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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I have been diagnosed with both large and small fibre

Customer Question

I have been diagnosed with both large and small fibre neuropathy. What do you think is the most effective treatment? I have been on every one of the meds with no relief. Had a spinal cord stimulator focusing on my feet and it only made the pain worse. I had it removed. I am considering a treatment that involves 16 treatments of morphine injections in my feet (3 on each ankle and 3 on the top of the ankle) followed by tens unit treatment. I am at my wits end and unable to do most activities. I would love to hear your perspective.
Submitted: 10 months ago.
Category: Neurology
Expert:  Dr. Frank replied 10 months ago.

Hello welcome to JA. I will review your statement and reply shortly. Please read this preliminary answer and respond. Dr Frank

Expert:  Dr. Frank replied 10 months ago.

I have to admit you have tried most meds for neuropathic pain. You didn't mention duloxetine ( Cymbalta) but I expect you might have tried it??? Send me more information. Do you have essential neuropathy? Or some known reason? Have you had an immunologic workup with quantitative immunoglobulins to exclude CIDP ( chronic inflammatory demyelinating polyradiculonueropathy) ? What about the BUTRANS patch weekly ( buprenorphine)? Get back to me to discuss the matter further or rate my service if satisfied. Dr Frank

Expert:  Dr. Frank replied 10 months ago.

I have never heard of morphine injections in the feet or ankles. It does not make sense to me. Another alternative treatment that I saw at the AAN conference that shows promise is LLLT low level laser treatment but I have no personal experience. Dr Frank

Customer: replied 10 months ago.
No known reason for my neuropathy. I have had nerve biopsies that showed the large and small fibre neuropathy. I have been to both Mayo and Duke and they can not figure out cause. I have tried Cymbalta to no avail. My PCP just ran some tests that test positive for connective tissue disorder (same results in the past) but when they test further nothing tests positive. I honestly can't say if I have been tested for CIDP but I will make a couple of calls tomorrow to find out. Are the Butrans patch anything like lidocaine patches? I did not tolerate them at all plus they didn't help the pain. Do you know what the success rate is using LLLT? The clinic that I am supposed to get the morphine injections say they have a 90% rate for patients with some level of relief and 30% total relief. Limited to peripheral neuropathy only. I am beyond desperate for relief! As you can imagine!
Expert:  Dr. Frank replied 10 months ago.

I cannot imagine not getting a response to all you have tried. The peripheral nerve research clinic/lab run by Dr James Dyck at the Mayo clinic in Rochester is really the best place I know in the US, so if they cannot figure out a reason for your neuropathy, I don't think I am going to get an successful answer as to why from here. Butrans patch is buprenorphine, a neutral agonist of opiates, so it is like methadone, providing long half life opiate relieve from pain, but not with the euphoria/somnolence that is part of using opiates. The patch provides one week of continuous infustion of buprenorphine, and my patient do well on it with chronic pain. Obviously it is just providing pain relief. Your nerve biopies were tested for CIDP if you went to the Mayo. If you have the report, I would love to look at it, just upload the record minus your name as this is a public forum. Was your ANA positive, and then the dsDNA test for lupus negative? I can explain those blood tests if you need that information.

The LLLT treatment as reported at the Academy Meeting suggested around 15 % reported improvement above placebo (sham light stimulation in a double blinded study) which is not too bad. Patients in the group were mostly diabetic neuropathy patients, with both demyelinating and axonal injuries to their nerves. Please get back to me if I can help. Ask questions and I will respond. In terms of your opiate injection therapy, I really cannot comment as I have never heard of it, but given your history, I don't think you have much to lose. You might ask your pain management doctor about the butrans patch though. dr Frank

Expert:  Dr. Frank replied 10 months ago.

Sue. I hope I was able to send you the information you need to get some resolution to your problem of pain as it relates to neuropathy. I am here to answer your questions or discuss this further, just reply. If satisfied with my answer, please remember to rate my service by clicking on the rating stars, as that is how I am compensated for this work. thanks *****