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Very painful PN
Aug 22, 2004

My partner of 19 yrs. has painful PN. Nothing yet has helped,Vicoden,Percoset,Fenatyl patches, Dilauded, Neurontin, and Morphine. he's been positive for 12 yrs, at least in treatment. He cannot walk & is great pain at ALL times. We have been to many neurologists & to apain clinic. They say they can do no more. Can you help? Thank You

Response from Dr. Conway

I am sorry to hear of this serious problem. First, I would want to make sure that there is nothing else going on (such as thyroid disease, diabetes, syphilis or B12 deficiency, as examples) that can be treated more specifically. I would then want to know that this, in fact, neuropathy and not some other condition with similar symptoms. Nerve conduction studies are useful here.

Assuming it is neuropathy, I try to avoid the use of narcotics. They seldom work well, and a person may well develop dependency. I use regular and high doses of non-steroidal agents for acute severe pain. More chronically, I use amitryptiline and neurontin. I have found that some people are reluctant to use the doses that may be necessary to produce relief. I will push to 200 mg/day of amitryptiline and 1200 mg three times a day of neurontin.

I hope some of this is helpful to you and your partner.

painful PN
Phenotypic testing

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