First time poster
 

I've been reading the postings here and have found the information invaluable. Much thanks from me.

Though I haven't come across a scenerio quite like mine. I had my gall bladder taken out Novemebr last 30th. Everything went well, and two weeks post-surgery my surgeon told me it looked great, no limitations on anything. I asked him if that included going to the gym and he said of course, whatever you want. So I, very stupidly, went, where upon working out I thought I had ripped something, and was back at the hospital within a few days with severe burning pain across my abdomen.

Nothing showed up in the tests, and I went away for the holidays, where the intense burning pain worsened. My surgeon at this point washed his hands of me, saying he had no clue and sent me to a pain specialist, who said my problem was probably permanent. Outraged, I forced my way to a neurolgist and demanded every test there is.

From reading he stickies, I think I had every necessary blood test performed. There is no indication of any underlying cause other than the injury suffered from lifting weights. Also, the EMG/NCV study came back normal; the thoracolumar spine MRI was fine too. So I was diagnosed with small nerve damage, and was told by one neurologist that it should heal within six months, by another that it should be back to normal within a year.

The key test I've discovered is the skin punch biopsy for small nerves. My insurance, however, wants me to see the head of neurology here at UCLA (where all the above has occured) before appoving this out of network test. Medication wise, during this process I started on neurontin, which made me pleasantly high but had little effect on the burning pain. We switched to Lyrica at 150 a day, again nothing, so I raised if to 300, still not much effect. So now we are on to Cymbalta (30 a day), still no effect but it is having some negaive side effects. The only thing that helps the pain is the lidocaine patches, bringing the pain from a 7-8 to a 4 on a daily basis.

So my questions are, has anyone out there gone through this type of neuropathy? Does the diagnosis sound right? Is there anything I can do to speed along this process? Does anyone know of a place in Los Angeles that performs the skin biopsy test? Any suggestions on meds? And how do you get these lidocaine patches to stay stuck for 12 hours and, also, is it actually no good to use four patches at once? The warnings say three max, but so far nothing untoward has happened.

I think that's everything. Please excuse the length and the rambling nature of my post. Any replies will be much appreciated, as has reading the posts already here, as the past four months have been filled with somewhat debilitating pain and aggravation. It's been been both hope-inducing and calming just reading what others hav to say.

Thanks.

Is this pain
 

only at the surgical site?

I would keep using the patches. I found personally that for my MP pain, that the lidocaine eventually put the nerve to sleep and the nerves stopped firing
after 2 weeks.

Another thought is shingles. You can have a herpes zoster titre run to see
if you have activated the zoster virus. Sometimes there is only pain, and no
eruption with this. If the titre is very high, you can ask for Valtrex for a month, and it may help.

Where are you placing the Lidoderms? Only over the pain area? Try a second one around on the back on the side where you have the pain. I would put it a bit higher near the shoulder blade along the spine vertically...that way you will hit 4 vertebrae. If your pain is lower, in the abdomen, then lower on the spine accordingly.

I know a guy who had laparoscopic gall bladder removed...he had pain in one incision for YEARS. If you can get away with using Lidoderms and not the more centrally acting drugs with mega beaucoup side effects, you might
see some improvement over time.

Re: Small fiber skin biopsy
 

I had punch skin biopsies [2 places] to test for small fiber nerve damage. [BTW, I do have it.] My skin punch biopsies was performed by a dermatologist under the direction of my neurologist. The containers to place the specimens were supplied by the lab that was going to analyze the test. That was the lab at Columbia University. It is my understanding that the other lab that performs this analysis is in Utah. At the time I had my biopsies those were the only two labs in the country to do this analysis.

Someone in your network certainly can perform the actually biopsies. The insurance company is probably balking at the cost of the specimen analysis. I dug out my EOB from my insurance company for the lab charges. In October of 2006 the lab charged $1,716.00 to anaylze the 2 specimens. My insurance company paid them $1,348.04.

