Prednisone and Neuropathic pain?

[ll64260]

Hi,

I have pretty bad neuropathic pain and it goes between a scale of 7 and 9 every other day.
I tried almost all the painbills, nortriptyline, neurontin, vicodin, ultram with little effect. Just taking an initial dosage on any of the above generated unbearable side effects, I can't stay on them long enough to show any benefit.
Then, I was having a very bad allergy reaction to cipro a while back. The doctor put me a a 9-day course of prednisone because I had big itchy rash covered 90% of my body. By the 5th day on prednisone, my nerve pain gone down to scale of 4 and 3. Two days after I finished the prednisone, my nerve pain shot back to its normal self.
It was so sad and prednisone had the least side-effect on me among all the other painbills.

Why is that? I don't know much of prednisone so would you tell me why it worked so well on my nerve pain? And would I be able to take it as a painkiller instead?

Thanks

[zaziwe]

Have you tried Elavil?

[stephen212]

I recently had a conversation with an extremely bright physician friend of mine about prednisone. Though I've both been asymptomatic for the last few years, I was wondering if I could improve my pulmonary function. I went to see a pulmonary specialist who did a routine diagnostic study to establish a baseline and to see whether my lung capacity could be improved, he prescribed a two-week course of prednisone, the anti-inflamtory effect of which might demonstrate the possibility of an improvement.

Even though a two-week course of prednisone would probably not be long enough to compromise my immune system my friend thought that the pulmonologist was a "maniac." Prednisone is some strong sh*t and should be taken, especially long-term, with extreme caution. (I never took it.)

Perhaps your degree of pain may make its insidious side effects worth the risk, but make sure that you've exhausted all your other options first.

Here is a list of side effects that I cut and paste from another Web site:

Prednisone is a glucocorticoid(steroid). It is used to treat many different conditions which require either a strong anti-inflammatory or to decrease the immune system. Once absorbed prednisone is metabolized in the liver to the active drug prednisolone. There are some people who have difficulty with this metabolic step and should be given prednisolone. Prednisone should be given in the smallest dose for the shortest time necessary. This is because prednisone accelerates the aging process of the body. Consequently, it increases the rate of hardening of the arteries, increases osteoporosis, can cause diabetes mellitus, increases the cholesterol, causes cataracts. For all the bad things that prednisone(and similar drugs) cause it is often the only drug available to treat certain conditions.

[SCI-Nurse]

Prednisone is indeed a drug that should not be taken lightly. There are other drugs that can be tried alone or in combination. I will refer you to an earlier post which discusses MS pain which is also a neuropathic type of pain. Check out this post at: http://carecure.org/forum/showthread.php?t=44287

(EMK)

[Wise Young]

VH, Hi. A number of people that I know have pain every other day. It is something that I do not understand at all because I don't know of any cycle in the body that has a 48 hour period.

Prednisone turns on the corticosteroid receptor which initiates a cascade of anti-inflammatory responses. We found recently that methylprednisolone (which is very closely related to prednisone) turns off gene expression of the pre-inflammatory cytokines interleukin 1-beta and suppresses interleukin 1-alpha and interleukin 6.

Have you ever tried a COX-2 inhibitor (such as celebrex) for your pain? Likewise, have you tried Tylenol (acetaminophen); it is also a COX-2 inhibitor but only in the CNS. Neuropathic pain is not responsive to many of the standard analgesics because its mechanisms are different.

Neurontin is also missing from the list of drugs that you have tried. Cass indicated that she was not willing to try 3000 mg of neurontin. Do you feel that same way? Actually, as clinical trial data is coming out, neurontin appears to have the least side-effects. A recent clinical trial suggests that it is even more effective when combined with dextromethorphan, posted earlier in the
care forum (http://carecure.org/forum/showthread.php?t=3246)

Wise.

[ll64260]

Thankyou all for the information, Dr Young for starting the pain forum. I would think twice next time I come across prednisone!!
I did tried one or two dosage of neurotin. When it didn't show any relieve, I just stopped. I hate the idea of depending on drug as a long term pain relieve and to say the least of taking a high dosage of them overtime.
My newest prescription is Topamax and I haven't take any of them. Just looking at its side effects makes me weary. I did took a 325mg Tylenol upon seeing your earlier post, but it didn't do anything. I will ask my rehad doctor about Elavil and Cox-2 next time I see her which is in a distance future (insurance thing). In the mean time, I am on a waiting list to try out a 15 week session of Acupuncture as alternative pain reliever.

