Neurology institute for pain

[Tip and IBS]

Interesting article from a neurological center(click on the link please):

Pain: Hope Through Research:

http://www.ninds.nih.gov/disorders/chronic...hronic_pain.htm

QUOTE
Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system (see The Nervous Systems in the Appendix). Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment. Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome (see below), which can follow injury; phantom limb and post-amputation pain (see Phantom Pain in the Appendix), which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.



QUOTE
Burn pain can be profound and poses an extreme challenge to the medical community. First-degree burns are the least severe; with third-degree burns, the skin is lost. Depending on the injury, pain accompanying burns can be excruciating, and even after the wound has healed patients may have chronic pain at the burn site.


Complex Regional Pain Syndrome:

http://www.ninds.nih.gov/disorders/reflex_...c_dystrophy.htm

Chronic pain:

http://www.ninds.nih.gov/disorders/chronic...hronic_pain.htm

[Silverfox]

Thanks for the interesting post. Neuropathic pain is what I have been diagnosed with.
Neuropathic pain is very difficult to treat because all the conventional pains meds doesn't help much. The neuropathic damage lies within the nerve itself. I am now using a lower dose of neurontin for my neuropathic pain with some success. It helps me get some sleep. I am not taking a large dose as I tend to have uncomfortable side affects like sleepiness.

I have also been told that my nerve damage is throughout my entire body and this means it is systemic. Severe neuropathic damage has been to my sensory, motor and autonomic nerves. Autonomic nerve damage can cause some to have a heart attack and they cannot feel it because the nerves are damaged.

Sensory nerve pains are very painful and they are throughout the body. Sometimes they can see this nerve damage in a biopsy that will show fewer small sensory nerve fibers. Its thought that this is caused by slowly blocking the nerves from getting oxygen and nutrients that keep them healthy. Nerves are very needy cells, delicate cells and so the nerves can be starved.

It is very important for anyone who suffers with neuropathic pain to get a diagnosis for the exact cause of their underlying disease as sometimes the process can be stopped from getting worse.

Here is another helpful site might help some who wish to know more about neuropathic pains. It is at a web site called neurocentre.com This is in the Uk but open to all, and is excellent. Another is neuropathy.org
I believe there are 20 million in the US who suffer with neuropathic pain and there are more than 100 causes.

Silverfox

Hypothyroidism 3 1/2 grains Armour thyroid
sensorimotor neuropathy and autonomic nerve damage

Quote my pain Dr. at IC conference; "identifying the source of the pain is not the same as defining the disease"

[JanL]

Thank you both for this information. I, too, suffer from what I believe is nerve pain. I am taking neurontin and elavil and dealing with it. The biggest blessing that came from your posts was to make me realize that the diagnosis that we have been looking for with my Dad may be post-herpetic neuralgia. He has been in intense pain with burning and stinging for about 3 months now. When I saw the description it hit me that this is defintely a very likely cause for all of his pain--he has had severe shingles twice. I immediately called my brother who started investigating and said that it is the most likely diagnosis so far. He said that when he went through med school it was not really mentioned and that this is kind of new thing. They are just now realizing how much nerve damage can be done. Anyway... I just wanted to say thanks for posting and you may have put on us on the right track to getting him correctly treated.

Janice

[Tip and IBS]

Your SO welcome JanL

It is so important to help other people.

Where are you from?
Anyway,i just wanna to tell you that i got severly sunburn on my back in Florida a decade ago(i felt asleep on the beach).The hitching was SO bad when i decided to take a shower that i decided to go at the E.R. over there.The doctor told me to buy SOLARCAINE SPRAY.
That was like a miracle.The hitching stopped immediatly.OMG i know how debiliting burn pain can be.

I hope your dad is OK and think about SOLARCAINE SPRAY.It's OTC stuff.
It may ease the hitching...seriously

[JanL]

Thanks for the input. I know he has tried Benedryll, etc. I may see if he will try solarcaine. I have used it before. I really think that his is nerve damage. It is just so sad to see how much he has changed in just a few months. He has even had doctors try to tell him that it is all in his head--sound familar. He says that it is like a burning and stinging from inside. From one article that I read, they suggested a tens unit. I have one of those and an alpha stim unit (very similar) so I am going to get him to try that. The scary part is that we tend to be alot alike genetically.
I am from Collierville, Tennessee (suburb of Memphis). Let me know if you ever come this way. Hope you have a great day!

Janice

[Tip and IBS]

Maybe i have the same thing as your dad.I may have found the name for it:

Check this out:

http://www.rsds.org/2/what_is_rsd_crps/index.html

What is RSD?

Reflex Sympathetic Dystrophy Syndrome (RSD) - also known as Complex Regional Pain Syndrome (CRPS) - is a chronic neurological syndrome characterized by:

severe burning pain
pathological changes in bone and skin
excessive sweating
tissue swelling
extreme sensitivity to touch

http://www.rsds.org/3/treatment/stacy_campbell_pregabalin_gabapentin.htm

Recently, pregabalin (Lyrica®) was approved by the Food and Drug Administration (FDA) for the treatment of post herpetic neuralgia (PHN) and...

