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NEUROPATHY
Nov 6, 2000

My Dear Doc:

Does Neuropathy is a special med term for HIV only? Or it relates to pain that causes by many reasons?

If the neuropathy is HIV-related, is there any treatment for it? What kind of medicines will help to reduce the pain immediately? Should HIV infected patients have the virus put under control first before starting treatment for neuropathy?

Thanks DOCS. We love you all.

Response from Dr. Cohen

Thanks. We love you back.

The word neuropathy is simple -- is means Damaged Nerve, in latin. So many things can injure nerves that the term is universal. It is Not just for HIV related reasons.

As for managing the neuropathy pain -- first it makes sense to figure out why it is there. And then if possible treat it, and HIV itself, at the same time. It may be that HIV itself causes nerve pain -- so that the treatment would be to control HIV itself. It may also be that someone gets neuropathy as a side effect of the antivirals -- in which case we just try to either reduce the dose or make a drug substitution as a treatment.

As for pain relief, there are several approaches. There are meds that just relieve pain -- like aspirin and ibuprofen and others in that category that people take for pain. Like codeine, and other stronger narcotics, that some might take for pain control. Some will also try other classes of meds -- for example some of the meds that are primarily used for seizures might have control nerve pain. This is mainly shown for two meds -- lamotrigine and gabapentin. Some appear to find benefit from meds called tricyclics -- often used as antidepressants as well. However there are fewer data that support the use of this class despite some who clearly find them helpful. Finally there are other approaches some find helpful -- like acupuncture or massage or other non-drug approaches.

Hope that clarifies.

CC

Cal Cohen, M.D., M.S.



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