NEUROPATHY PAIN

Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. . These damaged nerve fibers send incorrect signals to other pain centers.

What causes neuropathic pain?

some common causes of neuropathic pain include: Alcoholism Amputation Back, leg, and hip problems Chemotherapy Diabetes Facial nerve problems HIV infection or AIDS Multiple sclerosis Shingles Spine surgery

What are the symptoms of neuropathic pain?

Symptoms may include: * Shooting and burning pain * Tingling and numbness How is neuropathic pain treated? Some neuropathic pain studies suggest the use of nonsteroidal anti-inflammatory drugs, such as Aleve or Motrin, may ease pain. Some people may require a stronger painkiller, such as those containing morphine. Anticonvulsant and antidepressant drugs seem to work in some cases.

 How Nerve Pain Feels People with nerve pain feel it different ways. For some, it's a stabbing pain in the middle of the night. For others, it's a chronic tingling or burning they feel all day. Uncontrolled nerve pain can be hard to bear. But with treatment, it can often be controlled.

Understanding Nerve Pain

Pain is supposed to be a warning. When your hand gets too close to a stove, the nerves send a pain signal to the brain -- and you pull back before you burn yourself. But if you have nerve pain, that system isn't working. Damaged nerves may send false signals -- and you feel real pain without another cause. Or damaged nerves may stop you from feeling pain when you have an injury.

Nerve Pain Triggers

Some find that certain body positions or activities -- like standing in line or walking -may become painful. Nerve damage may also make your body overly sensitive. Even a gentle breeze on your face may become excruciating.

Loss of Feeling

Nerve damage may cause loss of sensation, making it harder to do things with your hands. Knitting, typing, and tying your shoes may become difficult. Many people with nerve damage say that their sense of touch feels dulled, as if they are always wearing gloves.

Nerve Pain and Sleep

Nerve pain is often worst at night. The touch of sheets or the pressure of lying down may be terribly uncomfortable. If you can't sleep because of your nerve pain, make sure to mention it to your doctor. Changing some habits or taking medicine could help

Losing Balance

In addition to dulling your sense of touch, nerve damage may decrease muscle strength. These two effects may make it harder to keep your balance -- and that could lead to falls. Assistive devices -- like braces, canes, or walkers -- may help.

Unseen Injuries

Nerve damage doesn't just cause pain. It may also cause numbness that may prevent you from feeling pain when it matters. People with nerve damage sometimes hurt themselves without realizing it. Your doctor may recommend that you check yourself for injuries regularly -- especially your feet.

Nerve Pain Progression

Left untreated, nerve damage may worsen over time. It usually starts in the nerves farthest from the brain and spinal cord -- like those in the feet and hands. Then it may move up into the legs and arms. However, if you get control of your nerve pain promptly, you may be able to stop the damage -and even reverse it.

OTC Treatments for Nerve Pain

Over-the-counter painkillers may be the first treatment your doctor recommends. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen -- or analgesics, such as acetaminophen. Other options include painkilling creams, ointments, oils, gels, or sprays that are used on the skin.

Nerve Pain: Prescription Treatments

There are many prescription medicines that may help with nerve pain. Some are powerful painkillers. Other drug types might help too. Studies have found that some medicines originally used for depression and epilepsy may also help relieve nerve pain.

Natural Treatments for Nerve Pain

Complementary or alternative treatments may help. For instance, studies have found that acupuncture may ease nerve pain. In some cases, nerve pain is caused or aggravated by a deficiency of vitamin B12. Taking supplements -- under your doctor's care -- could help.

 GENERIC NAME: gabapentin

BRAND NAME: Neurontin, Gabarone
DRUG CLASS AND MECHANISM: Gabapentin is an anticonvulsant that is used for preventing seizures and for treating postherpetic neuralgia. The mechanism of action of gabapentin is not known. Gabapentin structurally resembles the neurotransmitter gamma aminobutyric acid (GABA). It is possible that this similarity is related to gabapentin's mechanism of action. In animal models used for testing the anticonvulsant and analgesic activity of drugs, gabapentin prevents seizures and reduces pain-related responses. The FDA approved gabapentin in December 1993.

PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Capsules: 100, 300, and 400 mg. Tablets: 100, 300, 400, 600, and 800 mg. Solution: 250 mg/5 ml STORAGE: Tablets and capsules should be stored between 15-30 C (59-86 F). Gabapentin solution should be refrigerated between 2-8 C (36-46 F). PRESCRIBED FOR: Gabapentin is approved for treating seizure disorders and nerve damage from herpes zoster (shingles, postherpetic neuralgia). There are many non-approved uses for gabapentin. These include alcohol withdrawal, cocaine withdrawal, hiccups, restless leg syndrome, hyperhidrosis, headaches, diabetic neuropathy, hot flashes, and fibromyalgia. DOSING: Gabapentin may be taken with or without food. The recommended dose for postherpetic neuralgia is 1800 mg daily in 3 divided doses. The initial dose of 300 mg daily is increased over several days to the recommended daily dose. Seizures are treated with 900-1800 mg/daily in 3 divided doses. Withdrawal of treatment should occur slowly over a week.

 DRUG INTERACTIONS: Antacids reduce the concentration of gabapentin in blood. Therefore, gabapentin should be administered 2 hours or more after taking antacids. Morphine significantly increases blood concentrations of gabapentin and may increase central nervous systemrelated adverse events associated with gabapentin.
PREGNANCY: Safety in pregnancy has not been established. NURSING MOTHERS: Gabapentin is secreted in human breast milk. Nursing mothers should only use gabapentin if the benefits outweigh the unknown risk to the fetus.

 SIDE EFFECTS: Common side effects of gabapentin are dizziness, somnolence, ataxia, fatigue, fluid retention, hostility, nausea and vomiting. Other adverse events associated with gabapentin include hypertension, anorexia, bruising, joint pain, motion sickness, and pneumonia.
Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

 USES: Gabapentin is used with other medications to help control seizures in adults and children (3 years of age and older). It is also used to relieve nerve pain associated with shingles (herpes zoster) infection in adults.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Gabapentin may also be used to treat other nerve pain conditions (e.g., diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia).

 SIDE EFFECTS: Drowsiness, dizziness, unsteadiness, fatigue, vision changes, weight gain, nausea, dry mouth, or constipation may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these serious side effects occur: tremor or shaking, swollen arms/legs. Tell your doctor immediately if any of these unlikely but serious side effects occur: loss of coordination.

 SIDE EFFECTS: A small number of people who take anticonvulsants for any condition (such as seizure, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor immediately if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat/fever/cough, unusual bleeding/bruising, pain/redness of arms or legs, trouble breathing, fast/slow/irregular heartbeat, hearing loss, stomach/abdominal pain. A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

 PRECAUTIONS: Before taking gabapentin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease.This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially swollen arms/legs or loss of coordination.

Caution is advised when using this drug in children because they may be more sensitive to its effects, especially the mental/mood changes (e.g., hostility). This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. Gabapentin passes into breast milk. Because the effects of this drug on the nursing infant are unknown, consult your doctor before breast-feeding.

 DRUG INTERACTIONS:
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.See also How to Use section. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: antacids containing aluminum or magnesium, morphine. This product can affect the results of certain lab tests for urine protein. Make sure laboratory personnel and your doctors know you use this drug. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

 GENERIC NAME: ibuprofen

BRAND NAME: Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc. DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Other members of this class include aspirin, naproxen (Aleve), indomethacin (Indocin), nabumetone (Relafen) and several others. These drugs are used for the management of mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The FDA approved ibuprofen in 1974.

PRESCRIPTION: Yes GENERIC AVAILABLE: Yes