Brief Answer:
Reason for the pain?

Detailed Answer:
Good afternoon from XXXXXXX Ohio, USA. My name is Dr. Dariush Saghafi and I am a neurologist in private as well as academic practice.

So sorry that your wife is having to deal with this type of problem. I hope I can help shed a little bit of light on this all too common problem having to do with pain management.

First of all do we know what the origin of her pain is and where it is located? Does she suffer with for example, chronic low back pain, fibromyalgia, neuropathy or radiculopathy? Depending upon the entity which is actually responsible for the chronic pain a particular treatment could be dictated.

Has she had diagnostic studies performed such as CT, MRI, and laboratory studies? Do we know what her Vitamin D, thyroid, or cortisol levels might be?

Is her poor sleep known to be as a direct consequence of her chronic pain or is that something she's had IN ADDITION TO the pain element? Does she suffer from anything such restless leg syndrome, sleep apnea, insomnia, nightmares?

What sorts of medications or other interventions has she been tried on?

Therefore, I hope you can appreciate the amount of information we still need in order to make a better informed and medically sound decision as to what other medication/intervention is needed or better suited in to make her feel more comfortable and potentially eradicate this pain.

Do you have any digital pictures/images that you could upload to the system so we can see if there are any of neck or back issues? How about the brain? Is it possible that she could have, for example, a central neuropathic pain syndrome (meaning it is emanating from the brain?).

A little more information would be just lovely and I will wait to see what comes back through later on. What is her PMD's working diagnosis for this problem?

Cheers!

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Brief Answer:
Thank you for additional information

Detailed Answer:
Thank you for the additional information on your stay in the Bahamas for 2 years, however, I would still like to know what sorts of laboratory studies and diagnostic tests she's had to date that could help know what the CAUSE of her neuropathy might be. Have any of her doctors actually done bloodwork, MRI studies, EMG studies to try and determine the cause of her symptoms. So for example the following SHORT list of studies would be examples of what would be typically done to look for a cause of neuropathy:

1. Thyroid studies
2. Vit. B12, folate, Vit. D, D2, D3
3. ANA, ESR, CRP, RF, Lupus Anticoagulant
4. Liver studies
5. Kidney Studies
6. Serum glucose, HbA1C

In addition, depending upon other symptoms that she could be having such as neck or back pain it is possible to think about getting either CT scans or even MRI's of the neck and back. Some might even consider doing what is known as an EMG (electromyogram).

What is your wife's drinking and tobacco usage stats as well and is there is any history in her family of similar problems.

As far as medications for the pain and discomfort are concerned there could be many options. However, it is always preferable and BEST to know the primary cause (if that's even possible)....most cases of neuropathy never can be discovered as to cause so it's not guaranteed at all that doing any of the above tests would be fruitful but certainly, if we don't LOOk, we don't FIND.

In terms of medications I would think that probably the least helpful types of medications for her would be anyting of a controlled nature such as narcotics and other powerful painkillers or benzodiazepines (Valium Ativan, Xanax, etc.).

If she has not tried any of the TRICYCLICS (e.g. nortriptyline, amitriptyline, imipramine, or desipramiine) then, she could very well get substantial relief from those drugs. Otherwise, alternative agents such as SSRI's (Paxil, Prozac, Welbutrin, and Zoloft) and possibly antiepileptic types of drugs (Phenytoin, carbamazepine, oxcarbazepine, and lamotrigiine) could be helpful.

There is also one particular calcium channel blocker which is often useful in neuropathies for diabetics that don't respond to other agents (mexilitene), however, this drug should be reserved for a physician who can get proper testing on her first (ekg) and then, be able to follow her closely while on the drug.

I hope your wife feels better soon.

I would appreciate your written feedback to this question as well as your CLOSING THE QUERY if there are no further questions or comments.

This response required 20 minutes of physician specific time for review, research, and final draft documentation for envoy.

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