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Meds For Neuropathic Pain?

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  • #16
    One of my last eye doctors insisted that I suffered from neuropathic pain and wanted me to take tricyclic antidepressants, but my psychiatrist only prescribed me Gabapentin, since tricyclics would worsen the dryness. I took it at night for some time, and it seemed to help reducing the pain at first, but after a while it stopped working, so I discontinued. Then one day I was talking to some friends and the subject "headache" came by, and one of then said their doctor prescribed Ketorolac Trometamine pills for it. This is an non-steroidal anti-inflamatory drug (as common headache pills often are) and since in Brazil is easy to buy a sort of non-prescription drugs over the counter, I decided to try that for my occasional headaches. For my surprise, it didn't stop my headache so effectively as my friend told me so, but it did reduce my ocular pain!! When researching more about this drug, I discovered that it's the same principle of the Acular drops (indicated for allergic conjunctivitis)... of course it was not prescribed for me and I'm conscious that NSAIDS can cause nasty gastrointestinal problems, so I do NOT overuse it. But I thought it would be worth to mention it, maybe you can talk to your doctors about it. It's not a neuropathic pain management drug, but at least for me, it reduces the eye disconfort if I need it...


    • #17
      Gabapentin (Neurontin) is often prescribed for neuropathic pain. It is also off-labeled for migraines among other conditions.

      Lyrica is FDA approved for fibromyalgia pain and is also thought to work through nerves.

      Cymbalta is an antidepressant (serotonin and norepinephrine blocker) that is FDA approved for depression and fibromyalgia.

      TCAs can cause more dryness b/c the drugs are "promiscuous". This means that in addition to binding to serotonin transporters, they also bind to lots of other receptors, including histamine, so they essentially act as anti-histamines as well. This is why they cause drowsiness and dryness as side effects. The newer SSRIs are more specific, resulting in fewer side effects.

      If anyone has any antidepressant-specific questions, I'd by happy to help. I wrote my dissertation on antidepressants and the serotonin transporter.


      • #18
        I am constantly on a tricyclic antidepresant -a low dose of dosulapin 75 mgs and also constantly on the NSAID naprosyn +cytotec for spinal arthritis
        I have to take these to control my back pain

        I have my eyes well under control -even taking these
        I have no idea how i would be re- eyes without these drugs,and will probably never find out as they are non-negiciable in my case

        I would say to anyone out there to take antidepressants and NSAIDS if you need them
        THey will help you to control your pain - I dont know if they dry my eyes -they cant be doing too much damage or i would not feel as good about my eyes as i do


        • #19
          Rosenthal, et al wrote a good article on this called Corneal Pain Without Stain, Is It Real? He's from the Boston Foundation for Sight.
          Belmonte, et al from Spain wrote Neural Basis of Sensation of Intact and Injured Corneas. Both covered what happens at the cellular level when nerves are cut and try to regenerate and end up producing more pain than if they were never cut.


          • #20
            Originally posted by Chemia View Post
            ...We have Doctors dismissing the pain since they don't have the answers. I actaully had an opthamologist shout at me and tell me to get a psychiatric evaluation. I left his office in tears.
            Chemia, I read this article and thought of you:


            I quote the article:

            In rare cases, patients experience eye pain long after surgery despite having nothing in terms of corneal staining that indicates they have a problem. He commented that surgeons tend to “write off” these patients as “crazy”.

            The article then mentions complex regional syndrome and what not.

            We're not crazy!


            • #21
              Eye Pain

              Raginator, thank you so much for this wonderful article and thinking of me. I read it with great interest. In fact after seeing countless doctors, I was taken seriously by 2 doctors who at last admitted that the pain was unusual. I was told it could be occiptical neuralgia or corneal neuralgia and possibly a misfiring in the signalling process. For most doctors, if they can't see the problem, they can't figure it out. I have tried some pain meds like Lyrica but eventually stopped because I was too nervous of becoming dependant on them.

              I tried accupuncture (suggested by the opthamologist) and it helped somewhat. I am hoping I wake up and the pain disappears. Currently, I just deal with it.

              One of the doctors suggested the BSL could help and isolating the eyes could benefit me. That may be my next step.


              • #22
                I have corneal neuralgia

                I was shopping in March of 2005 when suddenly I felt as if tiny ice picks were being driven into my eyes. I saw over 21 eye doctors, corneal specialists, neuro-opth., etc. They found that I had some dryness but nothing that explained the pain I was in. They agreed it was probably psycosomatic . I lived in agony for 3 months. I was seriously contemplating suicide so my doctor gave me percocet for the pain which put me in the hospital because of side effects. Once there, I had CAT scans, MRI's, etc. and they didn't show anything. A psychiatrist came in and he prx me an antipsychotic. My primary wouldn't allow them to give it to me though. Then a russian neurologist came in and said he believed it was a form of neuralgia. Then I was prx Cymbalta 60mg(because it helps with nerve pain and the depression), gabapentin/neurontin 2 600mg tabs 3X/day, I also take 1 tramadol 3X/day, restasis, and lorazepam (anxiety med) 1X/day because I have to lay down every afternoon to rest my eyes and everyday it's a struggle for me to do it and I still suffer with alot of anxiety. I know that might sound like alot of meds. I NEVER took anything before I got this. I hate medicine but when it literally became a life or death thing I didn't care anymore. This regimen lets me enjoy my life somewhat. I still have a day or several weeks at times when the pain gets worse for ??? reason and then it subsides again. It was 5 years for me in March. I met a pain specialist who told me I had corneal neuralgia but my corneal specialist told me there was no such thing. Then I met Dr. Rosenthal at the Boston Foundation for Sight and he confirmed my diagnosis. I've heard other people have tried Lyrica without alot of success. Yes, the meds have made my eyes drier and I have to deal with that discomfort but that's a hangnail compared to childbirth when you've felt nerve pain. I was a very happy, upbeat person prior to this but when you live with this kind of pain how can you possibly not become depressed and anxious??!! My faith in God has helped bring me through but everyday is a struggle. I just have to remind myself that yes, it could be worse. I just heard of an 8 year old girl who got the flesh eating bacteria in her hands and feet and had all 4 limbs amputated just last month. I live 2 hours from Boston. I've been to the best of the best and even they assumed I was just crazy. I went to see the doctor who invented a certain plug and he didn't even want to deal with me. His assistant was very sympathetic and told me that the doctor had seen several people just like me over the past week and he didn't know what to do with us, so, he sent us away without any help. Sad! God bless all of you! I'm so sorry any of us have to suffer with this.