Two specimens must be taken. One is taken in the problem area. The other specimen is taken from an area without symptoms. That way there can be a comparison.

Re: Skin Punch Biopsy....
I had mine done at Johns Hopkins. Usually 3 areas are taken for samples. Mine was ankle, thigh & hip.
You seem to have switched meds quite quickly at comparatively low doses. It makes me wonder who has been demanding the changes- you, or your doc?
Usually 1800-3600 mgs of Neurontin (gabapentin) is the daily dose, and it is titrated up over at least one month's time to arrive at the desired level.
Lyrica is minor at 300mgs/day.
You don't seem to have been given a combination 'cocktail' to affect the symptoms & pain. Usually a pain med (like Tramadol) iis given, along with the Neurontin or Lyrica. This can be up to 400mgs/day in divided doses.

Seeking a consult with the chief of neurology at the hospital, is a good thing.
My neuro is the head of the dept at Hopkins.
There you will have available the whole dept of neuros, one of which should be a PN specialist.
He's the one to see, and the one to start you on a serious regimen of meds.
You've got to titrate up to levels that work. I was up to 4200mgs/day of Neurontin (& 400mgs/day Tramadol) before switching to Lyrica (600mgs/day) & Tramadol.

Hi Dennis11 - welcome to NeuroTalk! :welcome_sign:

I see you've already gotten several responses to your first post! I'm sorry you're having such a hard time with pain right now. Hopefully someone can offer you some suggestions as to what they have done about their pain. I'm glad, though, that it's been helpful for you to read over the last several months. :hug:

Kelly

I'm sorry that I can't add anything to the answers that you've already received Dennis, but I still wanted to welcome you to NeuroTalk just the same.

I hope you get the answers that you're looking for, and good luck with getting approval for that biopsy.

LA and Testing
 

I Live in LA - and it really doesnt have the resources that those back east have for care here! If you can get in to see head of neuro at UCLA - that would be great - I started my quest there and never got to see more then a resident there though - with no answers - and an appointment with a "regular" doc was more then a 9 month wait... however, I have had biopsies - one done at a more local hospital where I live now for sural nerve that was then sent to UCLA for analysis - another done at a local cancer center with directions from the Boston Amyloid center after I contacted them myself (I had one local positive biopsy and wanted it cofirmed) - the center did the biopsy according to Boston's instructions and sent it back to them for evalaution....... (and they got a negative so its still iffy)... However, may be worth it to find out if the skin biopsy can be done if there is a super long wait by someone else and then then sent on for evalaution to another center that is versed in reading these.....

It also sounds like your insurance company may be balking a bit about the expense and using this as an excuse - I'd inquire a bit more into it!

:winky:

Thank you for the information.
With respect to the meds, it was the pain specialist who made the changes. I brought up increasing the dossages, but she wanted to change...

Did you find with Lyrica that it didn't work at lower dossages for you until you got to 600mgs a day?

I'm not familar with Tramadol. What group of meds/type of pain med is it?

Hi and Welcome, Dennis!
 

Tramadol is a pain reliever and comes in two forms...slow release and regular. Tramadol is a narcotic-like pain reliever, a synthetic opioid. You can read more about it here:

http://www.drugs.com/tramadol.html

I take Tramadol. It's about the only thing that relieves the burning and other types of pain I experience from PN. The risk of addiction with Tramadol is very low, especially for what I take it for. It can be used long term. There are people here that have used it for years.

My doc wouldn't put me on Lyrica (for the RLS - Restless Leg Syndrome) because it's related to Neurontin which made me suicidal. I took Neurontin for PN. It did work for a bit. But soon I had increased pain and my dose was doubled. That's when I became suicidal.

I currently take Mirapex for the RLS and it seems to help the PN symptoms somewhat. The burning I still experience but it's not as bad as it was. Thanks to the vitamins I take. Check out the stickies at the top of the forum. There's a lot of really good info there. :)