Sunday, 4 September 2016

The Limitations Of Neuropathy Consultations

Today's post from (see link below) is an illustration of what frequently happens when people write to doctors with their neuropathic complaints. The picture is of a person with probable causes and several clear symptoms of nerve damage. The doctor quite rightly gives an accurate opinion and assessment but unfortunately, because of the nature of the 'consultation', that's where it ends. My point is that this reinforces the need for a detailed examination of the patient, his/her history and the treatments he has tried. He/she needs to be examined holistically. It sounds 'new age' but only means that his complete medical history and symptoms need to be looked at, as well as his life style and experiences that have brought him to this point. Only in that way can a doctor come to a careful conclusion based on many factors and try to treat the patient with better reference to his circumstances. Then he stands a better chance of receiving successful treatment. Ths doctor here can see the problem but is limited in what he can say. The patient has clearly already been through the mill regarding his diagnosis and possible treatments but needs quality time with a doctor to be able to target his medication better. How many doctors have time for that in this day and age? It's true; for many people, nothing works  but throwing one medication after another at him is an unsatisfactory solution at best. You may well recognise yourself here.

Dr. Roach: Extensive pain likely due to nerve damage, but not shingles By Dr. Keith Roach Posted: August 17, 2016 - | Updated: August 18, 2016

North America Syndicate

Dear Dr. Roach:

In April 2014 I had an outbreak of shingles — right hip, leg and foot. I got the shingles vaccine in 2010, but apparently it did not work. My doctor prescribed Neurontin. The following month, I was diagnosed with follicular lymphoma, and for the next year, I received six rounds of chemotherapy (cyclophosphamide, doxorubicin, vincristine and rituximab) followed by 20 radiation treatments. The treatments were successful, and the cancer is in remission. While that is a true blessing, I am now suffering from constant pain in my right foot and have been for over two years. I have done everything I can think of to get relief. I have had X-rays, an ultrasound and a nerve conduction study; I have been examined by a neurologist, a podiatrist, a spine specialist, a chiropractor and an acupuncturist; I have taken Lyrica, used topical creams, received laser therapy and spinal injections, and used a TENS unit. Nothing has helped. I take 10 mg of Percocet three times a day, which does give me some measure of relief but the pain never goes away completely. There are days, even with the Percocet, where the pain can be debilitating. The neurologist told me that in his opinion, I do not have “typical” neuropathy; he believes I suffer from chemotherapy-induced nerve damage and that most likely the condition is irreversible. I hate to think I have to live with this condition for the rest of my life. Do you have any suggestions or an opinion that might lead me to finding a solution to this condition? — I.P.


The constant pain in the foot could very well be a neuropathy: I think it is the most likely explanation based on what you’ve told me. I also think your neurologist is correct that it is likely to be related to the chemotherapy, especially the vincristine, which is well-known for causing permanent neuropathy in a proportion of those who use it. I suspect that without the chemotherapy, your post-herpetic neuralgia (the term for neuropathic pain following shingles) would likely have gone away. However, the damage caused by the Zoster virus increased the likelihood of damage due to the chemotherapy. At least, that’s my opinion about how you may have acquired this pain syndrome.

Your neurologist has tried many of the common therapies for neuropathy, but there are some people in whom nothing works. I don’t have an answer for your continued pain. My experience is that the doses of gabapentin (Neurontin) needed sometimes are much higher than most doctors are comfortable giving. In the study that got gabapentin approved for post-herpetic neuralgia, the most effective dose was 1,200 mg three times daily. Unfortunately, this dose has significant side effects, and it may take months of slowly increasing the dose to get there.

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