What to do for neuropathy?


Question from Rita: I still have pain from Taxol, neuropathy in my fingers, and it really hurts bad sometimes. What can I do?
Answers - Ann Berger The same medications we've talked about before—the tricyclics and antidepressants, like Desipramine, Nortriptyline, and Elavil—are some examples. Also, drugs like Neurontin, Tegretol, or Dilantin. The other thing would be going for rehabilitation medicine. They actually do things like what they call sensitization. They work with exercises with balls, and they are sometimes able to help neuropathic pain.
Marisa Weiss, M.D. There are some pain management protocols that include both Neurontin and Glutamine with significant success. These are still in the research phase. Again, this type of pain can be very difficult to manage. I have a patient, for example, who had trouble walking because of this type of pain in her feet and ankles. But miraculously, about six months after her treatment was over, the pain did go away, and she was able to stop all these medications.
Ann Berger In conjunction with these medications, one may be giving morphine-type medicines, opioids, which usually will take the edge off. They will take the pain from a ten to a seven, but not take away the pain totally.
Marisa Weiss, M.D. Dr. Berger, would you agree that insomnia and chronic sleep deprivation can make any pain worse than it has to be?
Ann Berger It's cyclical, because pain causes insomnia, and it works both ways, but absolutely.
Marisa Weiss, M.D. Are there sleeping medicines that work well or don't work well with the pain medications we're discussing here?
Ann Berger I never add sleep medicines, because the tricyclic antidepressants and the gabapentin (Neurontin), the anti-seizure medicines, as well as the opiates, are extremely sedating. That's usually the limiting side effect in terms of not being able to increase doses, and so what I would normally do is give those medicines at night, or more of it at night to help with sleep, but then I know I'm taking away the pain. The sleep medications that are generally used are more benzodiazepines like Ativan.

Those medicines are not going to help the pain, so you can make people sleep better, but they will wake up in pain. My goal is to help the pain, and all of them make people so sleepy that, if you give enough of them, you don't need to give an extra sleep medicine.
Marisa Weiss, M.D. If some of you are experiencing pain as well as hot flashes, the hot flashes coming from early onset of menopause or related to medications you're taking, the good news is that some of these pain medications can also improve hot flashes.

On Wednesday, April 17, 2002, our Ask-the-Expert Online Conference was called Breast Cancer Pain. Ann Berger, R.N., M.S.N., M.D. and Marisa Weiss, M.D. answered your questions about managing pain caused by breast cancer and breast cancer treatments.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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