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What is the remedy for recurring neuralgic pain in the arm and chest of a diabetic with seizures ?

my patient has pain in left arm and chest. It is neuralgic type as many ecg are within normal limits and she is a diabetic. I have started her on pregabalin 150 mg / day. and she is on carbamazepine for seizures 600 mg per day. Her pain continue to occur once a week. What can i do for her? Thanking you in anticipation for your reply, Dr. Ashish Subhash Kakaria. (MD Medicine, India)
Asked On : Mon, 9 Apr 2012
Answers:  2 Views:  39
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General & Family Physician 's  Response

I suggest to add anti anxiety drug as well and monitor the response after 15 days.

Pregabalin and Carbamazepine both act in similar way you can replace it with anti anxiety. If the nature of the pain changes then it is better to refer to a Psychiatrist as well for counselling purposes. If the nature is the same, a trial and error pain medication should be applied.

Answered: Mon, 9 Apr 2012
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General & Family Physician Dr. Finu Mathew's  Response
A Neurology referral would be in order i think as its important to rule out all Organic causes for such Limb pain. An imaging of the Cervical spine may be appropriate.

Tweaking of Drugs for Neuropathic pain should bring the pain under control. Amitryptylline might be a good choice i think.
Answered: Tue, 10 Apr 2012
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