Drugs?

Barefoot TJ

Barefoot TJ

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Mar 5, 2010
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#1
Hi Docs! I know, I know, I know...treating the root of the problem is the best way to reduce or eliminate pain...BUT, you all know that I have had surgeries on my feet to remove the neuromas, and I still am in a lot of pain. I have done everything in the book to remedy this problem, but I still am in a lot of pain.

I currently take Ultram, only as needed, and I try and try to avoid the stuff, and I haven't taken it much or often since I got the prescription 2-3 months ago, but when I do take it, it won't let me sleep, hence my being on the site at 2 a.m.!

So, what other pain meds are out there that are kick ass, but won't mess with my head?

I am alergic to oxycontin, hydrocodone, percocet,

Demerol and Codeine mess with my head.

If my results from the EMG and NCS come back neuropathy, I can get medical cannabis (in Georgia?), but man, I DON'T want to do that!

Anything? Please?
 
#3
I pass on this one - because since they don't treat the cause you'll just end up going from one to the next to the next. This is how people get addicted to pain killers. And it's also how they get addicted to anti-inflammatories. Actually, to some degree, the more anti-inflam drugs you take, the more inflamed you become.
So what do you do? Try acupuncture, or look for a deep tissue specialist to help you with that scar tissue.
 
#4
But, Doc, how do we treat the cause of what I am going through? My nerves are screwed up, pre-surgery, post-surgery, they are trashed. How do we get to the root of this? I've done every conceivable treatment (save ablation) to prevent having to go through the final traditional surgery that has now added to and left me in this position.

I am seeing a deep tissue massage therapist, but there's nothing she can do about the nerves running through my feet. She took a month long break during my treatment to travel home to Thailand to visit family. She should be back after the 11th of May.

I don't need anti-inflammatories, apparently, my c-reactive protein test (measures inflammation in the body) was completely normal.

Cat, I have been taking neurontin since the 7th, have upped the dose to two a day now, and in a few more days, will up to the maximum of three per day. It's too soon to tell if it's of any benefit. It does knock me out quite a bit. (It's the same thing they give to epileptic patients.) I took it before the surgery, and it didn't do a thing to help me. If after I have gone through this next bottle, there is no improvement, I will stop taking it. (Oh, and the neurontin makes me sleepy, but it I take an ultram, then it erases any tiredness I may have from taking the neurontin, I have found out.)
 
#7
TJ, there's some docs I can refer you to or as we discussed before I'm happy to see you if you want to come to NC (and for everybody who knows me, that's not to strum up business). Remember (for everybody who asks questions here) - this is free advice we give, and it's pretty generalized. For me, the advice I give here and on my own sites is very generalized and only a fraction of what I do when I see a patient and actually have my hands and eyes on them and am able to to see exactly what is going on with their health. The advice I give (and I'd say the other docs too) is enough to not step outside my boundaries, and hopefully help my fellow runners without causing any harm. That being said, the advice will only go so far, not because I don't have more to offer, but because I can't, and shouldn't, via these means. Plus, there's only so much you can do to self assess and treat some of your own problems.

So, sticking with my honest approach and "say it like it is" philosophy, your problem, in regards to on-line advice, can go no further - at least from me. I hope you don't take it personally but I think it's more professional for me to say it to you here than just not respond.

PS - don't think you don't have inflammation just because your CRP is normal (which I define as <1.0 - not 3.0 as the "normal" states). It is only ONE marker of inflammation - and more cardiovascular focused.
 
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#8
Gabapentin is the generic for Neurontin. I take the Gapapentin, 300 mg 2 x per day and will increase to 3 x per day shortly. What do you take it for, Dutchie?

Dr. G., I feel I have done everything I can to treat what is causing my pain. I feel there is nothing left for me to do now but to manage it, and pray I will heal from this.

What other markers are there to indicate inflammation?
 
#9
TJ, My heart goes out to you.

Have you tried Nortriptyline or Cymbalta? They are drugs used for pain disorders as well as depression. You don't have to have depression for them to work for pain. They help turn down the pain signals to the brain.

I don't think inflammation is the issue here. You have damage to the nerves but should have some improvement over time.

I think that for most patients marijuana is overrated for pain, but there is no shame in trying it.

Consider seeing a pain psychologist. They have helped my chronic pain patients tremendously.

Certain forms of meditation can also be helpful.
 
#10
Cymbalta was recommended to me by the neurologist I am seeing, if the Gabapentin (Neurontin) doesn't work. Is it addicting?

I do find myself meditating when the throbbing and burning starts (almost nightly now). I lay still and tell myself to be calm, quiet, relax, repeat. It seems to somewhat weaken the pain as long as I am repeating the mantra. When I stop, it starts again.

Psychologists scare me. Too much history in my life they could pick apart. Hee. Besides, my insurance company is probably getting sick of me at this point. Ha! They should see a doctor!

Thank you for the info, Bess.
 
#11
Barefoot TJ said:
Gabapentin is the generic for Neurontin. I take the Gapapentin, 300 mg 2 x per day and will increase to 3 x per day shortly. What do you take it for, Dutchie?

Dr. G., I feel I have done everything I can to treat what is causing my pain. I feel there is nothing left for me to do now but to manage it, and pray I will heal from this.

What other markers are there to indicate inflammation?
Click to expand...

