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Thread: Question for Dr. Young

  1. #1

    Question for Dr. Young

    today mom is beginning to get more neuro pains shooting into her bicep area by her arm pit .
    it seems that it is progressing further up.
    On the referral her attending ER dr/wound care dr [internist]
    wrote something about T4 nueral based lesion? The appt isn't until
    the 6th of Oct, yet she is still having a lot of pain.
    She tried the gabapentin again today in hopes of some relief.
    Is there anything she can do until that time to alleviate the pain?
    Any help is much appreciated.

  2. #2
    Quote Originally Posted by 1010011010 View Post
    today mom is beginning to get more neuro pains shooting into her bicep area by her arm pit .
    it seems that it is progressing further up.
    On the referral her attending ER dr/wound care dr [internist]
    wrote something about T4 nueral based lesion? The appt isn't until
    the 6th of Oct, yet she is still having a lot of pain.
    She tried the gabapentin again today in hopes of some relief.
    Is there anything she can do until that time to alleviate the pain?
    Any help is much appreciated.
    I am so sorry to hear this. It does sound like neuropathic pain. The T4 dermatome is at armpit, at the same level as the nipples. A frequent area of pain in the segment at or just below the injury site.

    Not everybody responds to the same treatments. The first line therapy is a drug called amitriptyline (a tricyclic antidepressant that seems to take the edge of the pain at relatively low doses of 20-40 mg/day). The second is gabapentin (neurontin), which helps the sharp lancinating type of pain. People usually accomodate rapidly to the drug and require higher and higher doses of the drug until 4 or even 5 grams per day. Many people get unacceptable side-effects at these levels. The third is pregabalin. For some people, this may work but I don't have as much experience with this. The fourth may some combination of the above drugs with ketamine or dextromethorphan, which are glutamate receptor blockers. After this point, most people start using opioids. Most of the oral opioids tend to lose efficacy and most people gravitate towards stronger opioids, including fentanyl patchs (Duragesic). For people whose pain seem to be associated with spasticity, treatment with intrathecal baclofen may help both.

    There are some non-pharmaceutical approaches that may work for some people. These include spinal cord stimulation, acupuncture, and massage therapy. However, these usually provide temporary relief.

    A certain proportion of neuropathic pain may be due to a source of irritation that is increasing excitation in the spinal cord. For example, a pressure sore and a urinary tract infection may aggravate neuropathic pain. A syringomyelic cyst developing or enlarging the spinal cord may cause neuropathic pain as well. It is important and worthwhile to rule out these causes and elimination of these causes may alleviate the pain.

    Finally, some people have told me that Tylenol (acetaminophen) helps neuropathic pain. One Tylenol tablet (500 mg or 1000 mg) may provide relief for several hours. However, it is important to emphasize that one should not take too much Tylenol for too long because it is liver toxic. For example, taking up to 4000 mg of Tylenol per day for two weeks can cause liver enzymes to rise (Source). Thus, one should not exceed 4 grams a day for over two weeks. However, taking Tylenol may help your mother with her pain in the short run until she gets a chance to see the doctor.

    I am sorry that I don't have very much else to suggest.

    Wise.

  3. #3
    Quote Originally Posted by Raven View Post
    Quick question since I am in a lot of pain and can't even sit down for long. Is it possible for the nerve pain to affect the movement in my left side and spread more? I have noticed that the pain is now bothering me on my left forearm and has included my entire left side. The pain has become unbearable and unrelenting so that the vicodin nor the the neuronting seem to help much day or night. Please Wise or SCI Nurse give me some advice or idea.

    BTW, dr said said something about T4 nueral based lesion. Wonder what to expect with this.

    Raven
    copied from another thread.

  4. #4

    Question Amitriptyline and Tylenol

    Quote Originally Posted by Wise Young View Post
    I am so sorry to hear this. It does sound like neuropathic pain. The T4 dermatome is at armpit, at the same level as the nipples. A frequent area of pain in the segment at or just below the injury site.

