Treating Nerve Pain and Paresthesias

[Quixotic1]

This is a provisional discussion from another thread on the first steps in treating nerve pain.  I am hoping for a more thorough one from paindoc.  But, no one should go along with pain untreated whether or not they have a diagnosis.  People have a right to palliative care, be it from regular pain or neuropathic pain.

Treating nerve pain and paresthesias is something of a guessing game.  It is hard to predict what patients will respond how to each med.  It is a system of trial and error.  Typically they start with the "tried and true" meds and work from there.  It is well known that traditional pain relievers like acetaminophen and ibuprofen are next to useless.  Even the narcotics are pretty ineffective.

There are three that seem to get prescribed the most.  These are all originally anti-seizure meds.  It makes sense.  A seizure is a big nerve discharge in the brain that shouldn't happen.  The nerves just spaz out.  A paresthesia is similar.  A set of nerves starts sending a signal that they shouldn't send.  They also "spaz out."

One of the oldest nerve pain meds is carbamezepine (brand name Tegretol).  It can be very useful for many kinds of nerve pain.  It is especially known for one of the most painful of all, called Trigeminal Neuralgia (neuralgia = nerve pain).  This is a condition in which the nerve that brings back sensation signals from the face to the brain is damaged and sends excrutiating pain signals back.  The first line drug  to try is carbamazepine.  I used it for TN and it was VERY effective.

Gabapentin (Neurontin) was one of the next meds tried and found to be useful.  It has a wide range of dosing and is often very effective.  However, some people feel too weird on it and can't tolerate it.  Sometimes the doctor tries to start at too high a dose, dooming the trial to failure.

One of the most common - because of a huge multimedia marketing campaign and because it was recently approved to treat the neuropathic pain of Fibromyalgia - is pregabalin (Lyrica).  It has some similarities to Neurontin, but is also very effective and very expensive.  Some people do extremely well on it and others can't tolerate it.

Then there is a huge list of meds that are similar (originally seizure meds) that can be tried but there is less experience and testing behind them for neuropathic pain.

Often the pain managment docs try mixed therapy.  Many of the pain meds work so well together that lower doses of each are more effective together.  I don't know much about combination therapy, with one exception.  When monotherapy (one drug) is not working, and one of the main problems is that the pain or paresthesia is keeping someone awake at night, they may try adding in Amitriptyline.  This is an old time antidepressant in the category of "Tricyclic AntiDepressants."  It's main drawback is that it causes sedation.  But, added in a small dose at night, it affords very good additional pain relief and helps the person sleep.

Also, many of the other antidepressants can be very effective in treating chronic pain - both regular pain and neuropathic pain.  I am not well versed in these.

So, Julie, you should definitely ask you doctor for something that relieves nerve pain.  If he/she is not comfortable, then request a referral to a pain management doc or clinc.  They will be.

Sorry, guys, this is almost all I know about treating nerve pain or paresthesias.  No, it IS all I know.  :((

Quix

[Quixotic1]

No, I don't think so.  Treatment of the pain or paresthesias would treat an invisible symptom.  The doctor can't "see" your pain and so can't "see" when it is relieved except by your mood/attitude.  The meds won't treat your wobbles or weakness.  They certainly don't treat mine.

If need be, like you are just feeling ttooooooo good, you could taper off the meds to be in more pain just before the visit.

Ideally, your neuro would understand that you are describing pain that you finally had to get treated and is not as bothersome since you started the medication.  Any neuro that would dismiss you because you said the pain was relieved, ignoring all of the other stuff will not help you anyway.  A good doctor will take into consideration that treatment is relieving some of the symptoms and still be interested in finding the cause of the symptoms.

It's the same as a orthopedist who would dismiss severe back pain because the morphine was relieving the pain.  Huh???

Quix

[Wobbly]

Thanks Quix I will do that...but it wouldnt hinder me finding what is wrong with me??  

andie

[Quixotic1]

ask for a referral to pain management.  Your GP's fears, though trying to be in your best interests, are unfounded and a little cruel (tho not intentionally, I'm sure).

You need relief - 3 YEARS!!!  You need relief!

Chronic pain is not good for the body nor for the mind.  

Explain that you need relief.  Period!  And ask for pain management.  That is definitely what I recommend.

Quix

[Sarahsmom46]

Thank You!!!  

Julie

[floridamom2]

Thanks so much!!  I will be ready to pounce!!
Hugs,
Kristin

[Wobbly]

My GP gives me Tyl 3...for when the pain is bad...that doesn't help much anymore with my leg pains....he doesn't want to give me meds that have alot of side effects as it might interfer with my Dx...(it's only been 3 years)....boy oh boy

thanks for this information...

andie

[essdipity]

Based on Quix's response to me, I am guessing that if the OTC pain killers don't work for you, that's a sign that you have neuropathic pain. I refer to all the typical stuff---aspirin, Tylenol, Motrin, etc.

Hang in there till Thursday, but then pounce on that neuro to get a script!

ess

[floridamom2]

Yes, I am seeing new MS Specialist (Siddy's doc) on Thursday next week but just wondering if I can take anything in the meantime to get through the weekend.  
My flare has set off my back sending little nerve electric jolts everywhere and I feel like I could jump out of my skin along with the constand pain in my feet.  

I can make it til thursday but if you said "eating peas in the bathtub" would help right now I would be running for the pantry!  

Thanks again!!!
Kristin  

[Quixotic1]

I'm not sure of the exact answer to your question, but I will formulate one based on what I know of nerve behavior.

Yes, if the pain responds poorly or not at all to regular pain meds, but does respond to a med for neuropathic pain, then it is very likely to be nerve-based pain.  This may be an absolute.  I will punt the question to paindoc.

Kristin - do you have access to a doctor who might prescribe one of these meds?

Quix

[floridamom2]

Thank you so much for all this info on nerve pain!!  I am in alot of pain right now and have been all week. I have been noticing when I take ibuprofen or my Cataflam to try to see if it will help me, I start to get chest tightness and a bit out of breath.  I looked these meds up and found this is a side effect so I stopped taking them as needed.

Do you know of anything over the counter I can take to get me thru that may help w/ the pain?
Thanks!!
Kristin

[essdipity]

I responded in detail to the original thread about Neurontin that prompted what Quix has written here.

But my particular question is

... whether the efficacy of a particular med can confirm the source of the pain. For instance, if Lyrica works, does that mean the pain is neuropathic, and so on.


Thanks,  ess