[Tip and IBS]

Wait,you said your dad have post herpes pain.
I don't think Solarcaine would help because it is different from a sunburn.
I have tried it myself for my pubic burning and it dosen't works.

I have found this information however!
Post-herpetic pain website:

http://www.healingchronicpain.org/content/neuralgia/default.asp

http://www.healingchronicpain.org/content/neuralgia/conv_pharm.asp

Pharmacological Management

The selection of a drug or drugs for PHN is largely a trial-and-error process, which is influenced by the availability of some studies of specific drugs and by the medical assessment of the patient. The most commonly used treatments are as follows:

Anesthetic skin patches: Some patients with PHN benefit from using local anesthetics because they reduce the pain messages that the damaged nerves send to the brain. Topical lidocaine patches were approved by the United States Food and Drug Administration in 1999 for PHN. The patches are applied to the painful area for at least 12 hours per day. Studies show that a majority of patients treated with the patch reported moderate or greater pain relief (Kanazi, 2000, Rowbotham, 1995 and 1996). Topical lidocaine in either gel or patch form can relieve allodynia in patients with PHN. In another recent study, the topical lidocaine patch provided significantly more pain relief for PHN than a placebo patch, did not cause systemic side effects, and was simple to use (Galer, 1999).


Topical capsaicin cream: Capsaicin, a chemical found in chili peppers, is a main ingredient in certain pain relieving creams currently available for the treatment of a number of pain conditions Regular and cumulative topical applications of capsaicin cream have been shown to produce pain relieving effects in some painful medical conditions, including PHN (Long, 2001). In one double-blind clinical trial, cream containing 0.075% capsaicin applied three to four times a day greatly reduced pain (in week 2: 62% for capsaicin cream and 31% for placebo; in week 4: 77% for capsaicin and 31% for placebo) (Bernstein, 1989). In another study 0.075% capsaicin reduced pain by 28% at week 2 and 39% at week 6; of 83 patients followed for another 140 days, 86% of patients reported same or better pain relief with continued use (Watson, 1993).

Several studies have looked at a lower concentration of capsaicin (0.025%) and found it also to be effective, although two or more weeks of treatment may be required to get the full benefit of the cream (Bernstein, 1987). A recent placebo-controlled study reported that there was an average decrease of approximately 15% of the magnitude of pain with topical 0.025% capsaicin cream (McCleane, 2000), PHN.

Some people find it difficult to use capsaicin cream because of intense burning after initial applications. (Kanazi, 2000). However, this burning may lessen after repeated use of the cream.


Anticonvulsants: When nerve cells are damaged, they can become chronically overstimulated and continue to send pain messages to the brain even when there is no injury present.

Anticonvulsant medications block the sodium channels along nerve membranes that cause nerve cells to activate, helping to quiet down these overactive nerves.

The anticonvulsant medication gabapentin (Neurontin) also has been approved by the U.S. FDA for PHN and is considered to be a first-line treatment. Numerous scientific studies, case reports and one large multicenter study have confirmed its effectiveness in reducing pain as well as improving sleep, mood and quality of life. In addition gabapentin is generally well-tolerated, with a safety profile comparable to antidepressant treatment. Most frequent adverse effects include sleepiness, dizziness, unsteadiness, peripheral edema and infection. (Kanazi, 2000) (Rice, 2001) (Nicholson, 2000) (Rowbotham, 1998).


Antidepressants: Antidepressant drugs are nonspecific analgesics and the analgesic effects can occur independent of antidepressant actions (Robertson, 1990). The evidence is best for the so-called tricyclic antidepressants (Rowbotham, 2001) (Koltzenburg, 2001). Approximately half of patients with PHN benefit from therapy with a tricyclictricyclic antidepressant (Watson, 2000), such as amitriptyline (Elavil). In several small studies, amitriptyline provided significantly better pain relief than either placebo or other antidepressant medications (Watson, 1982, 1992) (Max, 1998). Nortriptyline (Aventil, Pamelor) has also has been found to have a significant analgesic effect and to have fewer adverse side effects (Kanazi, 2000) (Watson, 1998). Side effects of tricyclic antidepressants can include dry mouth, constipation, dizziness, nausea, diarrhea, insomnia, headache, blurred vision and drowsiness, among others. They should not be used by patients taking MAOI antidepressants, and should be used cautiously in the elderly, people with epilepsy, thyroid disease, liver disease, closed-angle glaucoma, and pregnant or breast-feeding women, among other conditions.

There is also evidence that the newer antidepressants, such as venlafaxine (Effexor), bupropion (Wellbutrin), and paroxetine (Paxil) have analgesic properties. The overall effectiveness of these drugs is probably less than the tricyclic antidepressants, but the likelihood of troubling side effects is substantially less. Patients who are predisposed to tricyclic side effects, or who have not been able to tolerate these drugs, may be good candidates for trials of the newer antidepressants.


