Best medicines to use

[Sunshine43]

I have had my right foot partcialy amputated because of the pain.I have been useing Neurontin 400mgs 3 times a day along with Oxycontin 20mgs 2 times a day .I suffer with diabetic neuropathy,and some days are better than others ,its like I have flair ups some times and cant hardly get thru the day with it.I find no relief with the neurontin medication.I have had to have some of my foot amputated all because a doctor was not handling my diagnois in the right manner.Is there any kind of surgery out that will benifit me. I hurt so bad all the time and it seems like they want to put me on antidepressants for the cure.I just want to learn how to live with my condition and have my life back again even if it means I have to count on pain pills to help me get thru the day,I also had to have 4 stints put in my heart and had to have a fem pop done also.If it seems as tho I am bitter ,its because I am .I feel that my doctor medicaly neglected me and did not make the best decsions in my case as far as treating me for the problem.I complained for almost 3 yrs before he finaly made a referral for me to go to a pain clinic.By this time the damage was already done .Can you recomend a good doctor for me to use at the clinic,or tell me how to cope with this pain I have all the time.I am looking forward to your responce .THANK YOU VERY MUCH

              Debbie

[CCF-Neuro-M.D.-CS]

The treatment for peripheral neuropathy pain includes anti-seizure medications (such as Neurontin or Topamax) and anti-depressants (such as Elavil or Doxepin). These medications are used at doses to treat pain, and not at levels to typically treat other conditions. You can also use narcotics. For patients suffering from severe regional pain they can occasionally have a surgical procedure to stop the sensation from that area (a rhizotomy). However if your pain is from diabetic peripheral neuropathy, then it may progress over time, and a surgical intervention may not be advised. Also pain from a peripheral neuropathy typically remits over time. What I would recommend is for you to see a neurologist to confirm your diagnosis. Then specific treatments can be recommended. Good luck.

[Kit1]

Actually, antidepressants *do* have a direct effect on pain, in addition to providing antidepressant action. They are often used in combination with other drugs, such as Neurontin or Elavil, to provide more relief than the pain medicine alone could.

Also, most antidepressants assist with getting proper sleep. This can help with pain also because pain often prevents normal sleep, which aggravates the very chemicals that play a role in maintaining pain.

Although no one wants to take a lot of medications, trying the antidepressants is something you might consider.

I understand your frustration with doctors, having experienced it myself. You have little choice but to go to them for help, but if they are not providing help, you feel lost or dismissed or disrespected. Totally understandable.

This is a time to focus on *your* needs. Finding ways to take care of yourself, both by seeking help from doctors who are supportive (they *do* exist!), and by extending kindness "to you, from you." It's good to see that you are not giving up, nor are you sitting around hoping for relief. Please keep at it, asking questions, finding support, and -- most of all -- taking time for yourself. It's not selfish, and the more love you have for yourself at this time, the better you can function.

Take care.

[ontherecord]

I am very sorry to hear about your problems and I hope that you find some relief for your pain.  The antidepressants will probably not help with the physical pain, but they may be effective in helping you mentally cope with your situation which may or may not incidentally help with the pain.  

If you are a diabetic, I would strongly encourage you to see a RETINA SPECIALIST, since there are many retinal conditions that are associated with diabetes -- collectively they are grouped under the name diabetic retinopathy.  A retinal specialist is an ophthalmologist who has additional training in treating diseases and pathology of the retina.  Diabetes (especially uncontrolled diabetes) puts you at higher risk for developing some of these insidious conditions and some of these conditions present a real threat to vision.  Therefore, it would be in your best interest to make an appointment with a retinal specialist as soon as possible, if you are not already doing so.

The mismanagement you describe is not an uncommon situation these days, and it unfortunately happens all too often.  I posted a comment to the thread "Frontal Lobe Meningioma" the second half of which I think you might be interested in reading in which I describe situations very much like yours.

[ontherecord]

I agree with you that an antidepressant will probably help this particular person, but I vehemently disagree with your statement that antidepressants have a "direct" effect on pain.  At best, they affect a person's *perception* of pain.  There is no antidepressant that I know of, or any research that I am familiar with, that indicates that antidepressants actually reduce pain.  Again, they can help with the perception of pain.  For example, although not antidepressants, benzodiazepines help many people with non-nanxiety conditions deal better with their physical symptoms.  By depressing the central nervous system, they reduce the *perception* of pain, and when the medication wears off, the perception of pain is no longer ameliorated. Moreover, antidepressants, which are administered in such a way as to continually stay in the bloodstream, do not wear off (unless someone withdraws) and thereby their effects can help to mitigate the perception of pain.  This is not to say that they help with the pain directly.  It is an indirect, almost inciddental effect.  Just like alcohol doesn't help with physical or emotional pain, antidepressants similarly blunt the edge of physical pain.
In the end, it's the same result, but I don't think you should confuse the mechanism of action.

Additionally, I agree with you that there are some doctors who are actually supportive, but I find these doctors to be few and far in between.  The unfortunate truth is that doctors care inasmuch as 1) they are getting paid to care for the patient and 2) if the proper care isn't administered, they face some potentially serious liability.  Believe it or not, I have been told from reliable sources that neurologists are some of the happiest doctors around (as compared to ER doctors, who are amongst the most miserable).  Why is that, especially given that neurologists see some of the most pernicious conditions that can affect us? Moreover, unlike doctors in most other specialties, neurologists can't really do to much in the way of treatment, since most neurological conditions (at least the serious ones) are progressive and often untreatable.  

Relying on the infallibility of doctors -- especially internists, family practitioners and other primary care physicians/general practitioners, can be a critical mistake.  The patient here believes that she was neglected by her doctor and didn't assert herself to get the care she needed.  Conditions progress, and things evolve.  What could have been treated easily Day 4 may no longer be able to be treated Day 14.  It essentially comes down to looking into conditions yourself and aggressively advocating your own behalf and not relying on someone else to do it for you.