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Can perineural cysts cause pain?
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Can perineural cysts cause pain?

Can Perineural Cysts cause pain?
by zobie


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zobie
Female, 50 years
San Marcos - CA
Member since Jun 2008
Mood: zobie is ...
  



, Jun 11, 2008 01:57AM
Tags: cyst, neck pain, Tarlov cyst, brachial neuritis
Hi Dr.,

Two years ago I was having severe back pain in my thoracic region. I finally had an MRI which showed perineural cysts at T5-T7. There were no other findings in that area.
  I was also having right shoulder and neck pain. I also had an MRI of the cervical spine. That showed cervical spondylosis from C4-C7 with no nerve impingement.
  During the last 2 years, the pain has gotten progressively worse. I now have numbness and tingling in my right arm and hand. I do have carpal tunnel on the right. But my bicep muscle as well as my wrist now throb all the time.
  My treatment has included physical therapy, which made the symptoms worse, and pain management. I am currently taking neurontin, zanaflex, cymbalta, and percocet.
  Up until today, I thought I was being treated for the perineural cysts. I was told by a neurosurgeon that these were also called tarlov cysts. Today my neurologist said the cysts do not cause pain, and that he was treating for brachial neuritis. It is the first time I have heard of this diagnosis.
  Is there any treatment besides pain medicine for these 2 conditions? I take low doses of percocet and zanaflex because I still work, but it is getting harder and harder to work. I have pain 24-7.
  Any help or suggestions you can give me would be most appreciated!

Thank You,
Zobie
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7 Comments Post a Comment
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501792_tn?1261114706
Hi Zobie,

       Welcome to the forum.

I'm so sorry to hear that your pain is increasing and it's becoming harder to do your normal day to day activities.

I'm by no means a DR and I've heard these cysts dont normally cause pain but have also heard that if the cyst begins to fill and enlarge it can press against the surrounding nerves and cause pain and a myriad of other symptoms like urinary problems, headaches and abdominal pain(I think there are a bunch more though)
Have you had a recent MRI to determine whether the cyst has grown in size?
If not, although he is not treating the cyst you may want to ask him if he feels this could be a possibility.

Have you tried a TENS machines through physical therapy? I know they work great for some. TENS sends elecric impulses to the nerves to help control pain.
If you havent you may want to consider giving it a try. I believe some insurance will even cover some of the cost. One of my insurance companies did but the other didnt.
Also steroid injections have been shown to help relieve pain.

I unfortunitly dont know much about Brachial Neuritis except for that it is rare and pain can present in the shoulders.  I think the pain can be quite severe and usually for this condition an opioid regimine is used along with physical therapy.
I'm surprised to hear that your DR does not have you on a longer acting pain medication.
Short acting medications cause a rollar coaster effect with pain. Pain can build and become harder to knock down. Especially if PT has a tendancy to increase your symptoms. If your finding your pain is becoming too extream you may want to ask your DR about something a little more stableand that will support your pain on a consistant level.

hope this helped a bit although I know little about these conditions.
and your able to find something to help your pain.  Make sure you get a definte answere as to which condition is causing the pain. Just because he's treating the BN doesnt mean your cyst hasnt increased in size so make sure you get all the info you can from him so you can know for sure.
Hopefully someone who knows more than I do on this subject will come along.  

TMA


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Avatar_f_tn
Thank You so much for your response. It did help.  This Dr. and I have been going round and round. He says the cysts do not cause pain, and yet that's exactly where the pain is. I have the cysts at T5-T7. I have had 2 MRI's. The 2nd one showed a slight increase in size from 2.5cm to 2.7 cm. I should tell you that this Dr. is a Neurologist.

  I started physical therapy, but quit going because while it was helping my neck, I have spondylosis from C4-C7, it was making my back pain worse. My shoulder wasn't responding very well either.

  He said that if the new drug he has prescribed, lyrica, doesn't work, then he will request authorization for a visit to pain management Dr.'s for me. I have asked him to please send me to a neurosurgeon to have the cysts removed. That I don't want to treat the symptoms all my life, I want to get rid of the problem. I hate how I feel on these drugs. It is starting to effect my work. I work at Home Depot. Alot of heavy lifting.