Opioid analgesics: Although opioid drugs are the most effective analgesics overall, some patients with neuropathic pain such as PHN do not respond well and many patients, particularly the elderly, struggle with side effects such as constipation and sleepiness. Many patients and physicians also fear these drugs because they are associated with the disease of addiction. Nonetheless, there is good evidence that PHN can be helped by opioids (Kanazi, 2000, Watson, 1998). The risks, including the risk of addiction are often overstated, particularly if the decision to try an opioid is made after a careful assessment that evaluates the severity and impact of the pain, the risk of side effects, the availability of other approaches, and the likelihood that the patient will be a responsible drug-taker.


Corticosteroids: Corticosteroid drugs such as prednisone and dexamethasone, may help with the pain and duration of shingles. They do not appear to reduce the likelihood of a patient developing PHN and are not used to treat the established pain syndrome. There have been recent positive studies that evaluated the spinal injection of a steroid for PHN (Kotani, 2000) (Kikuchi, 1999). These studies are provocative, but the technique has not been widely accepted because of concern about side effects and toxicity.


NSAIDS (non-steroidal anti-inflammatory drugs): NSAIDS have not been shown to be an effective treatment for PHN pain.


Other Drugs: Many other drugs are used to treat neuropathic pain and may be tried in cases of PHN. These include the oral local anesthetics (such as mexiletine), baclofen, and the so-called NMDA receptor antagonists (such as ketamine, dextromethorphan, amantadine, and memantine). A large body of experimental evidence in animal models of neuropathic pain suggests an important role of the activation of NMDA receptors. Studies using intravenous infusion of the NMDA receptor antagonist ketamine have shown a reduction in the magnitude of pain in humans with neuropathic pain, but a high incidence of side effects. (Eide, 1994) (Leung, 2001). Two small clinical trials tested the use of dextromethorphan (most commonly used as a cough suppressant medication) for painful diabetic peripheral neuropathy and PHN (Nelson, 1997). The results of these studies suggest that dextromethorphan may be effective for the treatment of painful diabetic peripheral neuropathy but there was no evidence of efficacy in PHN.

[JanL]

yes, it is pain that fits the description of post-herpetic neuralgia from Shingles. I had my doubts about the solarcain, but was willing to try it. He has been to several doctors, but is not getting a lot of relief. I can so empathize with him--not sleeping because of the pain, feeling depressed because the doctors can't figure out the cause, wondering if you are crazy, etc. He is also very allergic to a lot of things--latex, food allergies, pollen & mold, etc. Medications do really weird things to him so we have to be really careful with what he takes. Actually, the doctors and he originally thought that it may have been the blood pressure/ cholesterol med he was on that started this, but now they are shaking their heads in bewilderment. The good news is that they are trying the neurontin on him and he has just started the elavil yesterday. I keep telling him that elavil takes a couple of weeks to really get in your system, but you know how you want instant relief when you are in pain. My brother really thinks we may have hit on the correct dx with the post-herpetic neuralgia, but we are hoping that one of his doctors this week will dx this as we don't really want to be the ones to tell him that there really isn't a cure for what he may have (we all know how much fun that is to process Janice

[Tip and IBS]

Why are u using 2 drugs if he is sensitive to drugs?

Apparently anti-seizure(neurotin?) may help.

I'm also reactive to meds.I may just try a special ointment to target burning pain as i got it just under the skin.

[ICNDonna]

JanL: My sister-in-law had shingles back in November of last year. The rash is totally gone now, but she still has the pain. It is very gradually improving, however, and it's beginning to look like she is going to be okay. My husband and I both asked our doctor for shingles vaccine so we both should be safe now. Since it's possible for shingles to recur, you might think about suggesting to your father that he discuss immunization with his doctor. It's expensive, but well worth it to us.

Donna

[Tip and IBS]

I have been thinking to buy MSM gel.I think i have read that it could reduce pain/burn under the skin.A member called Roxie is using it.She talk about it on this post:

http://www.ic-network.com/forum/showthread.php?p=336472#post336472

Other than that i even think to call the burn unit here to see if they can help this sort of burning discomfort.I mean they must have a lot of people with pain like that.

[JanL]

Tip, he is on the neurontin for nerve pain and the elavil (which he just started) is also supposed to help with the pain. One doctor took him off of his lipitor and blood pressure med and put him on zanax (I guess he thought it was just stress related). Anyhow, he is trying to wean down off of the zanax, but it is apparently very hard to come off of.
He has had the shingles very severely twice. Donna, I know the pain can last for quite a while, but it had been gone for a long time when this really started. My brother is speculating that there has actually been another reoccurance, but it has just not erupted. I don't know if you could cover his whole body with MSM gel. It seems to be more of an internal nerve problem that comes and goes. He knows about the vaccine, but with his allergies I'm not sure if his doctor would give it to him. Can you take the vaccine after having shingles or if you have ever had chicken pox? I need to look into this further. I have had chicken pox and one of my brothers has had shingles. Geez--isn't family genetics fun! Thanks for all of your input. Janice

[Tip and IBS]

JanL,i didn't knew he had problems with his whole body.

Maybe Solarcaine could help then,or other sprays as it cover bigg areas.