next move is a different opiate. But I understand given my sensitivities to other medication that there aren't a lot of options out there. Which is why I'm trying to do my own research and maybe find something the doctor hasn't considered. I'm also going to a different pain specialist the end of the month, who's main focus is fibromyalgia. Current doctor doesn't think he'll have anything new to try, but said it wouldn't hurt to go.

"That said, you might ask about cyclobenzaprine (the muscle relaxant Flexeril)." Already on it at night. Also taking baclofen and alprazolam at night to sleep, along with magnesium. They help tremendously for the "regular" insomnia and RLS sleep related problems, but can't touch the pain or tylenol 3 induced insomnia.

"a Magnesium supplement at bedtime (helps with sleep, migraines, and muscle spasms);"
Magnesium helps a ton with sleep for me. Haven't noticed any improvements elsewhere since starting it though.

"getting enough sleep. Lack of sleep = BIG pain."
This right here is probably a huge component to the troubles I'm having. I can't sleep from the pain, and I'm in pain because I can't sleep. My doctors don't want to add too much more to what I'm taking at night because of, and I quote "you might not wake up." My sleep doctor has said repeatedly that until I get my pain under control, I will continue to have trouble with sleep.

"I know a couple of people who've found lidocaine patches helpful for different kinds of pain. They can be expensive, but they're non-narcotic and side effects are rare."

Thank you for this. It is one I had not seen before and will talk to my doctor about it.

"Work with your doctor on this one and if she's overfond of medication see about getting a new rheumatologist"
Rheumatologists in the area apparently don't want to treat fibromyalgia patients anymore. I've been told by a number they don't see fibro patients, and the two I've seen to diagnose and 2nd opinion on fibro have bounced me back to the pain clinic. It is very frustrating. But I have a visit with a new pain doctor who supposedly specializes in Fibro, so we'll see how that goes.

"For me, I am in drastically more pain when i don't work out. If I skip more than two days without any real exercise, i struggle for a week or two after. I hope you find that thing that helps you becuase this can really suck you dry. Good luck."
I'm on a graded exercise program, for about 5 weeks. I haven't noticed any improvement, but admittedly, my doctor started me very slow. This was after a year and a half of avoiding exercise because everything just made me feel worse. I have severe post exertional fatigue that started about 2 years ago. Before that, I enjoyed exercise and it (usually) made me feel more energetic.

"I have fibromyalgia. I've also been through the gamut of treatments. My pain doctor prescribes topical pain cream. It's amazing. I get it from here; it's mail order. It's sort of like Medco; my doctor calls it in, they process my insurance and mail it out. Your doctor can prescribe different combos. I'm currently on Flurbiprofen/Baclofen/Lidocaine/Pentoxifylline. Baclofen is a muscle relaxer. You can get other combos.

My doctor gave it to me because I'm tired of taking so much Tramadol and Flexeril. Flexeril works but gives me so many side effects. The pain cream gives me almost immediate pain relief and it doesn't have all the side effects. It doesn't stain your clothing; it's a little sticky, so I usually only put it on when I'm in my PJs."


hotelechozulu, what type of pain do you have? Is it widespread? Can you use the topical creams over large parts of your body? My pain is mostly the long bones - legs, and arms, deep down. I thought it was my bones at first, but it's become apparent it's the muscles and self massage (o professional) helps a little. It feels different than muscle tightness from stress or overuse. Sometimes when its bad it's the back too. Generally not joint pain, though really bad days my hip and should joints act up. Hand and wrist pain is relatively new and may be mostly unrelated. Doc things it might be mild carpel tunnel but made worse by my overall pain issues, so wants me to try braces at night and padded gloves on the computer.

