Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.
waiting for you to come online
what other info do you need
so why the radiation, where is this exactly?
Skin cancer, basal cell, approx. 5" above my left ear and directly in the hair line.
so have you tried topical meds?
There is nothing to put a topical med on. Treatment was finished in April.
you would smear a creme over the area that hurts. I assume it is an area starting at your mid temple, and going up to the vertex of your head? If it is in the hair line, you may not be able to smear a lot of creme in that area
do you have burning Pain?
do you have numbness?
Don't understand why it would help. The pain is the size of a man's hand, my eyebrow has sagged and it is all painful to the touch including my eyebrow.
capsaicin is a topical substance P inhibitor
you put it on the nerve end fibers in an area that hurts
it depletes the nerve of all the neurotransmitter to send pain signals
and it stops hurting
you need to cover it daily with a creme, cover the entire area that hurts
the creme will burn when you first use it, until you run out of substance P
and then you will not feel pain from that area
the alternative is to use neuropathic meds like you are currently doing
gabapentin at up to 1800 mg a day is indicated
Yes it is a burning pain, wish I had numbness. How could I use it in an area this large. If you put your hand on my eyebrow and fingers into the hair that is the area that the pain covers.
or there are other medications like pregabalin (Lyrica), or duloxetine (Cymbalta)
it would be difficult to cover that area
have you tried a supra orbital nerve block?
let me show you a picture
if you look at that picture, you will see the nerve as it comes out just above the eyebrow
you numb it with a long acting medication, like marcaine and you get pain relief for a week or so
it that is the right nerve causing the pain
no I haven't. Do you think the diagnosis is correct? The radiation area was right above the longest nerve in the picture.
yes,, that is just a drawing, the nerve comes up out of the supraorbital notch, If you feel your eyebrow and work towards
your nose, you will feel a notch in the bone right on the ridge of bone above your eye
that is the supraorbital notch
you can even push on the nerve at that point, and it may change the quality of the pain from the scalp in that area
so the nerve extends back on your scalp all the way to the middle of the top of your head
What would the supra orbital nerve block do, what is it?
well at that point on your forehead, just like in the drawing where you see the needle
you inject a combination of steroids (depomedrol which is methylprednisolone)
and lidocaine/prilocaine (Marcaine)
and that will numb up the nerve for a week
if that works, you can use agents like xylene
to numb up the nerve for a longer period
since you have had this for 4 months or so
I don't know if it is going to get better, has it become less intense over time?
No, it's becoming more intense expecially above and the eyebrow. Is there ever a cure for this or do You have to learn to live with it.
There are cures
you have to see a neurosurgeon that specialises in peripheral nerve surgeries
you would have a neurolysis of the supraorbital nerve
that may leave you with an area of numbness on your forehead
but you would not have pain
that would be an extension of the nerve blocks if they helped
What do they do, cut the nerves? I'm 72 and have health issues.
they would cut the nerve and bury the stump in an area under your eyebrow
you may not want that
but alternatively, there is only the shots to block the nerve signals
or the medication, which you said was not helping????
how much gabapentin have you tried?
For 12 days and I'm up to three a day. He wants me to go up to five a day and I will but the doctor is a dermatolgist and isn't sure they will help or what the prognosis is. He's never had this happen before.
are they 100 300,400, or 600 mg tabs?
well you can take it up to around 6 a day, but you should be seeing some improvement if you are taking 3 a day for the last 4 days
you may not see a complete resolution, but some improvement???
Thank you for your help although I'm a bit discouraged. I'll find a neurologist in OKC but probably can't get an appt. for 6 months.
I would suggest a supraorbital block with just lidocaine, as a diagnostic test
to see if you can abolish the pain, if even for a day
then you can consider other options than daily medication
Thanks again, I'll let you go now.
ok good luck
Dr Frank T