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Dr. Andrew Rynne

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Suggest treatment for idiopathic peripheral neuropathy

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3415 Questions

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Posted on Wed, 15 Mar 2017 in Brain and Spine
Question: I have been diagnosed with idiopathic peripheral neuropathy. I'm having a hard time adjusting and I'm on too much medication( in my opinion). I have it in both feet and my left hand. The pain is very intense and becoming harder to control. I need help. Any suggestions or input would be appreciated
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
More information on current treatment is needed.

Detailed Answer:
I read your question carefully and I understand your concern.

I am assuming that you have had proper testing done before the neuropathy being diagnosed as idiopathic. That is because if a cause is found naturally that should be addressed first.

When no cause is found then treatment unfortunately is limited in trying to alleviate the symptoms. Frustratingly that is not always easy, several medications may be tried at different dosages. Now coming to your case it is hard to judge on whether a medication switch or dosage change is possible to be recommended. You have not filled the medication tried field and do not mention neither what medication you're under nor the dosage. So while as I said at times may be difficult to achieve efficacy, can't say whether that is your case without all the information.

I remain at your disposal for other questions, possibly with the above info.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 3 hours later
i have tried lyrica and it did help with the pain. The dosage was 75mg 3x daily. The side effects were too much. i have also been on a couple of anti-depressants, most recently effexor 150mg 2x daily. Flector patches also, I'm not sure on the dosage.There have been many more but i will have to call the doctors office to be sure on the rest. Let me know if you would like me to do that. My current medications are Norco 10/325 6x daily, Ativan 1mg 4x daily, gabapentin 300mg 3x daily and 600mg at night, lunesta 3mg at night, levothroxine 50mcg once a day, effexor 150 mg 2x daily, and birth control. I have had two nerve conduction studies and an Emg. Also i have had MRI's on both of my feet and my upper and lower spine. i have been tested for celiac disease, lyme disease and diabetes. All were negative. The MRI on my feet and ankles did show i had inflammation in the sheath around the tendons in both feet and ankles. The Emg showed the nerves on the outside of my legs and the nerves across the top of both feet were affected. This all started for me in 2010 and I have seen a lot of doctors but no-one has been able to figure this out. Thank you. Let me know if you need more info
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Answered by Dr. Olsi Taka 7 hours later
Brief Answer:
Tough case, alternative methods.

Detailed Answer:
Thank you for the additional information.

Your case seems indeed to be a very difficult one. You seem to be right when you say to be taking enough medications as it is, perhaps too much. I would discuss with your doctor the necessity of Ativan at least, long term use creates tolerance (same dose is not enough) and the other medications you take should cover for its effect.
I don't want you to call the doctors office, given the list of drugs and tests I can safely assume that you have already tried a couple of first choice antidepressants for neuropathy such as Duloxetine , Amitriptyline and Nortriptyline. The dosages of the current medications are already high and there is not much place for increase really.

You seem to have already exhausted the medications used for neuropathic pain. In this situation perhaps some alternative treatments should be tried. Transcutaneous electrical stimulation (TENS) therapy is one such alternative. There are studies showing efficacy in treating neuropathic pain. It has helped in a couple of my patients. I don't want to say that it is a guarantee for success, doesn't work for everybody, but it is safe and it can be tried.
Accupuncture has also been successful for some patients although unfortunately there lack scientific studies for its efficacy.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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