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My Nemesis: Neuropathic Pain Attacks. I Am Taking Pregabalin ,
Question: 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?
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?
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?
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?
Brief Answer:
Need to mri brain and mri spinal cord.
Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
1. You have progressive disease like multiple sclerosis Parkinson's disease extra or not That depends upon the results of many investigations like MRI spinal cord MRI brain so I want to see your MRI brain report and MRI spinal cord report.
2. Yes if you have any of of above progressive disease then your pain will be worse in future.
3.
Yes you need a prescription for higher concentration of drugs.
4. Yes you should add try cyclic antidepressants they are very helpful in controlling the neuropathic pain and they do have Side Effects but their effects are more than side effects.
5. My recommendation is get MRI brain MRI spinal cord done.
I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas
Need to mri brain and mri spinal cord.
Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
1. You have progressive disease like multiple sclerosis Parkinson's disease extra or not That depends upon the results of many investigations like MRI spinal cord MRI brain so I want to see your MRI brain report and MRI spinal cord report.
2. Yes if you have any of of above progressive disease then your pain will be worse in future.
3.
Yes you need a prescription for higher concentration of drugs.
4. Yes you should add try cyclic antidepressants they are very helpful in controlling the neuropathic pain and they do have Side Effects but their effects are more than side effects.
5. My recommendation is get MRI brain MRI spinal cord done.
I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Need to mri brain and mri spinal cord.
Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
1. You have progressive disease like multiple sclerosis Parkinson's disease extra or not That depends upon the results of many investigations like MRI spinal cord MRI brain so I want to see your MRI brain report and MRI spinal cord report.
2. Yes if you have any of of above progressive disease then your pain will be worse in future.
3.
Yes you need a prescription for higher concentration of drugs.
4. Yes you should add try cyclic antidepressants they are very helpful in controlling the neuropathic pain and they do have Side Effects but their effects are more than side effects.
5. My recommendation is get MRI brain MRI spinal cord done.
I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas
Need to mri brain and mri spinal cord.
Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
1. You have progressive disease like multiple sclerosis Parkinson's disease extra or not That depends upon the results of many investigations like MRI spinal cord MRI brain so I want to see your MRI brain report and MRI spinal cord report.
2. Yes if you have any of of above progressive disease then your pain will be worse in future.
3.
Yes you need a prescription for higher concentration of drugs.
4. Yes you should add try cyclic antidepressants they are very helpful in controlling the neuropathic pain and they do have Side Effects but their effects are more than side effects.
5. My recommendation is get MRI brain MRI spinal cord done.
I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. Biswas: Your answer was not clear to me. Firstly, I did NOT say that I had MS, or ALS or Parkinson's Disease. I simply asked whether the kind of Neuropathic Pain that I am having is likely to be a progressive disease. Secondly, I have had an MRI of the brain and lower spinal cord. Those MRIs did not show any abnormality. I have also had an electromyography, and that test did not show any abnormalities in nerve conduction in my legs, where my Neuropathic Pains most often occur. Thirdly, I am now taking a total of 300mg/day of Pregabalin. Would it be beneficial for me to slowly increase that dosage up to 600mg/day? And, lastly, if I were to add a Tricyclic Antidepressant to my Pregabalin in an effort to gain some additional relief from the excruciating pain of my NP attacks, which antidepressant would be best for that purpose? Thank you for your clarifications.
Richard A. Freeman
Richard A. Freeman
Dr. Biswas: Your answer was not clear to me. Firstly, I did NOT say that I had MS, or ALS or Parkinson's Disease. I simply asked whether the kind of Neuropathic Pain that I am having is likely to be a progressive disease. Secondly, I have had an MRI of the brain and lower spinal cord. Those MRIs did not show any abnormality. I have also had an electromyography, and that test did not show any abnormalities in nerve conduction in my legs, where my Neuropathic Pains most often occur. Thirdly, I am now taking a total of 300mg/day of Pregabalin. Would it be beneficial for me to slowly increase that dosage up to 600mg/day? And, lastly, if I were to add a Tricyclic Antidepressant to my Pregabalin in an effort to gain some additional relief from the excruciating pain of my NP attacks, which antidepressant would be best for that purpose? Thank you for your clarifications.
Richard A. Freeman
Richard A. Freeman
Brief Answer:
Non progressive
Detailed Answer:
Hello
Welcome back,
If the MRI is normal, then your disease is non-progressive.
I hope your query is clear now.
The second thing, doen't make a dose of 600mg, keep it 300 total and add tablet amitriptyline 25 mg + chlordiazepoxide10mg twice daily... It will relieve your pain.
Thanks and regards
Dr Diwashish Biswas
Non progressive
Detailed Answer:
Hello
Welcome back,
If the MRI is normal, then your disease is non-progressive.
I hope your query is clear now.
The second thing, doen't make a dose of 600mg, keep it 300 total and add tablet amitriptyline 25 mg + chlordiazepoxide10mg twice daily... It will relieve your pain.
Thanks and regards
Dr Diwashish Biswas
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
Non progressive
Detailed Answer:
Hello
Welcome back,
If the MRI is normal, then your disease is non-progressive.
I hope your query is clear now.
The second thing, doen't make a dose of 600mg, keep it 300 total and add tablet amitriptyline 25 mg + chlordiazepoxide10mg twice daily... It will relieve your pain.
Thanks and regards
Dr Diwashish Biswas
Non progressive
Detailed Answer:
Hello
Welcome back,
If the MRI is normal, then your disease is non-progressive.
I hope your query is clear now.
The second thing, doen't make a dose of 600mg, keep it 300 total and add tablet amitriptyline 25 mg + chlordiazepoxide10mg twice daily... It will relieve your pain.
Thanks and regards
Dr Diwashish Biswas
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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