By Paul G. Donohue M.D. December 02, 2010 12:00 AM
DEAR DR. DONOHUE: I am a 68-year-old female. A little more than a year ago, I developed shingles on my midsection. the blisters and rash healed. I was left, however, with severe pain. my doctor prescribed Neurontin. I also am taking L-lysine and doses of vitamin B-13. I also took hydrocodone. Lidocaine patches worked for a while but became ineffective. I am now taking larger doses of narcotics to obtain relief. would any of the procedures you mentioned in your column previously (I have underlined them) work for me? I will try anything.
You have postherpetic neuralgia, pain that lingers well after the shingles rash has gone. the herpes zoster virus, the cause of shingles, damaged the nerves it traveled down to reach your skin and produce shingles. the item I wrote about (the one where you underlined treatments) involved trigeminal neuralgia, facial pain of an entirely different cause. None of the procedures I mentioned — microvascular decompression, the gamma knife, nerve-killing injections — is useful for postherpetic neuralgia.
Things that you haven’t tried but show some progress for postherpetic neuralgia include antidepressants like amitriptyline and Cymbalta (duloxetine). They are not given for depression. They’re given for their pain-relieving properties. Seizure-control medicines also are prescribed for pain relief. the Neurontin you tried is one. another is Lyrica (pregabalin). Zostrix, capsaicin cream, has been helpful to many.
A new product, the Quentza patch, contains a high dose of capsaicin. it is applied directly to the painful skin. A doctor has to apply it.
Opioids, the narcotics you mentioned, have a place in treating this distressful condition. Opioids bring the possibility of overdosage and addiction. it takes careful use for both patient and prescribing doctor to avoid these complications. if no other medicines bring pain relief and the pain is severe, then turning to these drugs is acceptable. Tramadol and oxycodone are two popular drugs in this class of pain relievers.
Have you thought of visiting a pain clinic? you should. the specialists there are experts in pain control.
DEAR DR. DONOHUE: I am fine, but my liver enzymes are very high. I have undergone an extensive search to find out why, including scans and blood work, but the answer hasn’t been found. my liver enzymes remain high. now doctors want a liver biopsy. I don’t want it. do you have any idea what’s going on?
I don’t. but I have faced the challenge of trying to find an answer for people like you whose liver enzymes are high but who have no symptoms. Your doctors have pursued their search by employing every noninvasive test they could. the best test for you now is the biopsy.
The liver is very close to the skin. A needle can obtain a piece of liver tissue quickly and relatively painlessly. the skin and underlying tissue are numbed. it sounds grim, but it really isn’t. I urge you to reconsider your doctor’s suggestion.
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