  I don't know much about pain mangement. I know I am afraid of having a needle put in near my spine. You seem pretty knowledgeble, any idea's?

Thank You,
Zobie
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501792_tn?1261114706
Hi Zobie,

        My first thought was that maybe you would want a second opinion on what can be done, surgery wise.  If you feel the pain in the area of your cyst you need to know if that is the culprit and what can be done as a step before pain management would be needed.
   I have heard alot of good things about Lyrica, but everyone is different. I do hope you get as much relief as you can from it. But i undersatnd exactly where your coming from. If I had the chance to have surgery to possibly fix the problem, I would rather do that than take medications.
There are lots of things PM DR's can do. There are injections that can help like local anesthetics with cotison type medicines that can lower nereve activity to lower pain and nereve blocks that can block nerve pain in a certain area of the body. They can do TENS and acupuncture.
They do of course also prescrible medications.
Not all are Opioid. There are many meds that are known to help block the nerve pain by stopping or changing the "pain" message to your brain. Antidepressants, abti-convulsants and anti-anxiety medications.
But every pain DR does different things. There are some that dont want to use narcotics unless they've tried all options they have and some that dont do accupunture or TENS.
But most pain DR's will refer you to psychotherapy and physical therapy if you need it.
If you do take narcotics they will start you on a very low dose and increase it until your comfortable to the safest dose with the least amount of side effects.

PM DR's specialize in treating pain so they know more techniques and have more options than our regular DR's will know about or offer.
If you need it dont be afraid to go.It can help you fuction better with pain and have a more fufilling life while your pain is effefcting you so severely.
But if you can get a second opinion about the treatments and options you want to try before going to PM then do that.
You deserve to make sure your getting all the treatments available to you like surgery if thats what they can do and if thats what you want.

I didnt know what a PM DR was before I had to go. I thought it was a DR that did holistic medical treatment. And some do some of that like accupuncture. But Pain docs do so many things. Remember it's your body. You always have the option to decide what is not right for you. Just make sure you weigh the benefits out. If something is going to help you function and be more active it may be worth a try.

I hope you get the answeres you need and feel your DR's are doing all they can for you. Dont let anyone brush your pain off if you feel that there is something going on.

TMA

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501792_tn?1261114706
I also wanted to mention, dont be afraid of the needles. The PM's are really food at doing those types of procedures. A friend of mine was getting some injections in her neck and told me they werent as bad as she thought they would be. And of course they numb you up so you feel as little as possible. Just make sure you get a good pain DR thats been practicing for awhile. They will make sure that you are totally safe and that they do the best job possible. They dont take injecting needles into the spine and neck lightly.  They have tons of experience and do it all the time. In PM it's a really common procedure,
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Avatar_f_tn
Thank You for all of the great suggestions and support. It really helps.
  I am on Lyrica 50mg twice a day, I was taking neurontin 1200mg twice a day, but that quit working. Percocet 7.5/500 every 6 hours. And Zanaflex 2mg twice a day. I hate the way that they make me tired, fuzzy headed, and slow thinking, moving etc.
  I have been to 6 different Dr.'s where I live, San Diego county. So far, all these Dr.'s do not believe that these cysts cause pain. So I will just keep looking until I fimd one.

Thanks again And Take Care,

Zobie
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501792_tn?1261114706
I'm glad I could help:)
It does sound like you can use some stability with the pain meds. Short acting medication like your being given give you a rollarcoster effect. The pain increases and increases until you can take a dose and it's not always able to knock it down because it's been increasing for too long. Thats why PM Dr's like timed release medications. They give 24 hour support by slowly releasing in your system over time and help the pain not go up and down so much. Not to mention all the acetomenophine in percocet and vicoden. It's much safer for the body to be on something without apap.
Of course medication decisions are always up to the DR.

You seem to be a really strong and determined person. That will help alot in finding a DR to validate your pain and help control it.
Keep hanging in there. I'm always here if you ever want to chat.

TMA
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Avatar_m_tn
From experience of myself and many, if you can stay away from PM docs.  they push injections that can make and have made many worse, but are quite profitable and write scripts.  Band aids that are quite profitable.
for the small percentage that they help, the risk is great.  they are nothing more then anesthesiologists messing with your spine.
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