                • #23
                  My stabbing pain started almost 1.5 years ago and it's still around. I, like you, and a few of us here have been in similar situations where we go from one doctor to another to find a cure, an explanation, or something, only to be turned away or thought of as being "crazy".
                  I have had 2 MRIs done, been to Duke Medical twice, once to the Mayo, and countless local opthamologists and corneal specialists.
                  They either offer me the same dry eye treatments we are familiar with, or suggest I see a neuro-opth. Either way, I have seen no relief. I wake up with pain, and go to bed with pain.
                  The only time I feel normal are the few minutes of satisfaction I get from numbing drops, and some relief from my Wiley sunglasses.
                  I have tried cyclic antidpressants ( 2 different types), lyrica, and neurontin.
                  Unfortunately, the side effects were too much for me to handle and actually interfered with my job. I was either too sleepy, too hyper, not to mention the severe dry mouth and the dry eyes. And yes the wonderful constipation (sorry, had to throw that in).
                  I was also given some Xibrom eye drops for the pain and I have yet to try it. I hate the fact it has BAK in it.
                  So, I can't really say I am still searching for the answer or the cure. I guess I may just have to get used to it and just manage.


                  • #24
                    How is neuropathic pain like ? What I feel is like a muscular pain in the back of my right eye. They've checked my optic nerve and everything is fine. It feels like some sort of pressure. It's really annoying and drives me crazy. Thanks god it's not constant and occurs me when I'm working on the computer or I look myself in the mirror at a very close distance.


                    • #25
                      Cristian, do you wear glasses and did you have a refraction done? I ask only because what you are describing could be eye strain.
                      My eye pain for the most part is a constant achy pain more like a headache in the eyes. Sometimes it gets so intense it feels like a migraine and light becomes an issue. It also feels like a horrible eye strain and I squint a lot. The eye pain also gets bad and I start developing headaches.
                      Eye drops don't help. The only thing that helps is closing my eyes.


                      • #26
                        I've thought alot about neuropathy for my new eye pain as well. When you are constantly "focused" on your eyes (and how can you NOT be?) then you could, in theory, get kind of a "pain wind-up" where your nerves don't recognize the fact that you aren't in pain anymore, etc...

                        I am currently taking Elavil (Amitrypteline sp?) and increasing the dosage by 10 mgs every 2 weeks. This was suggested to me by my sister who is a nurse practitioner. I was already on 10 mgs of Elavil for migraines.

                        It is helping. I just quit all drops, etc 2 days ago. I've had it and I'm going this route for now.


                        • #27
                          so discouraging

                          I was so happy to get a letter from Dr. Rosenthal explaining that I had corneal neuralgia. I went to my regular corneal specialist in Boston for a check-up. I figured he'd finally believe me after reading the letter. He smirked at me and said, "yah, he believes in that stuff", like we were talking about UFO's!! I've had this for 6 years now and I too wake up in pain and go to bed in pain. Some days I just crumble, cry, and pray. I have ocular rosacea as well.


                          • #28
                            That pretty much always happens to doctors on the cutting edge, I think. In ten years corneal neuralgia may just be a 'household name' among cornea doctors. It's a process that takes time.

                            Looking at the bigger picture, it is pretty much routine in dry eye that the more doctors you ask, the more different answers you will get. Each has their "niche" that they are very attuned to. Who is actually "right" may or may not be a meaningful question. The same patient may go to 5 doctors - all highly reputed specialists. One thinks they have moderate to severe MGD. One things that conjunctival chalasis is causing all the pain. One thinks it's all about allergies. One thinks it's all about demodex. One may think it's corneal neuralgia. Don't forget... they might ALL be right, and yet all wrong... as in, you may have any or all of those conditions but what is actually causing your discomfort? No one can really know that to a certainty, unless and until they can deduce it by what removes the discomfort, and even then, it may remain a great big question mark.
                            Rebecca Petris
                            The Dry Eye Zone


                            • #29
                              I am two and half years post lasik, I too am in terrible pain, especially at night but like many of you, I can't do anything without Panoptix and many drops, never a "comfortable" moment. I was recently dx with cornea nueralgia by Dr. Rosenthal. I went in to have a sclera lenses fitting and the pain was excruciating, thus the dx. My question is, does it ever go away, is there any documented evidence that it can get better on it's own? And why are they still doing LASIK????



                              • #30
                                Hey everyone,

                                I was wondering if my problem was also neuropathic pain after LASIK. Do any of you have pain that alternates eyes during the day? like a couple hours in your right eye, then a couple hours in your left eye, then back to your right? and almost never pain in both at the same time?