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

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.