Zaxour, thanks for the suggesting of healingwell. I'm not a member, but I frequently scour their forums when looking up health related topics.
posted by [insert clever name here] at 3:18 PM on June 12, 2013


I also get pretty nauseous from opiates, although I recognize that my bad interaction with them may be different than yours. In any case, when I have been prescribed Vicodin or Percocet recently, I have been prescribed hydroxyzine with it. It's an antihistamine similar to Benadryl; it not only induces sleepiness in most people but also synergizes with opiates, so a lower opiate dose canbe taken to be just as effective. For me that has really helped with nausea. I suggest it with caution because I know some people have issues with Benadryl and else. Good luck!
posted by Tandem Affinity at 9:48 PM on June 12, 2013 [1 favorite]


Thanks Tandem. I actually just discovered benadryl for nausea a few months ago for other, random bouts of nausea. It was a godsend an d I can't believe I didn't know about it sooner. I'll add that to my list of things to talk to my doctor about.
posted by [insert clever name here] at 1:15 AM on June 13, 2013


On the alternative but somewhat scientifically supported/personally tried and tested list:

- magnesium supplements,

- omega 3 supplements,

- avoiding foods that make you flare up (for me its chocolate, tomatoes, and something other than MSG that's in Chinese food),

- MEMORY FOAM ON YOUR MATTRESS (my god, the difference),

- yoga (hatha or similar, not one of the hot or athletic kinds...similar effect as a massage but mainly I found it useful for attuning mind-body awareness, so that instead of just thinking "ow, pain, pain, stupid pain" I can figure out "I have pain in my X because I'm sitting the wrong way / clenching something / need a different work surface / etc")

- TIGER BALM and for convenience, the pricier O24; I have similar pain to what you described and mild RLS (feels itchy inside the bone unless I'm moving my legs)--I find many topical things (voltaren, absorbine) useless (although try voltaren, it works for some people) but a good old fashioned heat rub seems to confuse the nerves fairly deep under the skin, at least long enough for me to get to sleep

- iron supplements, because low iron can cause all sorts of wacky symptoms you wouldn't think of, very much including periodic limb movement when you're asleep--you don't need to be iron deficient by normal standards either, as I apparently need to keep mine well into the higher side of the normal range
posted by sarahkeebs at 10:38 PM on June 13, 2013 [1 favorite]


My pain:

My fibro pain is mostly on my upper half. It starts in my shoulder blades and spreads up into my shoulders, collar bone, neck, head, arms, hands. I get low back pain too. It feels like muscle cramps and burning. My joints and bones also hurt. I can feel all the joints in my upper half burning; they feel inflamed. It's hard to describe. I also get the deep bone ache you describe. Sometimes my muscles freeze up; I get claw hand. I get HUGE muscle knots; I recently had a knot in my upper right arm that was about the size of a golf ball. I could barely use that arm/hand. My muscles feel fatigued and it seems to get worse with activity. Sitting upright for long periods of time is agony. I also have endo/IC/IBS so I have lots of abdominal pain. Every once in awhile I'll get pain in my knees/feet/hips, but it's nothing like my upper half. There's always something hurting; it's miserable.

The pain cream bottle advises 1-2 squirts, and the squirts are pretty big. 2 squirts will cover the upper half of my back to the front of my shoulders. My pain doc said that the cream is effective on bony areas. A little goes a long way; I think it's fine to use on large-ish areas of your body. If you can get it, I'd definitely recommend it.

Sorry you're going through all this. I know that it's misery. I hope you can find some better methods of dealing with it.
posted by hotelechozulu at 12:19 PM on June 14, 2013


Thanks hotelechozulu. That sounds the most promising. You have very similar symptoms to me. It doesn't start I my neck/head area, but the type of pain sounds right, down to a t. Even the sort of feeling inflamed, but hard to describe. For me it feels warm like it would be inflamed, without actually being warm. Blood tests constantly show no inflammation - or very low, likely contributed to my allergies, and that makes sense - I've had mild inflammation on blood tests for years, along with allergies... Loooooong before this all started. I was actually a bit surprised when a blood test in the middle of tree season came back with 0 inflammation. . .

Anyway, thank you again for your suggestion, it really sounds promising.
posted by [insert clever name here] at 12:29 PM on June 14, 2013


You've tried a lot of stuff. I don't know if you'll have someone on your medical team who will be familiar with it, but I have had success with low dose naltrexone for the pain associated with my severe ME/CFS. As a side benefit, it seems to help my energy, too. Like the pain cream mentioned, it's another one you'll probably need to mail-order through a compounding pharmacy.

