Suggest Ways To Manage Neuropathic Pain In The Feet And Buttocks

Posted on Wed, 21 Dec 2016

Question: Hi. I have neuropathic pain in my feet and right butt cheek from a spinal cord injury five years ago. The only relieve I have received is from opioid medications such as oxycodone/OxyContin, hyromorphone, Fentanyl, etc. I rotate every three or four months to try to stave off my body's acclamation to the various medications. I have used non-narcotic men's like lyrica, gabapentine, baclofen, and many others with minimal effect. I currently take oxycodone 30mg up to six times per day, Methadone 10mg 2x per day and lyrica 150mg 3x per day. I also gain some pain relief from Cymbalta but it was originally prescribed for mood enhancement.

Yet I am sitting here with feet that feel as if they are on fire. My butt will soon be the same as I have not been sitting for five minutes.

What are my options? I have a great pain management doctor, but she is ok with me researching on my own. We discuss any change in my treatment before I change and she is the only one who I let prescribe for me.

Maybe a new generation of Extended Release opioid is what I need, as the Methadone is currently the weak link, I believe. Honestly, if it wasn't for the Oxycodone, I don't know what I would do.

Answered by Dr. Dr. Erion Spaho (48 minutes later)

Brief Answer:
TENS, antidepressants, extended release opioids.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

The scheme to control neuropathic pain should be always adjusted to patient's needs, good control with minimal side effects and low dependency chances should be aimed.

Besides the current treatment, in my opinion, you could discuss with your pain management Doctor about possibilities such TENS ( transcutaneous electrical nerve stimulation ) application.

Other possible drugs to use in your case include antidepressants ( Amitriptyline ), local application of capsaicin cream, lidocaine patches, extended release opioids such Opana ER, Avinza etc.

OxyContin actually is one of the extended release forms of opioids.

Hope you found the answer helpful.

Let me know if I can assist you further.

Kind regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Erion Spaho (39 minutes later)

Sorry i didnt mention that i have a spinal cord stimulator implanted permanently. My T12 shattered in a hard landing of an ultralight aircraft. The stimulator is in the epidural space around T9 or T10. It helps a lot, but it had started to lose its effectiveness (2 years in) so i rotate months tthat i turn it on.

It appears that Avinza has been discontinued. Can you recommend other Extended Release Opioid medication which can effectively treat neuropathic pain from a spinal cord injury.

https://www.drugs.com/avinza.html

Thank you very much.

Answered by Dr. Dr. Erion Spaho (10 hours later)

Brief Answer:
Other opioids ER listed below.

Detailed Answer:
Welcome back and thanks for being on follow up.

First, TENS is a procedure that doesn't interfere with spinal cord simulator, so, it should be considered as an option.

Other possible extended release opioid drugs include:

-Exalgo

-Fentanyl transdermal patch

-Kadian

- Nucynta ER

Hope this helps.

Kind regards.

Above answer was peer-reviewed by : Dr. REMY KOSHY