Some years ago, Neuropathic study demonstrated meaningful reduction in neuropathic pain occurred in only 23.7% of cases.
Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There? http://painmuse.org/?p=2640
Subject of present article was case of Amyloid Neuropathy which proved very resistant to treatment but responded “immensely” well to intrathecal drug delivery system with infusion of hydromorphone.
Refractory Pain Management in Amyloid-Associated Peripheral Neuropathy
Nafisseh S. Warner et al
Regional Anesthesia and Pain Medicine 43(3), April 2018, 1-4
- Systemic Amyloidosis involves overproduction of light chain immunoglobulins which damages multiple organs including nerves
- methadone 40 mg/day insufficient
- duloxetine 60 mg no
- gabapentin then pregabalin modest effect
- topical ketamine-amitriptyline limited
- scrambler – temporary
Left will an insolvable case, implanted pain pump caused “immense improvement”
called intrathecal drug delivery system (IDDS) pain decreased from 7 to 3 and remained so with continued treatment. They used hydromorphone.
Comment – I had a lady in Thursday with widespread pain that I was able to demonstrate to a pharmacist. Patient’s pain of late was running 7/10. With the ketamine injection, her pain would drop to 3-4/10 for 3 days at which time she could return for another shot.
Office Ketamine For Chronic Pain Poster http://painmuse.org/?p=5611
Ketamine’s antidepressant effects made a significant difference as well.
One factor was pain in her right knee over medial plica which was steroid injected as well. With the attention to local issues, and ketamine, she does all right.
Marijuana would be an option.
However, in the case with even methadone not working, a pump would be a reasonable alternative.