My nemesis: Neuropathic Pain Attacks. I am taking Pregabalin, 150mg, 2x/day. I have recently added 75 more mg/day. But the breakthrough pains continue to occur randomly from time to time during the day. I have had intermittent Neuropathic Pain attacks for over a decade. Recent flare ups of my recurrent Neuropathic Pain have been more painful and have occurred more frequently than previous flare ups. It seems that this systemic nervous system disease is getting worse over time. Even more distressing, I have no control whatsoever to stop or to diminish the Neuropathic Pains episodes. When they occur, I am defenseless against the pain. I fear that they will get even more painful, and even more frequent, until I will be unable to cope with these Neuropathic Pain Attacks. The pains are not simply “pins and needles” or numbness. They feel like sharp, mini-electrocutions at needle-like points deep within my body. They occur sometimes on my calves, sometimes on my shins, sometimes on my thighs, my groin, my left lower back, my chest, and sometimes my scalp and my face, i.e. virtually any place on my body. The mini-electrocutions are like strong electric jolts. They occur at almost any time, without warning or apparent provocation, whether I am sitting or walking; lying down or standing; busy or sedentary. I once thought that sugar, or caffeine, triggered the attacks. Then, I thought that hypothyroidism (Hashimoto’s Disease) was the cause of the attacks. But, really, I cannot discern any apparent triggers for these very painful electric shocks. The one saving grace: So far, the electric jolts have only rarely occurred during my sleep. I have tried using Salonpas patches (purchased OTC without a prescription) that I place over the points of pain. They have worked to some extent in quelling the pains but, often, when I remove the patch, the intermittent, lancinating pains resume. The electric shocks are similar to someone jabbing an electrified, pointed dagger into the same spot on my body, again and again and again. The electric shocks used to occur repeatedly in one point on my body. Now, they tend to be dispersed around my body. In brief, I never feel really safe from having another series of highly painful, electric shocks occurring somewhere on my body. I am, therefore, sometimes afraid to go out to go shopping, to have lunch, to drive, to go golfing, to do anything away from home where I might have another painful, debilitating Neuropathic Pain attack. It is a very difficult way to live, to say the least. I have read the NIH article that was published XXXXXXX 1, 2019, titled “A Comprehensive Algorithm for Management of Neuropathic Pain.” It gave me some ideas, but not much solace for my prognosis, or for the effective treatment of my pains. For example, the article mentions the opioids, Tramadol and Tapentadol. But, among the side effects of opioids are a lowering of heart rate and of blood pressure. My resting heart rate, and my blood pressure, are already low: 54 beats per minute, and 110/60. About 3 ½ years ago I lost the central vision in my right eye due to a NAION (Non-Arteritic, Anterior Ischemic Optic Neuropathy) attack. It was probably due to nighttime hypotension resulting from two blood pressure lowering medications that I was taking at the same time. My blood pressure dropped to 90/50. If opioids cause a lowering of blood pressure, then I cannot take them. I don’t want to risk going blind in an effort to diminish my Neuropathic Pains. So, with this background, I have the following Questions: 1. Do I have a progressive disease, like Multiple Sclerosis, or Parkinson’s Disease, or ALS? Will my Neuropathy get worse with time? 2. What about Lidocaine patches? Do I need a prescription for higher concentrations? 3. In the alternative, should I add a TCA to my medication, such as Imipramine, or Nortriptyline? Would the side effects of TCAs for someone my age (77 years old) be worse than their beneficial effects? 4. Do you have any other recommendations to treat the increasing severity of my Neuropathic pains?