Dr. Prakashkumar P Bhatt
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have severe chronic nerve damage pain in my right elbow and arm. I am having issues with nerve damage, Lyrica has stopped working, I take 150 mg in morning and 300 mg at night. Still not helping. I feel like I am getting worse. Struggling to hold things, pain in right arm and elbow, struggling to manage from day to day activities. I need help with managing the pain.
Hello,
Welcome to icliniq.com. You are suffering from severe chronic neuralgic pain in the right upper limb. You are taking an optimal dose of Lyrica but as per you, it is not working now. I will request you to share your previous investigations or laboratory and neuro electromyographic reports to me. Why I am asking about this because of chronic nerve damage due to what and how much nerve damage occurred that we have to clarify. If we can treat the root cause then why should we focus on pain? Still, we gave many options for pain relief. I will suggest Gabapentin 400 mg + Nortriptyline 10 mg once daily for three days, then twice daily. And if still, it is not working, then I will add Duloxetine 30 mg once daily. But, my advice will be to go for a complete evaluation, if not done and if evaluated completely then you can start Gabator NT.
Patient's Query
Thank you doctor,
Can you help me with this?
Hello,
Welcome back to icliniq.com. Please send your reports for further guidance.
Patient's Query
Hi,
Thank you doctor. I have sent you my files.
Hello,
Welcome back to icliniq.com. I have gone through your details (attachment removed to protect patient identity). It is post-traumatic chronic neuropathy affecting your right upper limb, which was initially well controlled with Lyrica but now it is refractory to it. Many times such neuropathic pain needs to increment the dose of these anti-neuralgic pain medications. You have two options: 1) We can add a new drug. 2) Do magnetic resonance imaging (MRI) of the right upper limb to find out any compressive lesion to the nerve at and above the elbow. I think you should go for adding another drug. Please add tablet Gabator NT (Gabapentin 400 mg+ Nortryptilline 10 mg) once daily after food for three days. Watch for tolerability and if no issues then make it twice daily after food. Simultaneously, you carry out the ultrasound and magnetic resonance imaging of right upper limb nerves. If no compression of lesion found then one option is surgical exploration to find out subtle adhesion of nerve, for same you can contact your neurosurgeon or peripheral nerve disease specialist.
Patient's Query
Thank you doctor,
How do I get that medication? And do I take that instead of the Lyrica? Also, can you organize an magnetic resonance imaging (MRI) just in case as well? I have been so worried and it is affecting my daily activities. I am struggling so much. I am willing to try anything at this point. Please, can you organize the medication and the MRI to see what is going on? And do we need the last option?
Hi,
Welcome back to icliniq.com. Gabapentin, you have to get prescription from your local physician. It is easily available. After starting Gabapentin you will need to stop Lyrica slowly over three weeks to decrement Lyrica dose at 50 mg every fifth day.
Patient's Query
Hi doctor,
Thank you so much.
Hi,
Welcome back to icliniq.com. You are most welcome. Take care.
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