Dr. Divakara. P
Internal Medicine
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 am 60 years old. I am a Parkinson's patient. For about the last six months I am having pain in the left arm, shoulder and right leg from thighs downward.
Hello,
Welcome to icliniq.com. The pain could be just due to musculoskeletal pain which just requires some muscle relaxants like tablet Zerodol-MR (Aceclofenac and Tizanidine) two times a day for four to five days. But it could be also due to inadequate dose for Parkinson's and that in turn causing muscle stiffness. Kindly mention the drugs and dosage you are taking for Parkinson's disease. Until then you can take the above mentioned drug.
Patient's Query
Thank you doctor,
For Parkinson's, I was taking Syndopa plus quarter to half tablet at a time, every three to four hours or totaling up to three tablets per day. In addition, I used to take one capsule of Amantrel after breakfast. About six months back I changed over to Syncopane 100 mg, half tablet before meals. It gave better results. I am a regular golfer and about six months back I started feeling pain in my left forearm while taking a stance to take the shot. Gradually pain increased and shifted around the left shoulder and armpit. Doctors diagnosed spondylitis and prescribed medicines and physiotherapy. I used to get temporary relief, probably due to pain-killers. I gradually started having pain in the right leg, hip downwards (sciatica). I started having difficulties in getting and sitting down. I feel severe pain while bending forward and while using the toilet. I try to go for two to three walks in the evening and sometime in the morning also. My blood pressure (BP) is normal, no sugar problem, uric acid is 6.7. My hands and feet are generally colder to normal people.
Hello,
Welcome back to icliniq.com. Your dosage is adequate but it is not the maximum dosage that can be given. I suggest either you can take Syncopane half tablet two to three times or consult your neurologist and ask to increase the medication dosage. An improvement in your shoulder pain indicates that the problem was due to inadequate dosage. But one thing that is bugging me is the description of your leg pain as sciatica because the pain in Parkinson's is due to muscular rigidity and hence will be like a muscular pain, whereas sciatica is a sharp shooting kind of pain which is more of nerve-related problem. So if you are really sure that it is a sciatica then I advise you get a MRI (magnetic resonance imaging) scan of your cervical and lumbar spine and revert back.
Patient's Query
Thank you doctor,
Magnetic resonance imaging (MRI) suggests spondylo-degenerative disc disease at C5-C6 with disc bulge. Nerve test is suggestive of carpal tunnel syndrome. If I take half tablet Combiflam or Disprin twice a day it makes me feel better and overcome Parkinson's symptoms and relief from pain. Is it advisable to take on a regular basis? I have enclosed my reports.
Hello,
Welcome back to icliniq.com. Combiflam is a nonsteroidal anti-inflammatory drug. Long term usage of this can cause gastritis but more importantly, it can cause kidney damage. So, use it when it is required most and not on a regular basis. Your cervical magnetic resonance imaging (MRI) showing C5/C6 disc bulge can explain your symptoms of shoulder and hand. For that, you need regular neck physiotherapy. If the problem persists then you can use a soft cervical collar. But you have not got lumbar spine MRI which is required for the evaluation of your sciatica. I advise you to get it done. So overall I am almost convinced that it is not your Parkinson's disease that is causing the problem but it is the spinal cord disease. So more exercises and physiotherapy and occasional pain medicines is what you require. If at all you are not getting good relief from physiotherapy and exercises then you can take Combiflam on regular basis, but only on one condition that every two weeks you have to get serum creatinine test done and continue Combiflam only if serum creatinine is in normal limits.
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Internal Medicine
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