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Q. How to overcome my mental health issues due to chronic nerve pain after knee surgery

Answered by
Dr. Siva Anoop Yella
and medically reviewed by Dr. Himanshi Porwal
This is a premium question & answer published on Aug 06, 2022 and last reviewed on: Aug 11, 2022

Hello doctor,

I have had mental issues, and chronic nerve pain five years after knee surgery. I underwent treatment for nerve pain, but the pain did not subside. I took a neuropathic painkiller, but it had side effects. I have been experiencing difficulty in sleeping for the past year. I have mood swings, and I feel depressed. I am not interested in the activities and cannot concentrate on my work. I am worried about my future as I have a headache, fatigue, and mental disorder. Please help.

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Hello,

Welcome to icliniq.com.

According to the symptoms you have mentioned, it looks like you are suffering from insomnia, due to which you have symptoms of depression too. I suggest you take the tablet Pregabalin (consult a specialist doctor, talk with him or her, and take medications with their consent). Still, for your insomnia and depression, you might need antidepressants. Apart from this, I also want to know if you have been consuming any alcohol, cigarettes, coffee, or tea.

Thank you doctor for the reply,

To reduce the neuropathy, the specialists first tried various methods, which were not successful. Then they suggested the tablet Amitriptyline, but the side effects were too strong. The side effects of the tablet Pregabalin were very strong, but I believed less than Amitriptyline. The side effects and pain reduction need to be balanced, and I did not want to take a higher dose. These pain killers helped me for about one and a half years. However, I realized that pain reduction was significantly less when I started the medicine. I had to take a higher dose to experience the same pain relief as I did during the start. This scared me because this is not a sustainable path. I decided to stop taking medicine three months ago. Luckily it slowly started to improve again. My mental health slowly improved after I stopped taking medicine. I am very much in doubt whether taking Pregabalin is worth it. I realized that such neuropathic medications are not always right for me.

I would like to solve my mental issues without taking antidepressants. My most important issue is that I sleep very badly. I simply do not recover during my sleep. My stress level is significantly elevated during the night. Also, my breathing is elevated. I strongly believe I should focus on solving these issues first, as this has a strong cascading effect. I read that poor sleep can be caused by elevated cortisol levels. This cortisol can be elevated due to ongoing exposure to stress and chronic pain. Would it be possible to measure this and treat it?

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Hello,

Welcome back to icliniq.com.

I must say that other medications for pain relief and sleep could be taken with antidepressants. Hence I suggest you consult your psychiatrist for a better and significant improvement. Elevated cortisol levels are seen in stress and insomnia. Serum cortisol levels can be measured early in the morning.


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