Same as you, nerve pain in foot. 300 mg 2x per day. I was on a service call in Virginia this week and ran out, 2 days later the discomfort was coming back. Back home now and back on the gabapentin. Still some awareness but should be okay by tomorrow.
 
#12
Questions. Questions. Questions.

What causes the nerve pain in your foot?

How long have you been taking the Gabapentin?

How long after you started taking the Gabapentin did you see an improvement in your pain?

If your pain was a 10 on a scale of 1-10 without the Gabapentin, how much would you say the Gabapentin reduces the pain to? (Of course, I don't know how high your original pain scale goes.)

How long are you expected to stay on the Gabapentin?
 
#13
TJ, I had trigeminal neuralgia and was prescribed Gabapentin for that. Had surgery to correct that and was able to get off Gabapentin for that. Than I started to get discomfort and pain in my foot just as you had described earlier. It got really painful, so I know what you are going through, a couple of times I could barely walk. Than I remembered when I was on Gabapentin I had no symptoms, and back to my GP for more gabapentin, she ask why I needed it if my previous surgery was successful. I stated my symptoms for my feet, she sent me for xrays which showed nothing, and then she prescribed Gabapentin again. I find that 2x 300mg is just right for me. With my trigmenial neuralgia I was on 3000 mg per day to control the pain. As for the pain scale, that is hard to say as my tolerance for pain is not the same as everyone, but it was to the point that running would not have been possible. After reading about you adventures with your feet and surgery, I think I will keep going with Gabapentin as it seems to work right now for me. I believe that I have neuralgia in my feet just like you. I also have it both my feet, with my right one being the worse one. Also as to how long I have been on Gabapentin, I would say off and on for about 7 years.. Hope this answers some of your questions.
 
#16
Yes, but I'm not going to be taking 3000 mg. Geez, that sounds like a lot! I hope I don't have to go that high. But you said now you are on 600 mg per day right, so you went down in dosage.

I have Morton's Neuroma, pre and post surgery (as we are finding neuromas redeveloping in my left foot). I have never been told I have neuralgia, so I looked it up. The damage done to the nerves (understandably) by the surgeries seems to fit that description well (although I've had much of this pain prior to surgery too): intense pain, stabbing, electrical shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable, mostly spontaneous, but air currents can trigger pain. Yep! That's me!

Dutchie, I'm trying to understand. Trigeminal neuralgia affects the face; neuralgia can take place everywhere else, right? That's what I found under wiki. You had trigeminal neuralgia, that affected your face? Then had surgery to correct that and was able to get off the Gabapentin? Then you started to have foot pain? Or did you have foot surgery and that corrected the neuralgia? What did they do in the surgery to fix your foot (or face)? What was wrong with your foot to warrant the surgery, other than the pain, of course?
 
#17
The trigeminal neuralgia I had was on the face. At one point just before surgery I was up to about 7000 mg (he was okay with me going up to 9000 mg to control the pain). I had DMV surgery for that and it has never come back. They basicly opened the back of my head just behind the ear and put a little pillow between the blood vessel and the nerve. That was about 10 years ago. I found that I had the Morton's Neuroma (I am blaming work boots for this one) in my feet about 2 years ago. I will use surgery for that as my last option. As long as it is maintained by my Gabapentin I will not explore any other options. Just like I said I found out by accident that it worked to lessen the pain to about zilch. I was without Gabapentin for 2 days last week and noticed that my feet were getting sore again, now on it again for 2 days and trouble free. I totally feel for you as I can understand the discomfort that this nerve pain can cause. Talk to your MD. and see if a higher dosage will give you relieve. I personally do not have any side effects to this drug. Now talk about statin drugs, those disagree with me.
 
#18
I was on the gabapentin before the surgery, and it didn't work for me at all. After that, I tried Lyrica, the really expensive stuff, and that didn't work either.

You never got dizzy or tired in the beginning when taking gabapentin?

You have a diagnosis for MN? You do know that, that monster can potentially (most likely will) continue to grow and can deform the structure of your feet, right? Like mine?

I will be increasing the dose to 900 mg per day in the next couple of days. I will ask the neurologist what he thinks about going higher than that if I had to.

(Sorry, Dr. G. I know this conversation must be driving you nuts.)
 
#19
Never had any side effects on Gabapentin. The foot diagnosis is a story all on its own, and one that is still going on. The way my foot discomfort started was one day while out for a run I felt as if my sock was bunched up with a crease rubbing me. I stopped took my shoe off and found nothing wrong with the sock. This went on numerous times. Than I developed tingling in the foot, than the foot started to go numb at times, and following that pain developed. This was all over the course of about a 1 1/2 year. I went to her 2 or 3 times, went for xray which was negative. Finally she conceded nerve pain, put me on Gaba and told me nothing can be done about the discomfort. So now I am working on a referral. My gp is a work of art, but it is really hard in Canada to get a gp so we take what we can. Hope this helps, but everybody is a little different and respond differently to interventions. I hope you find one that works for you.
 
#20
dutchie53 said:
TJ, I had trigeminal neuralgia
Click to expand...

OUCH!!!!!!!!!!!

Back when I was in training we were taught that the most intense pain possible in a human being was trigeminal neuralgia.
The few cases that I've diagnosed and referred to specialists including one less than a year ago seemed to back that up.
Good to hear that yours was helped by the procedure!
 
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