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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can vitamin B12 supplements be taken for post-herpetic neuralgia?

Answered by
Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 3566 Questions

Posted on Mon, 6 Jun 2016 in Pain Management
Question: I have post herpetic neuralgia under my arm. It's mild, thankfully, but I certainly wouldn't want it to be any worse. Because of the pain, I have not exercised much for the past several months. I don't care about having a beach body, just being healthy and strong, and I am starting to think the lack of conditioning contributes to the discomfort. Yesterday I tried the gym again. I didn't push it very hard, and it actually felt good to move and stretch, but hours later the pain flared up worse than it's been in weeks. Do you think things will improve if I just push through it and exercise anyway, or am I just making things worse and maybe even causing further damage? It's so disheartening to think that this may never go away, and I can't spend the rest of my life huddled in a chair with an ice pack trying not to aggravate the pain.

I've also been considering B12 tablets. Would they be of any use? Is there anything I can do to heal the nerves?

Thanks for your help.
Answered by Dr. Matt Wachsman 29 minutes later
Brief Answer:
Can get an assessment of the situation

Detailed Answer:
B12 levels are measurable with a simple test. Giving b12 in the context of normal levels for *energy* makes as much sense as filling up the gas tank when it is full because you want the car to run peppier.

Herpetic neuralgia is treatable with rather great results with many simple *nerve pills*. These include anti epileptics (gabapentin), lidocaine patches, and blockers of spinal pain transmission (cymbalta and amitryptiline). espeically amitryptiline which has some effects of all of these categories. Each is better than 50/50 at providing excellent benefit.

And, good news, at age 40s, muscle function can come back. There is less data on women, who gain less muscle mass then men, and the levels of muscle growth hormones peak in the 30s to 40s BUT the breakdown hormones also rise during this time. So exercise has to be continuing to keep the benefits. Aspirin like drugs inhibit muscle breakdown so a continual amount of them in the system is good in this context BUT might not be tolerated due to effects on the stomach. They are not likley to prevent neuralgia pain, but they have a small success rate. The nerve pills have a high success rate.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Matt Wachsman 37 minutes later
Thank you. A few clarifications:

1. Would the "nerve pills" you mentioned truly heal the nerves, or would they just provide pain relief? At this time the pain is preferable to the side effects from heavy medications.

2. Are there any treatments that would heal the damaged nerves?

3. Exercise makes my nerve pain worse. Should I continue to exercise anyway? I can stand the increased pain if it's just a stage in the healing process, but I certainly don't want to cause further damage.

Thanks again.
Answered by Dr. Matt Wachsman 1 hour later
Brief Answer:
good questions

Detailed Answer:
1) they JUST dull the pain (ok, remove or block might be a better term) BUT the key point you are bringing up is that the nerve stays broken and you are kind of stuck on the (non toxic) medications for a long time. The lidocaine patch doesnt even get into your system past the skin level so except for reaction to adhesive it is pretty impossible to have side effects.

2) Not very good treatments. There are many scam treatments. Basically everything in a nerve is tried (vitamin, mineral, fats) but since the problem is the nerve healed wrong, these are misguided treatments that have not been proven/FDA approved to do anything.

3) Yes. This is called HYPERALGESIA and WIND UP. The nerve gets stimulated and twinges, this produces MORE nerve activity, etc. BUT fundamentally there is a question of being able to work. Furthermore there is a whole separate side of this. Of being able to turn off the upset about the pain at the brain level and increasing activity of the area and triggering the pain ON YOUR CONTROL overcomes the limitations.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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