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Neuropathic pain - Treatment

haribo1

haribo1

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Nov 29, 2006
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I've had a great deal of pain in my right leg. I was tried on several opioids and they didn't help much. Then they tried some non-opioid Pijnstillen ( nefopam for one) still no good. Eventually I was given amitryptaline which, while not removing the pain, worked a lot better than anything before.
Does anyone have a pointer to a paper discussing what drugs are used in neuropathic pain and how the damned stuff works. Amitryptaline at 50mg per day works OK and increasing the dose doesn't work well.
Some days (when it's damp) mean that my mobility is severely limited so they are considering adding buprenorphine to the mix. I suspect a stronger treatment for neuroleptic pain might well be preferable (as well as not being habit-forming and so on). They tried pregabalin and it was useless. THC didn't help either (pity)

Cheers,
Sean :)

PS I've read that low-dose ketamine can work, but I'm somewhat dubious about that particular path.
 
i know neurontin aka gabapentin works fairly well for various nerve pains i have from various injuries and car accidents. i have thoracic outlet syndrome meaning the main nerves that run between my upper rib and collar bones are pinched to hell causing pain in my arms hands back and neck also i have some mild neuropathy in my legs and the neurontin seems to take care of it all without any side effects altho i have to triple the dose sometimes but thats still not the max allowed dose so if it doesnt work at first just keep upping the does via the doc until it does
 
I have had 4 back surgeries for herniation of the L5-S1 vertebra - ongoing nueropathic pain down right leg after the third surgery. I have tried neurontin(gabapentin), lyrica and cymbalta. I had the best luck with cymbalta 60 mg a day- plus I hit too birds with one stone - pain and depression - one less script I have to pay for. I talked with my shrink before starting and she said every patient she has seen with chronic/neuropathic pain has been helped by cymbalta. (the cymbalta was prescribed by neurosurgeon)
Just google cymbalta and nueropathic pain or chronic pain - lots of info.

Good luck
 
There are plenty of anti-epileptic (eg sodium valproate) & mood stabilizing drugs (eg carbemazepine) that work well for different sorts of pain of neuropathic origin, but which one works for an individual is a matter of trial & error. I've been through opiods (dipipanone/Diconal, methadone), gabapentin, carbemazepine, assorted tricyclics (amitryptiline, lofepramine and another that I can't remember) for phantom limb pain and the only success, which was somewhat limited, was with methadone (which I'd rather not have to use because of the risk of physical dependance).

I have had success with low dose ketamine, but again I'd rather avoid that as I find normal day to day functioning nigh on impossible while under the influence. The only one that's worked without either fucking me up or running the risk of dependance is cannabis, which had the drawback of not being available through medical means until recently in the UK. Someone my wife knows who lost an arm in a bike accidentr and suffered terrible phantom limb pain was eventually prescribed Savitex, which is a sublingual spray preparation, but he had to go to a specialist pain clinic to get it prescribed (he also got oral ketamine prescribed, but found the same problems as me).

I'm fairly sure the only reason methadone had any effect was due to it's NMDA antagonist activity, but in the long run I feel my only option is to get referred to a pain clinic by my GP in order to see about Savitex - at least it'd remove the issue of erratic availability I've discovered for cannabis (and as it's a sublingual spray does away with the need to smoke, which I don't really like but oral dosing with cannabis can end up the same asketamine - too fucked to be functional)
 
There are plenty of anti-epileptic (eg sodium valproate) & mood stabilizing drugs (eg carbemazepine) that work well for different sorts of pain of neuropathic origin, but which one works for an individual is a matter of trial & error. I've been through opiods (dipipanone/Diconal, methadone), gabapentin, carbemazepine, assorted tricyclics (amitryptiline, lofepramine and another that I can't remember) for phantom limb pain and the only success, which was somewhat limited, was with methadone (which I'd rather not have to use because of the risk of physical dependance).

