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Suggest Treatment For Refractory Neuropathic Pain While Treating Stage IV Non-Hodgkin Lymphoma

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Posted on Mon, 27 Apr 2015
Question: I AM A 64 YR. OLD WHITE MALE. MY FIRST CANCER WAS IN 1994-NON-HODGKIN'S LYMPHOMA-STAGE 4-GIVEN A YEAR TO LIVE. THE FOLLOWING YEAR I HAD A PIONEER STEM CELL TRANSPLANT-SO EASY-IT WORKED. HOWEVER, VINCRISTINE IN THE CHOP TREATMENT PERMANENTLY DAMAGED THE NERVES IN MY FEET-NO ANTIDOTE-JUST PAIN RELIE-HARD TO BELIEVE THAT THERE IS NOTHING NEW. OUR LOCAL PAIN CLINIC TREATED ME FOR 18 YRS WITH TOLERABLE RESULTS-NARCOTIC, LYRICA, NEURONTIN, ANTI SEIZURE & ANTI-DEPRESSANTS. TWO YRS AGO THEY SAID NOT TO COME ANYMORE-YOU HAVE TRIED EVERYTHING-THERE IS NOTHING NEW-CHECK EVERY 4 MONTHS ON UPDATES-NONE. SINCE THEN I HAVE HAD 6 OTHER CANCERS-A MIRACLE-ALL IN REMISSION. IN THE LAST YEAR, I HAVE HAD MANY TESTS, DOCTORS, HOSPITAL STAYS WITH LITTLE PROGRESS. I AM NOW IN A NURSING HOME-VERY POOR BALANCE-SERIOUS FALLS-LAT 3 WEEKS HAVE BEEN LIVING HELL-NO RELLIEF FROM ANY PAINKILLERS-WHY? THEORY-I HAVE DIFFICULTY ABSORBING PAINKILLERS-TWICE I TOOK 13 TYLENOL 3 PRESCRBED DRUGS-NOTHING. I WILL INSIST ON FENTANYL PATCH FOR A TRY. I HAVE SPENT $300,000 ON ALTERNATIVES-TENS,ACUPUNCTURE(5), ULTRA SOUND, SUPPLEMENTS, HERBS, 25 CREAMS-EMLA BEST AND DIABETIC NEUROPATHY CREAMH.WITH LITTLE SUCCESS I HAVE SEEN 5 NEUROLOGISTS. ONE PRESCRIBED CYMBALATA INSTEAD OF EFFEXOR TO RELIEVE PAIN-NO WAY-TRIED 3 TIMES. I AM SCHEDULED TO SEE A NEUROLOGIST AND THE PAIN CLINIC NEXT WEEK. CT SCAN OF BRAIN TUMOUR-MENGENOMA ANY IDEAS. THANKS.
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Answered by Dr. Ajay Panwar (40 minutes later)
Brief Answer:
Refractory neuropathic management needs holistic approach.

Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your medical history and really feel concerned about you and pray to God for your good health.

So,your clinical diagnosis of neuropathic pain appears to be settled.I would like to categorise it as'Refractory neuropathic pain'.

The fact is that Refractory neuropathic pain is one of the toughest therapeutic challenge for the neurologists and pain specialists universally.

Regarding medicines I am not sure whether you have tried tricyclic antidepressants like amitriptyline which is an excellent drug for neuropathic pain.

You have almost tried all other options including lyrica,cymbalta and topical creams.However,lidocaine patch and capsaicin patch have not been tried probably and are good options.Fentanyl patch is also a viable option.

Drug management of neuropathic pain is actually nothing but a hit and try.So,keep hitting till you get the best drug for you.This is the way of management universally.

If nothing works,novel methods like percutaneous electric nerve stimulation may be tried at last.Refer your pain clinic regarding this option.

At last,acupuncture,massage therapy,relaxation therapy and medicines-these all modalities of management have to work holistically in order to treat neuropathic pain.

Hope I have answered your query.If you have some further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.

Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Ajay Panwar

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Practicing since :2007

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Suggest Treatment For Refractory Neuropathic Pain While Treating Stage IV Non-Hodgkin Lymphoma

Brief Answer: Refractory neuropathic management needs holistic approach. Detailed Answer: Hi XXXXXXX Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query. I have gone through your medical history and really feel concerned about you and pray to God for your good health. So,your clinical diagnosis of neuropathic pain appears to be settled.I would like to categorise it as'Refractory neuropathic pain'. The fact is that Refractory neuropathic pain is one of the toughest therapeutic challenge for the neurologists and pain specialists universally. Regarding medicines I am not sure whether you have tried tricyclic antidepressants like amitriptyline which is an excellent drug for neuropathic pain. You have almost tried all other options including lyrica,cymbalta and topical creams.However,lidocaine patch and capsaicin patch have not been tried probably and are good options.Fentanyl patch is also a viable option. Drug management of neuropathic pain is actually nothing but a hit and try.So,keep hitting till you get the best drug for you.This is the way of management universally. If nothing works,novel methods like percutaneous electric nerve stimulation may be tried at last.Refer your pain clinic regarding this option. At last,acupuncture,massage therapy,relaxation therapy and medicines-these all modalities of management have to work holistically in order to treat neuropathic pain. Hope I have answered your query.If you have some further questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me. Dr.Ajay Panwar, MD,DM(Neurology)