Hello Dr Henry:

I am an HIV Case Manager and am looking for some advice in a complex situation regarding neuropathy. My client who is sitting here with me has been experiencing "firery painful feeling from his feet up his legs to his extremities, up his arms, and up his face, flu-like feeling w/o a fever." He has been followed closely by his PCP and ID specialist since 2000 and by his neurologist since 2001. His PCP is against pain management and narcotics, and his neurologist is prescribing pysch meds, including Zoloft, Neurotin, Valume, Vicodin, Topamex, etc for his neuropathy. However, my client states his pain gets worse, he is sleeping little to nothing w/ sporadic awakenings. His PCP doesn't want to switch his anti-viral regimen b/c it works. While my client is sober and in recovery, he also knows that pain management might be the only option to maintain a functional lifestyle. Any advice would be greatly appreciated as we try to balance the line between a PCP who is against narcotics and a neurologist who just prescribed less Vicodin this month and will prescribe more pysch meds (Zoloft) as time goes on.

Sleepless in Salem

It sounds like he is getting fairly good care and has a challenging situation which is often frustrating. If he is on an HIV or other med that aggravates neuropathy then strong consideration should be given to switch off that medicine if possible. When I am faced with similar challenges I often get a pain specialist involved to work on the pain symptoms and to be responsible for the use of both narcotic and non-narcotic presciptions. Pain is a huge problem which is crucial to provide help for. KH