Re: Neuropathies and neurologists

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Posted by CCF Neuro MD on August 08, 1997 at 23:47:46:

In Reply to: Neuropathies and neurologists posted by charles alford on July 14, 1997 at 17:16:54:

My wife has made several visits to a pain clinic concerning chronic chest
pain that followed an "exacerbated chronic cholecystitis" diagnosis and
subsequent gall bladder surgery. After an anesthesiologist completed
a series of epidural nerve blocks, the conclusion was that the pain was
neuropathic and CNS as opposed to peripheral. I asked whether we should
consult a neurologist and was told "probably not".
I was skeptical of this answer and have made an appointment for my wife
with a neurologist. My questions:
1) "What types of neurodiagnostics are
there that should be considered?"
2) "Are there treatment modalities for
neuropathic pain besides drugs?. If so, what are they?"
3) "How long, if ever, does it take for nerve damage to heal"

Thank you for any response

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Hello, Charles,
Chest pain can come from a lot of reasons. It can be cardiovascular as in heart attacks, gastroenteral as in cholecystitis and reflux, and neuropathic as in peripheral neuropathy. Neuropathic pain arises from direct stimulation of nervous tissue itself. The features that characterize neuropathic pain are its persistence and, in general, its poor response to analgesic medication; its burning, gnawing, aching, and often shooting or lancinating quality. It gose without saying that its accurate diagnosis depends on the comprehensive neurological examination. The tests that are often used to aid the diagnosis include electromyelogram and nerve conduction studies. Usually this type of pain is rather difficult to treat. In addition to the pain medications, several special techniques have been tried with various degree of success. If the pain is regional and has a predominantly burning quality, capsaicin cream can be applied locally. Injections of epidural corticosteroids or mixtures of analgesic and steroids are helpful in some cases. Direct sympathetic ganglion injections have been helpful sometimes. Lastly, nerve root stimulations have also been successfully applied in some refractory cases. These treatment modalities usaully are applied in sequence. As far as the prognosis and recovery time for the nerve damage, it varies depending on the causes and the time past before the treatment is started. With the types resulting from systemic illnesses, the chance and time of recovery differ significantly depending on the course and severity of the systemic disease. Having said all that, I think the most important thing to do for your wife is to offer her a full neurological evaluation. This can be done locally as you already scheduled for her, or at our department at the Cleveland Cinic if trevaling to Cleveland is not a problem for you. Please call toll free (800) 223-2273 ext. 45559 for an appointment at your convenience. Good luck.
This information is provided for general medical education purposes only. Please consult

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