Van

[Wise Young]

Van, I hope that things work out. Sorry to hear that the acetaminophen did not help. It seems to stop autophagic behavior in rats. Another thing that seems to work in rats are daily GM1 injections but the dose has to be pretty high for the effect to take place. As soon as I can, I will post somethings about the new class of glutamate receptor blockers that may be effective. In the cancer field, low dose ketamine is being used. Wise.

[melliska]

hi van, i thought i would jump in on this post because i have a lot of pain also. some of mine is neuropathic and i rate it as a 9 or 10 without any medication. i went for almost a year without seeing a doctor about it because i thought i could "tough it out", but now i can't do it any more and have been going down the list of pills. i really hate taking pills so i have to force myself to take them, but i'm going nuts so i do it. i'm taking neurontin, vicodin (sp?), baclofen, and elavil (amitriptyline). i am still rating my pain between 4 and 6 so we're trying to find something that works better.

i tried ultram too but it didn't do anything. i was prescribed topamax also but i decided against taking it when i read the side effects. it increases the risk of kidney stones and i have already had a bladder stone so i didn't want to risk it. now i'm up to 3600 mg of neurontin but i can't tell if it's making a difference so i'm trying to decide if i want to go up to 4000 mg. i'm afraid to quit taking it though because i know from experience that my pain can be much worse. i'm going to slowly quit taking the 10 mg of baclofen though and i would also like to get off of the elavil because i don't think they are helping.

what kind of side effects have you had when trying out the different medications? have you tried ramping them up slowly? i know that you don't want to be dependent on a high dose of neurontin, but a lot of people require a higher dose to see results. i know it's no fun to have to take a bunch of pills but i also know how much pain can ruin your life. i would try more alternative treatments but i don't really have many options where i live. i remember reading that the moderator of the cure forum, sue pendleton, had some good results with acupuncture. hopefully it will help too so you don't have to go the medication route, but if you exhaust the alternative options please don't rule out the pills if they can help you.

i guess i didn't really help much but i just thought i'd add my experience. i hope that your acupuncture goes well and your pain decreases. you might want to look at the "pain" post by cass if you get a chance. melissa

Life is a lesson you learn when you're through.

[Deeterz]

:mad: Hi, Not sure if this is the right area but I saw some talk on here about prednisone and thought i would ask my question here. I have suffered from MS since the age of 16. About 6-7 years agao I developed a pain in my back that seems to be inside my right rib cage. It was hit and miss for a few years and then became constant which is how it is today 24-7 pain/discomfort. I have been to 16 different docs and spent a week at mayo clinic and every test, scan anything I have had comes out crystal clear....I have noticed over the last year or two that when I am on my prednisone for my MS - which is a wonder drug in that aspect my back pain gets worse...! Prednisone, even with all the bad side effects is used for so many things and is sort of a magic fix, so why is the pain worsening...? The head MS doc at mayo clinic did NO tests and said it was probably my MS. Probably?!?! I sure am glad I spent all this money and an 8+ hr drive to hear that. So, I explained to him that the steroids make my back pain worse which leads me to believe it is NOT related to my MS and he says "yeah that is weird." WEIRD!!! No its not weird its horrible and is killing me and I want some answers. Needless to say i got nothing and still continue to have no answers. I am on prednisone right now and it is killing me to even sit here and type this my back hurts so bad...... any idead for me????

[ima2003]

dr wise, what did you mean by a 48h "cycle". does pain work that way? i have pain every day starting at 1:00pm thru 7:00pm. it is always at least a 5and may be up to an 8. some days i am in tears even though i know it will subside to the ususal 2 or 3 by 7:00. i believe it is neuropathic...hot poker like pain both arms and hands right more than left. i can't even pet my dog the pain is so intense. i am on 3600mg of neurontin and 45mg of baclofen. i have tried tylenol and it works for m/s pain but not for the burning. i am very hesitant about heavy duty pain meds because of the constipating effects. should i try an anti-depressant or what else?

