Neuropathic Pain 2015 and…

Mayo clinic has a review but lacks imagination

It lists the causes as:

causes_neurop

Buried in that, is the fact almost 1/2 of neuropathic pain is going to be chronic radiculitis (arm or leg sciatica) with the majority due to chemical irritation from a damaged disc rather than mechanical compression. Spinal stenosis also there. Diabetic and pre-diabetic neuropathy is big, and 1/2 of Fibromyalgia has now been found to be a small fiber neuropathy.

Treatments included:

  • neuro_rxWhat is missing is a Canadian study finding only 1/4 cases may achieve adequate control with above measures. Considering opioids 3rd line? – No one is going to leave someone in agony with neuropathic pain waiting weeks for SNRI to kick in – Come on people! – would you leave your grandma with shingles in pain?
  • Daily subcut B12 shots [1000 ug/day] can cut pains by 20% [I am working on publishing that trial]
  • Ketamine shots – 10 mg intially in deltoid, and if not undo reaction another in 15 minutes¬† – given twice weekly can drop pains a couple of points [pain actually comes back on day 3 but because of the mood enhancement of ketamine – they don’t care].
  • Use of blocks, 3+¬† day IV magnesium, lidocaine or ketamine infusions have been written up in this blog.
  • Spironolactone 100-200 mg/day, found to help 1/2 of Fibromyalgia cases,might work on small fiber neuropathy
  • Recognition that in severe pain, there might be some inflammation and a pulse of steroid might clear up that possibility.
  • Caudal B12 2000ug injection in one study reduced diabetic neuropathy pains sometimes dramatically. I have tried it and people come in couple months back to have them repeated so must work for them.
  • The skin is often hypersensitive and the nerve tracts in these areas can be desensitized by having 3% glycerin in D5W injected intradermal – subcutaneous every cm. I found it very helpful in a painful meralgia paresthesica case and I saw on written up on internet as well.
  • Working the knots in muscles affected and the back joints has an impact.
  • Botox injections may not work well for occipital neuralgia by self but sensitize the nerves to the semineurolytic effects of 5% lidocaine – I have controlled one patient that way for 10 years now.

I’m sure there is more – this is what came to mind…

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