I have had success with low dose ketamine, but again I'd rather avoid that as I find normal day to day functioning nigh on impossible while under the influence. The only one that's worked without either fucking me up or running the risk of dependance is cannabis, which had the drawback of not being available through medical means until recently in the UK. Someone my wife knows who lost an arm in a bike accidentr and suffered terrible phantom limb pain was eventually prescribed Savitex, which is a sublingual spray preparation, but he had to go to a specialist pain clinic to get it prescribed (he also got oral ketamine prescribed, but found the same problems as me).

I'm fairly sure the only reason methadone had any effect was due to it's NMDA antagonist activity, but in the long run I feel my only option is to get referred to a pain clinic by my GP in order to see about Savitex - at least it'd remove the issue of erratic availability I've discovered for cannabis (and as it's a sublingual spray does away with the need to smoke, which I don't really like but oral dosing with cannabis can end up the same asketamine - too fucked to be functional)
 
Diabetic neuropathy and its pain have responded to alpha lipoic acid.

http://www.mayoclinic.org/news2003-rst/1733.html

I've seen that studies are planned to study ALAs usefulness for AIDS related neuropathy and other neuropathies.I haven't seen reference to ALA for physical injury. Pain relief in the present the already mentioned epilepsy medicines are the best bet for most people. Some causes of the pain might be treatable.
 
Milnacipran/Ixel has also been used,one pamphlet called it a wonder drug...
 
I was recently diagnosed with Diabetic Peripheral Neuropathy and have gone thru a litany of drugs...

Cymbalta was a nightmare for me, causing suicidal thoughts

Lyrica was amazing, felt great but caused emotional distress

Now on Folic Acid + Topomax (also known as Dope-a-max), feeling very tired, supposed to take a while to build up to make its mark. Hope this info helps some.
 
Benfotiamine is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities

# ^ Stracke H, Lindemann A, Federlin K (1996). "A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy". Exp. Clin. Endocrinol. Diabetes 104 (4): 311–6. PMID 8886748.
# ^ Thornalley PJ (2005). "The potential role of thiamine (vitamin B(1)) in diabetic complications". Curr Diabetes Rev 1 (3): 287–98. doi:10.2174/157339905774574383. PMID 18220605.


Also I wonder how pukateine would fare as i have just done a fairly pure extract and noted researching the literature it is indicated for neuropathies.
 
^^ Yeah what happened?

If you have not tried Tramadol, I suggest you give it a go.
 
I am currently on Tramadol 2 x 50 mg/ 4 times per day and Percocet 10-325 1 every 6 hrs. Combined with that I am taking a folic acid, mitanx (sp?), theramine, topamax and lidoderm patches.

Neuropathic pain is worse than ruptured discs (only other serious injury I've had) and has completely taken over my life. =(
 
I have a friend who takes Miacalcin (calcitonin derived from salmon) for phantom limb pain, and says it is somewhat effective. He may, however, go on methadone as the Miacalcin likely does not provide complete relief.
 
what are the thoughts of those who have seen and read through research of this nature on delta-opioid agonism and success with such conditions...?
 
...if someone wants to see what the FT says:

Vitamin D as an Analgesic for Patients With Type 2 Diabetes and Neuropathic Pain

Paul Lee, MBBS (Hons); Roger Chen, MBBS (Hons), FRACP, PhD

Arch Intern Med. 2008;168(7):771-772.


Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.


Treatment of neuropathic pain is generally unsatisfying for patients with type 2 diabetes mellitus,1 and patients with debilitating residual symptoms may be given nonspecific diagnoses such as "chronic pain syndrome." Although hypovitaminosis D is highly prevalent in patients with type 2 diabetes,2 to our knowledge, its impact on neuropathic pain has not been previously evaluated. Our objective was to evaluate the impact of vitamin D repletion on neuropathic pain in patients with type 2 diabetes and vitamin D insufficiency.

Methods

A total of 51 patients with type 2 diabetes with typical neuropathic pain, including burning, tingling, numbness, and throbbing sensations, and physical examination findings of reduced sensation to monofilament, were included. Severity of pain was evaluated by the short form of the McGill pain questionnaire (MPQ) and a 5-cm visual analog self-report scale (VAS) (0, no pain; 1, mild; 2, discomforting; .
 
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