Hello,
Since you mention guitar playing and the hand pain along with the Neuro thinking of a pinched nerve in the neck.

I will suggest looking at our Thoracic Outlet Syndrome (aka TOS) forum.
It can be related to long term repetitive strain injuries, previous sports or whiplash injuries, with postural or hyper mobility factors, hypertrophic upper body muscles, extra cervical rib, anatomy anomalies...and more.
TOS forum
http://neurotalk.psychcentral.com/forum24.html
TOS forum useful sticky thread - a sort of crash course of info here-
http://neurotalk.psychcentral.com/thread84.html

My main question now is have you had any x ray / MRI to check for any c spine causes or anomalies?
And Dr did not rx any PT, just rx'd the meds?

Don't know if you looked it up but the med is an anti seizure med.
[Oxcarbazepine is used alone or in combination with other medications to control certain types of seizures . Oxcarbazepine is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.]
http://www.google.com/search?q=Trile...ient=firefox-a

If it was me , I'm not one to take meds if I don't really have to, so I would start weaning off as new dr suggests.
But also ask for MRI if none has been done yet or at least a xray of C & T spine..
also ask for an evaluation by advanced PT if dr does not mention it.
A really good PT evaluation is sooo much more thorough than what many MDs will do - PTs and chiropractors too, study the body & how it works structurally for many more hours than required for MDs.

On the TOS usefull sticky thread post # 1 has lots of therapy links & info on alternative therapies.

Thanks for replying

I did look up oxcarb. and while it's mostly a seizure med, it's also prescribed for "neuropathic pain."

I actually have an MRI of that next week. I had one years ago which is why my doctor put me on trileptal.

My main concern is how drastically my hands have started hurting as soon as I have lowered my dosage, and why my new doctor does not seem influenced by that fact.

What is confusing is she wants to replace trileptal with Effexor, but while I have anxiety issues I am not looking to be on an antidepressant. I don't understand how that is a suitable replacement when my main problem is hand pain in both hands.

Did the old MRI show a nerve impingement?
But either way -still no rx for any PT??

I just don't understand why drs will rx meds before having a patient try some quality PT?

Big pharma influences I guess.. keep a pt on meds keeps the dr in business...

Personally I'd look for a expert chiropractor or Phys therapist and ask dr for a rx if your ins requires that.

I had the best results and cheaper - with my very good chiro - than all the PT places I was sent to during mt work comp injuries...
I did also seek out an advanced PT on my own for verification of my injury and he did find & suggest another thing that was a major help for me that all the other PT's missed.


Do you think repetitive motions could be a cause or factor??
heavy computer , gaming, desk work , or texting usage?
any previous injuries to upper body?
head/shoulders forward postures?

If by PT you mean physical therapy:

Yeah I did physical therapy for a few months and it had no effect at all. That's what led me to moving on to a neurologist, because my hand pain didn't seem to come from any obvious injury or strain. PT did not do anything for my hand pain. Trileptal did.

I believe the old MRI showed nerve problems, but I guess we'll see what the new MRI shows. I just can't last much longer like this because weaning off Trileptal is really hurting me.

Oh also:

I don't think I do any more repetitive hand stuff than other people. Obviously I'm on the computer often, all that. But the pain and tingling feeling is equal in both hands, and all the hand doctors I saw and x-rays and etc had no explanation and all of the physical therapy I did did not help, in fact sometimes it felt worse.

All I know is then I got put on trileptal and it helped...NOT 100%...But it helped. And now that I'm weaning off of it, slowly, I am in a lot of pain. And this doctor absolutely refuses to keep me on it, even though it seems to be a common prescription based on what I'm finding online.

Why she'd replace it with an antidepressant is very confusing to me, and kind of disturbing.

Happy to see you have come to be with us. Just let us know if we can be of any help. There are great and caring friends here to assist you. Our shoulders are here for support in many ways. Seems you have been through some ruff times. Please keep us up to date.

Again welcome, looking forward to seeing you around. My thoughts and prayers are with you.

Darlene

--what the doctor did with you is actually fairly logical, but it certainly isn't the only way to go, as many of the other respondents here are indicating.

What you have described sounds like neuropathic pain, which is differnt from regular nociceptive pain; it is generated by erroneous signals from compromised nerves (not accurately signalling nerves indicating other tissue damage). In such cases, the first line of medication often IS an anti-seizure drug, as many of these are often used to stop or lessen erroneous signal patterns from damaged nerves. (The most commonly prescribed of these drugs is Neurontin, or gabapentin, followed by the newer Lyrica, or Pregabalin). Anti-depressants, such as Elavil, are also often prescribed, as, at lower doses than used to relieve depression, they alter neurotransmitter balance in the nerves enough to have an effect on the erroneous signalling.

Still, a search for the CAUSE of your symptoms is very important. Given the location of your symptoms, problems in the cervical spine nerve roots, problems farther down in the shoulder upper arm (such as Thoracic Outlet), and even farther down the arm at the level of elbow or wrist are all possibilities, as nerves can be entrapped/compresses at any/all these locations.

You do need compreshensive imaging from the neck down, and possibly some nerve conduction studies, to try to pinpoint just what is generating the symptoms. Then you can plan on a therapeutic course of action, which may include medications but also physical therapy, exercise, perhaps, in extreme cases, even surgery.