Suggest Treatment For Small Fiber Neuropathy

Posted on Tue, 5 May 2015

Question: Hello:
I had endoscopic carpal tunnel surgery 5 weeks ago today. For the past 4 weeks I have been experiencing extreme numbness in my middle finger as well as burning, tingling, and numbness on the fingertips of my middle finger and thumb. Prior to the surgery I never experienced such discomfort at my fingertips. The sensation is relentless and has become very wearing at this point. I have been told that the nerve is "healing" and that is what is causing this "neuropathy" Is this a usual aftermath of the surgery? Thanks!
I am female - made a mistake above. Sorry.

Answered by Dr. Saumya Mittal (20 minutes later)

Brief Answer:
small fiber neuropathy

Detailed Answer:
Hi
I am Dr Mittal.
I have read your query.
I think I would be able to help you.
The symptoms of the query are quite suggestive of a small fiber neuropathy.
What happens is that some small nerves are damaged during a surgery.
This causes the sensory disturbance that you stated. A prescription for pregabalin or carbamazepine may help.

I have tried to make it as simple as possible. I hope that the information helps you. Please feel free to contact us for more information. Best of luck. Dr Mittal

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Saumya Mittal (24 minutes later)

Thank you for your reply.

Is this "sensory disturbance" something that heals itself in time - if so any idea of how long it might take? Or is this possibly a permanent condition with or without medication?

If I take the medication you suggest, is that for a limited amount of time and are there contra-indications for it?

Thanks again.

Answered by Dr. Saumya Mittal (14 hours later)

Brief Answer:
explained

Detailed Answer:
Hi
Thanks for the response.
The symptoms are usually short lived and resolve in 6 months.
I therefore suggest the medicine for this period.
The most important side effect is vertigo. Therefore, I usually suggest taking the medicines on the evening. Contraindications are if you are allergic to it and hypersensitive.
I hope that the information helps you. Please feel free to contact us for more information. Best of luck. Dr Mittal.

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Saumya Mittal (18 days later)

Hi

Thank you for your email.

I have just begun to take Neurontin for the residual pain I have in my fingertips, post carpal tunnel endoscopic surgery.

Last nite I took 100mg for the first time and today cannot keep my eyes open. The pain management physician would like me to work up to 300 mg in the next three weeks but am wondering if my reaction to this first low dosage will dissipate in a few days or am I just not a candidate for this particular medication. I work and certainly can’t be sleepy and not functioning properly. I am now also looking into acupuncture as something which may relieve my symptoms.

Any thoughts would be much appreciated.

Thank you for your time.

XXXX

Answered by Dr. Saumya Mittal (10 hours later)

Brief Answer:
specific information

Detailed Answer:
Hi
Thanks for the response.
the symptoms of the query are quite suggestive of a possible side effect of the medicine that has been started.
the dose of this medicine should be stepped up slowly, because of the side effects. the drowsiness does usually get reduced. So I think it's important to continue with the medicines suggested. if the symptoms persist , then you can change over to another drug.
I have read your query that you want to explore acupuncture as a option. Unfortunately, I do not have any valid experience in this. Therefore, I think it would be better that I do not make a suggestive comment.
I have tried to make it as simple as possible. I hope that the information helps you. Please feel free to contact us for more information. Best of luck. Dr Mittal.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Pradeep Vitta