DEAR DR. GOTT: I am a 70-year-old woman who developed shingles on my right leg last June and am now left with neuropathy. It went from the middle of my leg all the way down to my foot and toes. I was immediately put on an antiviral and a prednisone pack, so the doctor was surprised that I developed post-herpetic neuralgia. My leg and foot are completely numb and I cannot bend the right foot upward, so I wear a boot and go from a wheelchair to crutches and then to bed. It is causing excruciating pain.
I have seen two neurologists, who both ordered MRIs of my spine, an EMG and nerve conduction tests. Both dismissed me, saying there is nothing more they can do for me. The last neurologist suggested I see a pain management doctor. I saw one two weeks ago and am getting epidurals in my spine. The first one didn’t help, so I am hoping to get some relief with the second one, because as soon as I can get out of some of this pain, I can try a physical therapist to help me walk with this dropped foot.
I am currently taking 300 mg Neurontin four times a day, 25 mg Elavil twice a day, 40 mg OxyContin twice a day, and 150 mg Oxcarbazepine twice a day. One of these is causing me to have some involuntary movements. Do you have any thoughts on this?
I read your column daily and was hoping that you would have some input on my condition. I went from feeling fine to waking up one day and having my whole life turned around. The first neurologist I saw told me that I would never walk again, and the second one pretty much said the same thing because he had never seen a case like mine where the neuralgia is paralyzing the leg and foot. Any help you can give me would be very much appreciated.
DEAR READER: The most common symptoms of post-herpetic neuralgia (nerve damage caused by shingles) are pain and sensitivity to any light touch of the affected area. Less commonly, itching and numbness may be present. Rarely, weakness or paralysis of the area may occur. You appear to be one of those rare cases.
Treatment typically consists of opioid painkillers (narcotics), certain anticonvulsants, tricyclic antidepressants, and lidocaine patches (a topical anesthetic). You have been prescribed Neurontin, an anticonvulsant; Elavil, a tricyclic antidepressant; OxyContin, a narcotic; and Oxcarbazepine, another anticonvulsant.
Some patients may find relief by using a topical cream that contains capsaicin. Many readers have also written about the qualities of mentholated chest rubs in relieving numbness, tingling and pain associated with peripheral neuropathy, a similar type of nerve damage.
You may benefit from seeing a super-specialist at a teaching hospital if you fail to improve under the care of your newest neurologist. You may also profit by seeing a pain specialist, who may be able to help you control your pain levels, thus allowing you to begin physical therapy. You must keep in mind that despite appropriate care, the damage may be permanent.
Readers who are interested in learning more can order my Health Report “Managing Chronic Pain” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title when writing, or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
