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.


Do you have a question on Neuropathic Pain or Stroke? We have medical experts to help you right away. Ask a Doctor Now »

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.

Related Questions:
I have neck spasm and difficulty in walking. Please help.
MRI shows stroke and brain changes. Is it due to untreated sleep apnea?
Is stroke along with bleeding inside brain worrisome?

Dr. Hitesh Kumar


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

Ask your health query to a doctor online?
Ask a Doctor Online »
* guaranteed answer within 4 hours.

Related Questions & Answers

Anal Fissure: Causes, Prevention, and Treatments.
Article Overview: Pain in the anus is one of the most common complaints encountered in the outpatient clinics. The pain is sometimes described by the patient as 'my worst pain ever. This article provides some suggestions on how to avoid facing this annoying issue by making few dietary and lifestyle changes.  Read Article »
Dr. Mahmoud Ahmed Abelrahman Abouibrahim
Medical Gastroenterologist

An anal fissure is a tear or ulcer that develops in the lining of the anal canal after passing a hard motion. Actually, it affects one in ten people at some point in their lives. All age groups and both sexes are affected equally. Causes Constipation is the most common cause either by itself or ...  Read Article »
I have a pinching pain in my arm, shoulder, palms and fingers. Why?
Query: Hello doctor, From the last two months, I have a pinching and wound-like pain in my left upper arm and shoulder. I also feel pain in my palm and fingers while bending, stretching or gripping.  Read Full »
Dr. Ganeshkumar Suresh Satpute
Internal Medicine Physician

Answer: Hello, Welcome to icliniq.com. You seem to have a neuropathic pain because of a nerve compression syndrome. I suggest the following medicines: Tablet Gabapentin forte (Gabapentin), half a tablet, twice a day. Tablet Zerodol TH 8 (a combination of Aceclofenac and Thiocolchicoside) once a day, in the...  Read Full »
I have neck spasm and difficulty in walking. Please help.
Query: Hello, I weigh 39 kg and I am 31 years old. I have lost two kilograms in the last two months. I am having spasm in the neck since 2 months. It started when I had sudden sneezing and was not able to move the neck soon after that. Neck movements got restricted. I consulted a doctor and took tablet...  Read Full »
Dr. Amit Arora

Answer: Hi, Welcome to icliniq.com. Whole event started with a sneezing after which you developed muscular spasm in the neck. You took pregabalin for neuropathic pain but due to its side effect you discontinued.  After that you had physiotherapy and developed other neurological symptoms and you...  Read Full »

Ask your health query to a doctor online?
Ask a Doctor Online »
* guaranteed answer within 4 hours.

Ask a Doctor Online

* guaranteed answer within 4 hours

Most Viewed

Is it possible to cure my respiratory allergy and throat infection with some medicine?
Hi doctor, I am suffering from nose block, throat pain, fever, occasional running nose, and headache. I am taking Nasaf ...Read more »
Can inhaling enamel paint residual fumes cause health issues?
Hello doctor, I (66 years, 145 lbs) am using a can of enamel paint in my basement. Total of 1 to 2 minutes. Had a mask ...Read more »
Arthritis in Its Many Forms
Arthritis is defined as the inflammation of a joint. There are various types of arthritis and despite their similarities ...Read more »