You haven't mentioned Soma/carisprodol, which is another muscle relaxant, a quite old one. It might be difficult to get someone to write it - my GP is not allowed to (apparently because it has black-market value), so my specialist does. It will probably knock you out as much as Flexeril, so it might not be a good candidate. (I feel you on the pile of drugs at night - I take half a dozen soporifics myself.)

I would guess you might have already done this, but since you haven't mentioned it, do make sure your vitamin D levels are okay. Getting mine up into the normal range has helped a lot. Between the LDN, the D, and the Neurontin (which doesn't help you), the pain is bearable instead of unbearable.
posted by jocelmeow at 2:49 PM on June 14, 2013 [1 favorite]


Flexeril hard does anything for me in terms of sleepiness, in true, the others don't seem to either. Benedryl, ironically works quite well, but if I take it more than a couple days, it winds up the old rls/plmd. I'll ask about the carisprodol too. Maybe I can try it instead of the Flexeril.

I've read about low dose naltrexone, now that you mention it. But it must have been on a late night, insomnia fueled search because I didn't add it to my list. Bill have to see about that too. I've heard some people swear by it, and others say it does nothing.

Vitamin d is on the low side of normal. Was genuinely low almost 2 years ago. Got it up with supplements and sun. But can't seem to get it above 50 when my doctors have said it would be Ideal. It's usually in the low to mid 30s. But it hasn't been tested since November, so going for blood work next week.
posted by [insert clever name here] at 3:29 AM on June 15, 2013


I have heard from my specialist (ME/CFS guru Dr. Paul Cheney) that people with ME/CFS often have trouble getting their D into the normal range despite much supplementation. It certainly seems like that could be an issue in fibro, too.

One other thing - you say you're desperate for some good sleep. I have tried a bajillion things for that, and you might find something you haven't tried on my list. As I mentioned, I'm on several - Dr. Cheney prefers to have people use more than one thing at a time at lower doses rather than high doses of one so that they don't end up in the situation of one thing after another failing. Using multiple things has definitely improved my sleep quality and helped me start making a little headway toward improving.
posted by jocelmeow at 6:15 AM on June 15, 2013


Oh man, I'm so sorry! Much has already been discussed/shared/suggested here, but there's one thing I'll add. I too have fibro, and for me, the biggest thing that helps is sleep. I've tried sleeping pills, but I hate them, it takes me days to get rid of the foggy brain. Tried Seroquel (I also battle depression and bipolar), hated that too. (I'm already on Celexa and Lamictal, which they say helps somewhat with fibro, I dunno though, I take them more for emotional survival than physical pain.) I'm starting to suspect I have RA, and will find out soon.

ANYway, the reason for my rambling is to suggest melatonin to help you sleep. My meds doc recommended it, and since I've started taking 3mg about 45 minutes before I go to bed, I sleep SO MUCH BETTER than I used to. it doesn't help with the joint and muscle pain, which lately has been off the charts (such that I may need to explore opiates, or anything that'll be stronger than the ibuprofin I take now). But it does help me fall (and stay) asleep. You can go up to 10mg I think, and you can get it at any drug store in the vitamin section. You may also need to futz with the timing, if I relax myself and stop looking at my damn iPhone, turn off the light and close my eyes, it can help me fall asleep within 15 minutes.

Glad you're also in therapy, it really does help. But honestly, IMO, sleep is the number one tool in dealing with the asshole that is fibromyalgia.

Hang in there.
posted by flyingsquirrel at 4:19 PM on June 18, 2013 [2 favorites]


"But honestly, IMO, sleep is the number one tool in dealing with the asshole that is fibromyalgia."

I had to mark this as best answer not only because of the sage advice, but because it made me laugh out loud. I think I might need this as a tattoo.

I've tried melatonin in the past and it didn't work for me. Well, actually it works for the first couple nights, than stops. But maybe I'll try it again.
posted by [insert clever name here] at 10:28 PM on June 18, 2013 [1 favorite]


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