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Suggest treatment for postherpetic neuralgia symptoms

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Posted on Wed, 25 Nov 2015
Question: I am considering having a radio frequency abulation to get rid of my post herpatic pain that I have had from a case of shingles 21/2 years ago. Will I have increased pain for at least six weeks after the procedure is done. My pain is about intolerable now. Thank you
doctor
Answered by Dr. Matt Wachsman (1 hour later)
Brief Answer:
there are many drugs for this

Detailed Answer:
indeed this is the MOST susceptible type of pain to treatment with neuropathic pain drugs. These damp down the nervous system
1) lidocaine.
2) amitryptiline a pill with some lidocaine like effects and other effects
3) cymbalta, not as good as amitryptiline
4) ANY antiepileptic drug but lyrica and gabapentin are used
5) chemical neuroablation with cathepsin
6) other antiepileptic drugs like dilantin
7) other nerve acting drugs. ANY antiarrythmic (quinine amiodarone others)
verapamil (yes) maybe seroquel (doubtful but 1 week of it is no risk).
There isn't all that much risk of the radioablation except the loss of the nerve and change in pain.
There's more I could answer but need input where I go from here.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman (2 hours later)
forgot to tell youI was on Gabepentin and it was terrible--Loss of memory, falling down, tripping over objects that were not there --awful--took me three tries to get off of it. It is addicting. Have had none for 1 year. Tried Botox, infusions of Lysine and Vitamine B12--also supplements. Pain pills don't work. I even have a medical marijuana card. That did not go so well since I have NEVER smoked. I have a lot of anxiety every day and take Xanax at night. Other than Xanax and my blood pressure pill I take no meds. If I choose the cannibus, it would be something I could rub on the painful shingle area. I really don't want to take pills that scare me. Lyrica is poison and Gabepenti is one step below. Do you believe the Radio abulation will help and how much more pain will I be in afterward until the nerves calm down? Thank you
doctor
Answered by Dr. Matt Wachsman (1 hour later)
Brief Answer:
Many other possibilities

Detailed Answer:
B12 is the only one which is irrational if your level isn't low. It's not that uncommon to have someone be sensitive to medications. Surface ones do not pose the same issues; lidocaine patch is quite safe even in those with decreased drug metabolism (lower in older, non-smokers, smaller, and women).

"patients who have not responded to trial blocks or diagnostic injections would be unlikely to benefit from radiofrequency ablation. " might be testable if someone is able to respond to radiofrequency ablation.
http://www.medcentral.org/Main/RadiofrequencyAblation.aspx

The effects last about a year. They will tend to be on the shorter side for facial pain because the nerves are shorter and grow back sooner.

The pain afterwards is quite variable. typically it is not so much and for a very breif time but this is in a more sensitive spot than most of them and I cannot promise that there won't be even a marked worsening of the pain.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman (45 hours later)
So I should not be taking B12? My pain lessening or going away would be a God send--it has been almost 3 years non stop. Today I feel better and am thinking the intercostal helped? It varies every day. If nerves regenerate themselves, why have mine after such a long time not regenerated on their own w/o nerve blocks and medication? Am seriously considering the radio frequency abulation because I am out of options. It took about 10 pain Doctors before I know these procedures were available. I am on the internet all the time and found these procedures myself. So far this Dr. is the only one who has some answers.
doctor
Answered by Dr. Matt Wachsman (40 minutes later)
Brief Answer:
On the B12

Detailed Answer:
Do you just say, "gee, I want my car to run spiffier, let's put in more gas !" "gee, let's see if we can get it to really go, MORE GAS !!".
I'm just recommending looking at the gauge. It will be on FULL, to OVERFULL and GUSHING ONTO THE GROUND.

Check the B12 level.

The intercostal is likely to work and is very safe. If it worked once it is very likely to work nearly all the time (if it doesn't do great once, don't give up on it forever. Seriously, I've had a minority of patients in which it never worked, but many of those who have it work well have had some times when it hasn't done as well).

Mostly, post-herpetic pain goes away with the condition. But it's at least 1 in three where it continues. But then, that proportion is true of most any severed nerve. The nerves grow back funny when examining them under the microscope. That is true of both painful and non-painful ones. Certainly not growing back in quite the same pathway will predispose. We make up reasons why some are painful and some not. Certainly when they grow back funny the give the wrong signals.This accounts for feeling things in odd ways (things feel diffferent, often, they feel painful when they are not supposed to be painful). This accounts for the nerves being on a hair trigger like they are scraped or on newly grown in skin (hypersensitivity). Drugs that act preferentially on firing nerves do wonderfully in this condition.

You have tried the lidocaine patch, right? Lyrica? Cymbalta?Amitryptiline? these all are specific to hypersensitive nerves, and are more than even shot EACH to work in post-herpetic neuralgia.

XXXX
XXXX
many others.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matt Wachsman (6 hours later)
I have the lidocaine patch, but it always seems to get stuck to my clothes and falls off. Lyrica is worse than Gabepenten, Cymbalta--tried it for one day--not. These medicines give awful side effects--worse than the original pain. Do not want any medication that makes me feel worse. Amitryptiline,yes at night, but wake up with a horrendous headache and feel drugged the next day. I guess I am back to my original question. What about radio frequency abulation? Does it increase the pain until the nerves are not pissed off any more 5-6 weeks.? I know that if it works it only lasts a few months before you have to have another one, but a few months sounds pretty good to me considering I have been in pain every day for almost 3 years. I don't mean to be a pain with my questions (no pun intended)!!

Funny, but since I have had the intercostal 2 weeks ago today is my best day--pain about a 2--can stand it. Maybe it is a fluke, we will see tomorrow.
doctor
Answered by Dr. Matt Wachsman (35 minutes later)
Brief Answer:
I hope I am helpful

Detailed Answer:
I'm going to repeat myself a bit. First, it's not rare to have a genetic sensitivity to medications ... about 1 in 10. And, even if you do not, smaller people, older, and female have higher levels of drugs in their system for a given number of milligrams due to lower drug metabolism. Lower drug doses have to be given. Lyrica side effects overlap those of gabapentin, while mild they are quite common. It is a trade off on the pain and the side effects of medications and procedures. Intercostal is a pretty safe procedure. Radio ablation isn't a lot different in the expected side effects but since it is done in a different way and different spot, it cannot be predicted to be identical to an intercostal.

Therea re a lot of medicines; their doses can be lowered markedly.
and they will potentially have side effects that need to be balanced against their benefits.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Suggest treatment for postherpetic neuralgia symptoms

Brief Answer: there are many drugs for this Detailed Answer: indeed this is the MOST susceptible type of pain to treatment with neuropathic pain drugs. These damp down the nervous system 1) lidocaine. 2) amitryptiline a pill with some lidocaine like effects and other effects 3) cymbalta, not as good as amitryptiline 4) ANY antiepileptic drug but lyrica and gabapentin are used 5) chemical neuroablation with cathepsin 6) other antiepileptic drugs like dilantin 7) other nerve acting drugs. ANY antiarrythmic (quinine amiodarone others) verapamil (yes) maybe seroquel (doubtful but 1 week of it is no risk). There isn't all that much risk of the radioablation except the loss of the nerve and change in pain. There's more I could answer but need input where I go from here.