Nerve Ablation

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I have had PHN on the right side of the head for more than a year now. It means living with a headache all the time. I take Gabapentin 600 mg thre or four times a day, and Tegrital 25mg at night. I've had 3 injections in the right occipital nerve at intervals of 1 or 2 months. They are not providing any relief now. The neurologist says I should now consider nerve ablation. has anyone here ever had that treatment? Does anyone have any comments? Charlie, you seem to be the resource here, and I'm grateful, how do you feel about nreve ablation?

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  • Posted

    I used to work in a pain management program, about 25 years ago in Denver Colorado. I worked with some of the best pain docs in the western US.    Two of them, anesthesiologists who specialized in pain management, told me it was an option, but did not recommend it. They both said the nerve would grow back, and pain would resume. So, maybe not much better than a nerve block injection, which they also did not recommend but were not totally against. So, I chose to avoid both treatments, and used an experimental ibuprofen gel that one of them was thinking about marketing. It worked ok, about as well as Aspercreme or lidocaine gel, but no better. 

    So, long story short, I still use Aspercreme with good results 26 years later. My symptoms have decreased over the years, and also I manage pain and itching better now. It still bugs me, but it's an annoyance rather than a life disruption like it used to be. My life has been good after the first few years of PHN. 

    Cognitive behavior therapy (CBT) has helped more than any single thing. 

    So, if I were you I'd ask my doc if the pain could possibly worsen with nerve ablation. I'd also get a second opinion. I would go to a therapist who specializes in CBT whether I got the nerve ablation or not. 

    Hope me this is helpful to you Ron. I know how difficult this stuff is. Please keep in mind that you WILL make progress with time, for sure. 

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    • Posted

      Thanks for your kind comment Catherine. This is what works for people, focusing on solutions. My suggested guiding light for my patients when I was working was to evaluate thoughts, changing all unhealthy thoughts to healthy ones. To be healthy, a thought has to satisfy two rules:

      1.  The thought must be 100% true.

      2.  The thought must make you feel better, not worse. 

      Thoughts that fail EITHER rule are unhealthy and will contribute to low mood, anxiety, or other negative emotions. This is the basis of cognitive restructuring as I use it. Most patients found this extremely helpful to their mood and their functioning. 

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    • Posted

      Thanks for your kind reply, so much understanding. I'm going to see the neorologist today for the last attempt with Nerve Block then I'll discuss the ablation treatment as a last resort. There's a feeling I get from the docs that it's necessary to go on with more and more reatment and that I can't go on taking gabapentin at the amount I'm taking right now 3000 mg + - per day. But the fact is I can cope with the head pain okay taking that much med. There comes a point when I'm close to arguing the point with the doc, and I don't know where that would get me...

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    • Posted

      Ron,

      You can always ask them if it's possible to continue that dosage. 

      I forget if you've said what other things you've tried. Have you tried lidocaine gel, Aspercreme, etc?  If you've gotten partial relief from anything else, it may help to combine those things with the GABA/Tegretol you are taking currently.  You might even find a combination that allows you to decrease dosages. 

      You describe  "headache" rather than more surface "skin" pain that most PHN people experience. Have you tried drinking more water?  I ask because I've discovered, just in the last year, that if I get severe symptoms and then drink a large glass of water my symptoms decrease after about 30 minutes. This I interpret as mild dehydration exacerbating the pain, and the solution being hydration. You might try drinking more water for a few days and just see what happens. It's free, can't hurt, and might turn out to be helpful. 

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    • Posted

      Hi Charlie

      About the lidocaine gel, patches, Aspercremme etc., I've not tried anything like that thinking the head hair is going to be a problem - how would the patches stick? Creme or gel is going to make the hair a sticky mess isn't it? How effective are these things? I could try them at home. And drinking water? I'll try what you suggest but I drink water all the time, dehydrated due to Gabapentine.

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    • Posted

      Ron,

      I tried lidocaine patches, and found they did not work any better than the cheap gel I bought from a drug store.  Later I switched to Aspercreme, and found it worked best for me. 

      Use it at night.  You may be able to get away with using just a little of the gel or cream, maybe even in the daytime.  A little works as well as a lot.  So a very thin coating in just the areas that are the worst is what I use.  It washes out easily, or rinses off if you don't have time to wash your hair in the morning.  I guess I'm lucky that I'm bald in the areas that are most painful! 

      I'd sure be trying the topical creams/gels before I considered something more invasive like the ablation.  I found I got by OK with just the topical gel/cream, and never used anything else once I found them.  I still had, and have, pain and itching, but I have learned to tolerate and ignore it. 

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  • Posted

    I am not familiar with that procedure. I will research it.
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