Peripheral Neuropathy - Drugs

    
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Posted by CCF Neuro MD on April 08, 1997 at 09:16:27:

In Reply to: Peripheral Neuropathy - Drugs posted by Elsie on April 08, 1997 at 09:15:09:

: This Message was posted by: Elsie B. -  4/6/97 9:54:09 AM
  Message:
  I am 65 years old, female, have Sjogren's syndrome and renal failure.
  Pains in my legs (peripheral neuropathy) respond to Etrafon-D which consists of perphenazine and amytriptylene.
  I was told that the use of perphenazine is contraindicated in persons with renal failure. Amitriptylene by itself was not effective.
  Is there a drug which can be taken to alleviate the pains of peripheral neuropathy that is less damaging to kidneys than
  Etrafon-D?
  Thank you for any advice,
  Elsie B.
  Toronto, Canada.
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Hello Elsie:
The treatment of neuropathic pain can be a difficult management problem. The tricyclic classs of medications like amitriptyline
are commonly used in treating this type of pain. Other tricyclics that are helpful include desipramine, and nortriptyline. The use
of these medications nessitate careful follow up with your physcician who can adjust yuor dose so that you recieve the
maximum benefit from the drug without the unwanted side effects. Another medication called clonazepam can be used in
addition to the tricyclics at night time especially if there is significant worsening of pain at night time. Some medications
originally developed for seizures have also been found to be helpful with sharp shooting or stabbing type pain. The medication
most commonly used in this group is carbemazepine (or tegretol.) Baclophen, a medication from a different class of drugs, are
useful with pain associated with muscle pain or cramps. Mexiletine has also been used but are should be used with caution in
patients with
heart disease. Then there is capsacian cream that is applied to the area of pain. However, it can cause a initial worsening of
pain before it is helpful and so it has to be given consistently for over a month before determining whether it is helpful or not.
The treatment of this condition requires continued communication between the doctor and patient and a systemic trial of
several medication to achieve the best possible pain relief. The pain typically does not completely improve and so a realistic
approach should be taken. I hope this is useful information to you.