HI I am a neurologist and can try to answer your question
Hi I was hoping that you were online so we could chat about your problem.
but you are offline,in australia, so it should be about noon there, it is midnight here onthe east coast US
so anyway, I will leave you my answer and you review it. Please just ask questions if you feel I did not answer your question, or hit the accept button (the green button) if you feel I satisfied your needs and you have nothing to ask. and thank you.
so I have a 70 year old male with a pain that he describes as starting on the left side of his back, my guess is that he means the trapezius muscle border on the back and then comes around the front to cause a "shooting " pain around the stomach. You state that both doctors dismissed this as the shingles and you cannot reason that.
Here is my answer. What you describe is "shooting pain" means that it is radiculopathic in neurologic terms, it starts from the nerve root as it exits your spinal cord and travels in the nerve as it circles around to your front. this is neuralgic pain,and it seems to follow a "dermatomal" distribution, meaning that it stays within the distribution of a nerve coming out of your back, it is a strip of sensation, it doesn't move up or down much but should stay in about the same place. Well, my opinion is that you doctors are partially right. You may not have shingles, but you might have had the shingles rash there at one time of your life (although you don't need to have ever had the rash there) but now you have something called post-herpetic neuralgia of PHN. phn is a disorder where a herpes family virus (herpes zoster, the virus that causes the measles and shingles) lives in the nerve, actually in a part of the nerve we call the dorsal root ganglion, and causes mischief in interrupting pain fibers in the nerve which gives you pain. YOu don't have to get the rash every time, or actually it is rare to ever see the rash again, but you can have continued pain complaints that come and go for the rest of your life. that is the truth.
So if you have PHN, oh hi, are you there?
please type something if you are there
so anyway, the treatment for PHN is a few medications that can be tried for treating this type of pain. they are called neuropathic meds, aand youhave them is australia because I have a few pts from there on them.
Yes I am here.
the first is neurontin or gabapentin, then there is Lyrica or pregabalin, and there are other treatments like putting a lidoderm patch, a skin patch filled with lidocaine, right onthe area that hurts when it hurts. You have to discuss this with your doctor.
oh high, i am just finishing up please read this and we can chat
What is the treatment for the PHN?
There are several medications (they are listed there ) that you have to take continually during the time the pain flares. Are you having pain all the time or does it die down occasionally?
is it a burning pain?
we have a bad connection, so you cannot write me on chat. so read what I put down, there are other types of medications like trileptal (oxycarbamazepine) that you can try, but they all have to be taken on a regular basis every day during the time you have pain.
I will switch to the Q and A, please remember to hit the chat if you feel I answered your question and thank you. Dr. frank T
the problem still sounds like it is probably PHN, but there are other conditions that can cause neuralgia. Depending on the rib you are talking about, you should image with xray the vertebral body and the rib itself to make sure there is nothing entrapping the nerve along its way to your abdomen, if the Xray is suggestive of a lesion, then you need a follow up CT scan of the same area. Is the area on your abdomen hyperpathic, which means if you touch it lightly with your eyes closed, it feels wierd or hypersensitive? That would suggest that this is more PHN. if it is numb or less sensation, then think about a nerve entrapment problem. Hope that helps. Dr. Frank T.
HI If lidocaine doesn't seem to help , then you can try capsaicin creme. It is a substance p depleter, so it takes a while to work, and may actually burn more when you first try it. I am attaching an abstract about using it, they recommend low dose creme for starters, about 50% reported a dramatic improvement.
J Neurol. 1991 Dec;238(8):452-6.
Peikert A, Hentrich M, Ochs G.
Neurologische Klinik und Poliklinik, Technischen Universität, München, Federal Republic of Germany.
In order to evaluate the efficacy, time-course of action and predictors of response to topical capsaicin, 39 patients with chronic post-herpetic neuralgia (PHN), median duration 24 months, were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain on a visual analogue scale (VAS) and a verbal outcome scale. A follow-up investigation was performed 10-12 months after study onset on the patients who had improved. Nineteen patients (48.7%) substantially improved after the 8-week trial; 5 (12.8%) discontinued therapy due to side-effects such as intolerable capsaicin-induced burning sensations (4) or mastitis (1); 15 (38.5%) reported no benefit. The decrease in VAS ratings was significant after 2 weeks of continuous application. Of the responders 72.2% were still improved at the follow-up; only one-third of them had continued application irregularly. Treatment effect was not dependent on patient's age, duration or localization of PHN (trigeminal involvement was excluded), sensory disturbance or pain character. Treatment response was not correlated with the incidence, time-course or severity of capsaicin-induced burning. If confirmed in controlled trials, the long-term results of this open, non-randomized study might indicate that the analgesic effect of capsaicin in PHN is mediated by both interference with neuropeptide metabolism and morphological changes (perhaps degeneration) of nociceptive afferents