Since both my knees are shot I decided to get the right one replaced on June 1 of this year. Little did I know that he PN pain in the bottom of my right foot would go through the roof. I also contracted cellulitis the day after I got home from the hospital which I think contributed to the increased pain.

Just prior to the surgery (in march) I visited a new neuro who suggested I add Triliptol to my existing cocktail – 1800mg of Neurontin, random Tramadol, B12, Folic acid, Acetyl l-carnitine, R-lipoic acid, Slow mag, Vit D, Fish oil, Lidoderm patches,Epsom salts for soaking and Hydrocodone for flare ups. My heels had been bothering me quite a bit so I went along with the Triliptal.

Initial dosage was 300mg at breakfast and 300mg at bedtime. After about 6 weeks he titrated up to 600 mg at both times. I began to get some trembling/shaking in my hands so he changed the morning dosage back to 300mg which seemed to help the shaking. Pain in the heels seemed to be slightly better.

Following the surgery and the discovery of the increased PN pain under the foot, new neuro prescribed 25mg of nortriptyline. After 1 week, he titrated up to 75mg at bedtime while still taking the 900mg of Triliptal. Foot pain has decreased somewhat but now the trambling/shaking of my hands has increased. I have also noticed a rash on my forehead. Also, the therapy needed for the knee further aggravates the PN.

At this point I am not sure what to do. My neuro wants me to stop the nortriptyline and go back to my 50mg of Zoloft , continue with the Trileptal and add a Butruns patch!.

I am not sure what is causing the shaking and rash? Could be the Trileptal or the Nortriptyline! But something has helped with the burning feet?

Also, after reading some older posts it looks like Amitriptyline is a better choice for PN?

Any help with the combo of drugs I am taking would be greatly appreciated. Thanks.

Sounds like a real ordeal:

Carbamazepine and its cousin can cause rashes:
http://epilepsy.emedtv.com/carbamaze...e-effects.html

Should be reported to the doctor! My general feeling is that Trileptal is pretty toxic in many ways over the long haul, and maybe you'd do better without it.

Nortriptyline and Elavil are basically the same. Elavil (amitriptyline) is metabolized in the body to nortriptyline.
It can also cause rashes when you are exposed to the sun.

I think any pain, makes PN pain worse. I think we get sensitized to pain in some ways. For example, and this is a small example:

I scraped a thin layer of skin of the back of my left hand when I hit a sharp edge of a piece of furniture the other day. It didn't even bleed. So I cleaned it off, and put triple antibiotic on it just in case. The the next day my whole hand was throbbing. No oozing no redness just pain. So I started covering it with a bandaid, and antibiotic ointment and it healed up very fast...but it still HURTs and now it itches too. It is a very small injury...I mean a very very little thing. So why is it hurting so MUCH?
I took the bandaid off today and it is totally healed up...but still hurts! I am leaving the bandaids on it for a couple more days.

I've noticed that small things like a mosquito bite can hurt like the dickens too! I had one on my calf the in June and it felt like a knife stab! This is relatively new for me...so I guess it is PN related in some way?

So I imagine a knee replacement would be awful too. A person I worked with had one and had to take oxycodone for over 6wks afterwords! Expect pain I guess!

What did they give you for that cellulitis? Cipro or Levaquin? That would totally aggravate PN IMO.

mrsD - at the emergency room they put in a IV and gave some antibiotic that way (don't remember what it was) and then the doc gave me a prescription for Bactrim. I took all of the Bactrim and the cellulitis seemed to be better.

What about the shaking? Any thoughts?

Your right about an ordeal. A total knee replacement is a huge trama to your body. Until about 2 weeks after the suegery, when I got off the percocet, I then realized what it had done to the PN. Before the surgery it was pretty much isolated to the foot/ankle area but now it runs down all the way from the knee. And to complicate matters, the therpy I must do for the knee continues to irritate the PN. I stiil take an occasional Hydrocodone to get some sleep or to calm things.

So it doesn't matter if I take nortriptyline or amitriptyline, it all turns out to be the same in your body?

Thanks so much for your feedback.

"new neuro prescribed 25mg of nortriptyline. After 1 week, he titrated up to 75mg at bedtime while still taking the 900mg of Triliptal. Foot pain has decreased somewhat but now the trambling/shaking of my hands has increased."

did the trembling start straight after the nortiptyline? I had exactly the same. Also eg when I clasped my hands in a preying motion and squeezed hard my arms would wobble like crazy. I stopped the nortriptline after 1 week and my full strength came back and no shaking, second time I started back on the nortriptyline the trembling returned.

Hi alttom, your note was posted as a link to my questionings about the effect of knee replacement on neuropathy of my feet. I was trying to find people like me with neuropathy who've had knee replacement and if it made the neuropathy worse. Sounds like it made yours worse which I'm sorry for your discomfort. Now its been several years since your knee replacement so I was wondering how is your neuropathy now? Do you think its made the neuropathy worse permanently or just during the rehab from the knee replacement? Thanks, Skippyfeet

Hi there, I am also very sorry for your discomfort Alttom. I have never posted on any thread ever before, but my mom who has pretty severe PN would like to have knee surgery, as she can barely walk due to "bone on bone" in her knee. I am extremely concerned that the knee replacement will increase her pain. I too was also hoping to hear if Alttom is feeling better.

I would also love to hear from anyone else who has PN and had a knee replacement and how their experience was.

Thank you very much and much sympathy to all of those suffering from PN.

Hi, you may hear from others on knee replacement issues BUT I deal with nerve damage from hip replacement in 2010...from this surgery my OA knee is way worse as is my foot/ankle, it's all connected. I pretty much got rid of my 5 yr long burning issue but 80% of my thigh is still numb. I do all I can to NOT do knee surgery. Ride my recumbent bike "easy", do cycle work on my bed to keep knees moving, creeking and all. Wear knee support and foot support and use supplements and topicals. I had hip done at 72 and that was just over 5 yrs ago. I use a few pain meds and supplement pain products.

Still thinking about Prolozone injections for the one knee and you can read up on Prolozone and arthritis. There is a lot of info out there. This is my story.

Hi Caroline - Thank you very much for your reply. I really appreciate your sharing of the alternatives you use to avoid knee replacement...recumbent bike, supplements, topicals, wearing knee supports. I will share this information with my mom. Really appreciate your feedback and hope you are doing well!

I had a knee replacement several years after the PN--just couldn't take the bone-on-bone any more. Everyone kinda felt I was being a real baby with the knee pain as it didn't get much better until sometime between the 7th and 8th week BUT I really didn't notice the PN pain/burning so much during this time--I guess the knee superceded the foot (?), or else the pain pills for the knee were also working on the PN--I'm not sure.

I was very conscientious about doing the exercises and now my 5-year old knee is doing great--it never gives me any trouble but I'm back to dealing with the burning legs and feet once again. Any of the lotions with menthol really help with the burning!