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Suggest Treatment For Peripheral Neuropathy
Question: Hello,
I'm having what I believe is peripheral neuropathy in my left hip, thigh and knee. There's tingling, skin is sensitive to the touch, and a lot of pain in the knee, leg and thigh when I walk. Sometimes the tingling will go down to the ankle. Should I have a NCV done now? My primary care doc says I should wait 6 months but I'm afraid too much damage will be done if I wait too long plus the pain is killing me. It already been 2 1/2 months.
I'm having what I believe is peripheral neuropathy in my left hip, thigh and knee. There's tingling, skin is sensitive to the touch, and a lot of pain in the knee, leg and thigh when I walk. Sometimes the tingling will go down to the ankle. Should I have a NCV done now? My primary care doc says I should wait 6 months but I'm afraid too much damage will be done if I wait too long plus the pain is killing me. It already been 2 1/2 months.
Brief Answer:
Some probing should be done.
Detailed Answer:
I read your question carefully and I understand your concern.
If the symptoms have been going on for over two months I do believe some more attention is needed. Nerve conduction studies are one of the main tests and if peripheral neuropathy is what the physician thinks to be in your case I believe they should be done, I do not see why start treatment for neuropathic pain should be started and not have the test. If he’s uncertain maybe can refer you to a neurologist beforehand in order to check for additional signs and territory involved, in order to confirm the necessity for NCV and if necessary other tests.
As for the cause if the HSV-2 infection involved a nerve covering that area it could well be the cause for the pain, otherwise unlikely. As for the antivirals they are not known to commonly cause nerve damage. Cause may be a nerve compression, but it is necessary to identify the nerve involved first and then perhaps imaging may be needed.
I remain at your disposal for other questions.
Some probing should be done.
Detailed Answer:
I read your question carefully and I understand your concern.
If the symptoms have been going on for over two months I do believe some more attention is needed. Nerve conduction studies are one of the main tests and if peripheral neuropathy is what the physician thinks to be in your case I believe they should be done, I do not see why start treatment for neuropathic pain should be started and not have the test. If he’s uncertain maybe can refer you to a neurologist beforehand in order to check for additional signs and territory involved, in order to confirm the necessity for NCV and if necessary other tests.
As for the cause if the HSV-2 infection involved a nerve covering that area it could well be the cause for the pain, otherwise unlikely. As for the antivirals they are not known to commonly cause nerve damage. Cause may be a nerve compression, but it is necessary to identify the nerve involved first and then perhaps imaging may be needed.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Taka for your thoughtful response. My doctor is willing to do an MRI but it may be awhile before they can get me in. Even so I have a lot of pain when I walk and need some relief now. I have a business trip coming up where I will be doing a lot of walking. What would you recommend for pain? I've tried tramadol, naproxen and ibuprofen but none seem to help. I just need something that will greatly reduce the pain for at least the short term.
Brief Answer:
Gabapentin or Pregabalin
Detailed Answer:
Hello again!
Since the common analgesics do not seem to help you should try medication for neuropathic pain. Most commonly used first line medication are anticonvulsants Gabapentin or Pregabalin. Another alternative commonly used for chronic neuropathic pain are some antidepressants such as Duloxetine or Amitriptyline.
I hope to have been of help.
Gabapentin or Pregabalin
Detailed Answer:
Hello again!
Since the common analgesics do not seem to help you should try medication for neuropathic pain. Most commonly used first line medication are anticonvulsants Gabapentin or Pregabalin. Another alternative commonly used for chronic neuropathic pain are some antidepressants such as Duloxetine or Amitriptyline.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Taka,
Oh, I forgot to mentioned in my last email but it is in my profile that I tried Gabapentin and I'm currently taking Amitriptyline at night before bed. Does it take these medications a long time to see results? Also, is there anything like getting a cortisone shot or pain patches that can help me for this upcoming trip?
Thanks so much.
XXXXXXX
Oh, I forgot to mentioned in my last email but it is in my profile that I tried Gabapentin and I'm currently taking Amitriptyline at night before bed. Does it take these medications a long time to see results? Also, is there anything like getting a cortisone shot or pain patches that can help me for this upcoming trip?
Thanks so much.
XXXXXXX
Brief Answer:
A specific site is needed for injections.
Detailed Answer:
You are correct, you had included them in the medications tried field, but because you mentioned the other medications in the question I didn't check that field, I am sorry.
It can take some time for these medications to see the results, a couple of weeks or more, especially with antidepressants.
Regarding cortisone shots, those are an option, but only when the level involved has been precised. In your case without any imaging that would be difficult as one wouldn't know where to inject.
Patches can be tried, but generally their efficacy is limited, are inferior to oral medications, when oral analgesics haven't worked it is unlikely they will
A specific site is needed for injections.
Detailed Answer:
You are correct, you had included them in the medications tried field, but because you mentioned the other medications in the question I didn't check that field, I am sorry.
It can take some time for these medications to see the results, a couple of weeks or more, especially with antidepressants.
Regarding cortisone shots, those are an option, but only when the level involved has been precised. In your case without any imaging that would be difficult as one wouldn't know where to inject.
Patches can be tried, but generally their efficacy is limited, are inferior to oral medications, when oral analgesics haven't worked it is unlikely they will
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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