PAIN MANAGEMENT FOR NERVE PAIN, NEUROMAS
Continuing my series of blogs chronicling my battle thru nerve pain from neuromas. This blog begins four months after April 08 open surgery for 6 neuroma excissions. I was referred to pain management for continued pain despite taking neurontin, medrol dose paks, celebrex. When I got back in town, I had to find one in my area. That involved asking my PT to ask one of the OSs in the medical building who did his Fellowship with Dr Noyes, who he would recommend. Had to wait for him to get back from vacation. Finally got a name and good feed back from another kneegeek who used him. Went to make appointment and found I needed a letter of referral from Dr N. Once the letter came thru. I was able to make an appointment for PM. This whole process has taken a month to do. I was told to bring a driver incase I got an injection in the knee.
This PM doc is an anesthesiologist who has nerve experience, which is what I was told to find. He'll have to do alot of explaining before he thinks of doing that. I have noticed the nerve pain increases when the leg is bent and I can now feel a lump in the area of the most sensitive pain, highly tender to touch, which leads me to think I have another neuroma forming.
I had my first pain management appt. He spent 45 min with me. He was really amazed I had 6 neuromas. From my description of pain and progression, he also felt it was probably another neuroma. I asked if this could happen again at this point in time post-op and he said yes. He laid out several options of treatment for the nerve. They ranged from medications, surgery again, to cryo treatment,spinal stimulator. Medication is where I am at right now. He is increasing my Neurontn to 1800mg/day if I can tolerate it, if not, then I can adjust down to where I can tolerate., adding lidocaine patch which I can wear all the time and taking hydrocodone on a regular basis. If I need to progress on narcotics he will send me to a MD Pharmacist who specializes in medication combinations with narcotics. If I am to go to cryo treatment he will send me to that doc. Cryo would help at first but nerve could regenerate again after a couple months. Surgery to remove it was probably a better way to remove the problem. Then there is a spinal stimulator which I think is more invasive than surgery. It sounded like it is much like the TENS unit in that it delivers a current and causes the brain not to process the nerve pain. One way is to place the wires in the knee on the nerve and connected to pacemaker size unit in ABD or back. The other way is to place wire in spine. I told him I've used a TENS unit and that basically distracts you with the current but only good as long as you have it on and would need to have it on all the time. I am not too keen on this stimulator and feel it is just too invasive and could come with it's own problems. This would be a last resort for me. They will call me in a week to see how I am doing on the meds. Injection wise , he only does cortisone and local in the knee. he felt cortisone would not do much at all for me.
At first I did not think I would like this doc because his nurse came in first and asked if I had thought of using a spinal stimulator. I was pretty taken back by this and said isn't that a bit too invasive for this problem !!!!! I thought OK, this doc is out to promote this stimulator, on to another PM doc and opinion. Doc came in and spent 45 min and I felt better about his treatment plan and his understanding of nerve problems, especially mine and listened to me. I did not have to sign any contracts and he said if Noyes has any additional meds or treatments to add, then great. Probably if I have to go to the special pharmacy doc then I would be signing contracts since that would involve more intensive narcotic use.
According to this booklet having intractable pain is rare, so chalk one more rarity up on the ole knee.