Q. My friend is suffering from neuropathic pain after a thalamic stroke. Please help.

Answered by Dr. Hitesh Kumar and medically reviewed by iCliniq medical review team.

 

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Hi doctor,

My friend, who is a 48 years old female, suffered a CVA three years back. She was diagnosed with a right thalamic hemorrhagic stroke with pericardial effusion, left hemiparesis, autoimmune thyroiditis, hypertrophic cardiomyopathy, ischemic unstable angina, grade 3 obesity, altered glucose tolerance, and depressive disorder. She suffered a CVA after a high blood pressure episode, and her BP was 240/120 mmHg. Subsequently, a right side adrenal nodule and Cushing's syndrome were discovered, for which adrenalectomy was performed, following treatment with Glucocorticoid. The cerebral CT performed three years back showed thalamic hemorrhage.

Now, she has left-sided spasticity in the leg and arm, left-sided sensory loss, and neuropathic pain. For endocrine problems, she was given Prednisone 5 mg and Synacthen 5 mg. The remaining adrenal gland does not work properly. My friend is under observațion for endocrine problems. For neurological and depression symptoms, she was given Gabaran and Rivotril 0.5 mg, twice a day. Gabaran was interrupted after approximately a month when the pain almost disappeared, but the treatment was resumed after six months when the pain was very strong. This time it had no effect, so the doctor advised her to take Carbamazepine. She took it several weeks with no improvement and interrupted the treatment. She tried Lyrica, but it did not work because of some side effects. She followed Cymbalta, with the same result. So, she returned to Gabaran 400 mg again, but the pain persists, so she started taking Zoloft 100 mg. She is also taking Cerebrolysin from 2 to 3 months and Actovegin in between. Lioresal for spasticity and she takes kinesiotherapy three times a week. Even with all these treatments, there was no improvement with the pain. I will appreciate your advice and opinion in finding a solution for the pain, which is very important at this moment. Your advice will be discussed and taken into consideration together with our specialist's doctors.


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Dr. Hitesh Kumar
MBBS., MD MEDICINE., DM NEUROLOGY
Neurology

Hello,

Welcome to icliniq.com.

  • Thalamus is the part of the brain, through which all sensory information is relayed. After a stroke involving the thalamus, many times, the patient develops thalamic pain syndrome, which is very poorly responsive to medications.
  • But as you told that it was relieved to some extent by Gabapentin, and the patient has already tried Pregabalin and Carbamazepine with no improvement. So, in such case trial of a new medicine can be given in a hope to get some betterment.
  • For the spasticity, the patient is already on Lioresal. If that is not showing any improvement, then injection Botox (Botulinium toxin) in the stiff muscles of the left hand can be tried. But it is a costly injection and is needed to be repeated every 4 to 6 months. I suggest trying tablet Duloxetine 30 mg, twice daily. It is effective for pain and also for depression.
  • Consult your specialist doctor, discuss with him or her and start taking the medicines after their consent.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


 
 
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