[firesmurf]

just a few tidbits on prednisone.i know it does help with pain that is inflammatory in nature and gets used for many many other things as well.it does help with some of my pain in my knee that is a combo of different problems including RSD.the medrol dose pack has saved my knee many times when things just get too out of control.i can usually get a good pain decrease on days two and three and then it goes right back up again as i get thru that taper down.i know it has alot of possible side effects and that scares me ALOT only because my son has to be on it every single day (since june 2000) to maintain anti rejection status of his transplanted liver.without it(believe me,we have tried tapering him)he ends up with hepatitis within about two days,so he has to go right back onto it.one huge thing i have noticed tho is his immune system is even better than the rest of our family.which suprises me given what is stated about it in the Rxing lit.he has actually been able to avoid things in the home that the rest of us will get like strep and other little nasties that pop up from time to time.i think he is at just enough to keep things on track but not enough to really compromise his immune system.one thing i don't do is make my home as germ free as possible.i am not the greatest housekeeper in the world,espescially since my SCI and the other medical nightmares that keep popping up all the time kind of sap my energy for that stuff.i think that has actually helped him in building a better immunity to things.he just never really gets "sick" like the rest of us.amazing really.he also appears,from different types of testing done,to really not be suffering any of the other side effects that can also come along with pred use long term.overall, a pretty healthy kid,considering.

taking pred,like alot of the other things we have to try with this horrid type of pain,well,its all a big trade off ya know?i have put up with some really ugly side effects from many different meds just trying to find that little bit of relief along the way.if you can actually find any relief with pred and can maintain at the lowest dose while doing it,i really don't think its a whole lot different than some of the absolutley viscious side effects i have had to endure(we all do) from some of the other side effects from the types of meds we have to take.but thats just my opinion.everything we have to take is a trade off.but on the other hand,if you do have a good response to pred and you know at least some of your pain is simply from that inflammatory response,there are other anti inflammatory meds that can at least be tried anyways.

ima,what exactly does your pain stem from,SCI? or something else,like just the MS?have you ever tried lyrica?i had good response from it pain wise but the side effects were just way to over the top to even begin to think i could actually stay on it,but not everyone has those types of actual side effects.just a thought for you.it is something that should at least be tried at some point just to see how it works for you personally.one of the Rxing criteria for using it is that you need to have at least tried neurontin,and you have,so that part is taken care of anyway.i really wish i could have stayed on it as it has been the only med that has had any effect at all on my central pain,nothing else even touched it except for the lido patches on the hot spots when they get out of hand on me.just some thoughts for ya.good luck,Marcia

[ima2003]

oh marcia, where do i begin? i have both m/s pain from overuse and central pain. it's the neuropathic pain that i cannot get a handle on. what kinds if side-effects does lyrica cause?

my sci stems from an intramedullary abscess at C5 extending to T1. i was totally paralyzed (shoulders down) prior to surgery and after. i got alot of movement and feeling back although my right leg is still paralyzed and i have varying degrees of movement and sensation over the rest of my body.

i feel like a big whiner. nobody wants to talk about "how much pain they have". even to my doc i have not shared how bad it is. that is my own doing but now i need to get it under somewhat of a control. i see my doc on friday. we'll see. do anti-depressants work?

[firesmurf]

sorry for what you are having to deal with ima,really.you are not a whiner,you are a human being who is suffering in pain.the one person who you really HAVE TO be honest with regarding your pain IS your doc,since he or she is the one who is helping you try and manage it.they cannot help with what they don't know about ya know?if i were you,i really would at least give the lyrica a good try run.it did help with some of my pain,even the central that nothing else appeared to even touch.i have been having problems with it seems just about every anti S med now and mine could just be my kidneys.i do have a kidney and liver disease and i think it is creating the biggest problems with metabolization and other issues.some people have absolutely no real side effects from lyrica(like any other meds we take) and others do.its all kind of a crapshoot.you just have to give things a try and see how they work on you personally and your pain processes.

is your doc an actual pain management doc or some other type?getting to an actual PM is so much better and can offer you so many options to try that no other type of clinic or doc possibly can.this is what they do all day long,treat pain,chronic pain.i thought having an intramedullary cavernoma bleed was bad,i cannot even imagine what is much have been like and be like with an intra abscess?wow.how did that actually occur?Marcia