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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Chronic Neuropathic Pain

Hi I have chronic pain/sciatica following a low back injury...disc was grade 3 tear and bulge, I had an L5/S1 spinal fusion which helped somewhat but my problem now is the chronic neuropathic pain that becomes worse with exercise or activity...can t take anti epileptics, analgesics don t help and antiinflammatories do a bit....cortisone injection under CT guidance had no effect at all....I live with awful pain which causes irritability and depression...any further suggestions
Mon, 13 Oct 2014
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Orthopaedic Surgeon, Joint Replacement,  's  Response
I have studded your case and I have full sympathy with you. There can be two causes of such pain. First is that you might be having some nerve compression which was either missed during previous surgery or recurrent. Other thing is that it can be due to vitaminB 12 deficiency. I would suggest you to get following investigations.
1. MRI of the spine
2. serum B 12 estimation
after going through these tests we will get the idea if there is compressive neuropathy or non compressive neuropathy. Accodding to that we can plan further management. If there is nerve compression present than you might need a revision surgery. If there is no mechanical compression then you should start taking vitamin B 12 as a neuro supplement, some time it can have a psychaiatric component as well. For this I would suggest you to take Tablet Amytryptalin 10 mg.
I hope this answer will be useful. Let me know if there is any other followup questions.
Thanks
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Suggest Treatment For Chronic Neuropathic Pain

I have studded your case and I have full sympathy with you. There can be two causes of such pain. First is that you might be having some nerve compression which was either missed during previous surgery or recurrent. Other thing is that it can be due to vitaminB 12 deficiency. I would suggest you to get following investigations. 1. MRI of the spine 2. serum B 12 estimation after going through these tests we will get the idea if there is compressive neuropathy or non compressive neuropathy. Accodding to that we can plan further management. If there is nerve compression present than you might need a revision surgery. If there is no mechanical compression then you should start taking vitamin B 12 as a neuro supplement, some time it can have a psychaiatric component as well. For this I would suggest you to take Tablet Amytryptalin 10 mg. I hope this answer will be useful. Let me know if there is any other followup questions. Thanks