    Not everybody responds to the same treatments. The first line therapy is a drug called amitriptyline (a tricyclic antidepressant that seems to take the edge of the pain at relatively low doses of 20-40 mg/day). The second is gabapentin (neurontin), which helps the sharp lancinating type of pain. People usually accomodate rapidly to the drug and require higher and higher doses of the drug until 4 or even 5 grams per day. Many people get unacceptable side-effects at these levels. The third is pregabalin. For some people, this may work but I don't have as much experience with this. The fourth may some combination of the above drugs with ketamine or dextromethorphan, which are glutamate receptor blockers. After this point, most people start using opioids. Most of the oral opioids tend to lose efficacy and most people gravitate towards stronger opioids, including fentanyl patchs (Duragesic). For people whose pain seem to be associated with spasticity, treatment with intrathecal baclofen may help both.

    There are some non-pharmaceutical approaches that may work for some people. These include spinal cord stimulation, acupuncture, and massage therapy. However, these usually provide temporary relief.

    A certain proportion of neuropathic pain may be due to a source of irritation that is increasing excitation in the spinal cord. For example, a pressure sore and a urinary tract infection may aggravate neuropathic pain. A syringomyelic cyst developing or enlarging the spinal cord may cause neuropathic pain as well. It is important and worthwhile to rule out these causes and elimination of these causes may alleviate the pain.

    Finally, some people have told me that Tylenol (acetaminophen) helps neuropathic pain. One Tylenol tablet (500 mg or 1000 mg) may provide relief for several hours. However, it is important to emphasize that one should not take too much Tylenol for too long because it is liver toxic. For example, taking up to 4000 mg of Tylenol per day for two weeks can cause liver enzymes to rise (Source). Thus, one should not exceed 4 grams a day for over two weeks. However, taking Tylenol may help your mother with her pain in the short run until she gets a chance to see the doctor.

    I am sorry that I don't have very much else to suggest.

    Wise.
    Dr. Young:

    Is amitriptyline something like Effexor? Samantha has decreased her daily dosage of gabapentin. Was at 400mg 3 times a day, night dosage 800mg. Now is taking 300 mg and night dosage 600 mg. with 200 mg at afternoon dose. Has had no bad side effects. Can the Tylenol be taken with the gabapentin if she were to reduce gabapentin dosage more? She's very concerned about muscle atrophy. She has been on gabapentin since 2007.
    Aggie Mom 2007

  5. #5
    They are both classified as antidepressants but amitriptiline is in the TCA category and is used for pain. Effexor is usually more for antidepressant and possibly anxiety attacks.

    CWO

  6. #6

    Question Tylenol and Amitriptiline

    Quote Originally Posted by SCI-Nurse View Post
    They are both classified as antidepressants but amitriptiline is in the TCA category and is used for pain. Effexor is usually more for antidepressant and possibly anxiety attacks.

    CWO
    SCINurse
    Can the gabapentin and Tylenol be taken together? If Tylenol taken in lower dosages such as 750 mg a day?
    Aggie Mom 2007

  7. #7
    Quote Originally Posted by jhorn4012 View Post
    SCINurse
    Can the gabapentin and Tylenol be taken together? If Tylenol taken in lower dosages such as 750 mg a day?
    I'm not a nurse but I know that mom has taken Gabapentin along with her Vicodin which
    contains acetaminophen together. Just today for example to prepare for the transferring
    of bed to stretcher. She didn't have any bad side effects, and was chatting on the phone after we got home from the dr's.
    Hopefully the nurse can help you out.
    Good luck!

  8. #8
    How well does neuropathic pain respond to opioids? I was always under the impression that it's effect was limited.

    Also, when I landed in the ER in March, I had horrible neuralgic pain and back spasms (I have TM/MS). The doctors gave me a combination of 650mg Tylenol and 1500 mg Ibuprofen
    Tylenol. The effect was amazing! It did wonders without having to resort to something stronger.

  9. #9
    Senior Member
    Join Date
    Mar 2006
    Location
    connecticut
    Posts
    8,272
    What I find is that a med that treats any NON nerve pain I am having, allows my body to better deal with the nerve pain. And the effect of the nerve pain is lessened,
    T7-8 since Feb 2005

  10. #10
    yes the gabapentin should be taken on a scheduled basis and the tyeleonol when needed.

    CWO

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