PHN in hand

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I am 38 year old women and Had shingles on my left arm Last year. I have excruciating pain in my hand, thumb & 1st finger. I have tried gabapetin (max dose)with tramadol and paracetamol for 3 months but still no relief. I am now taking tramadol & paracetamol & ibruprofen with pregabalin & sertaline (antidepressant) for 4 months but I am still in so much pain. It has consumed my life and feel it's never ending..

I have paid to see a pain management consultant because it's a 12 month waiting list onNHS. They say it's AHN and want to change pregablin to carbamazepine & antidepressants to amtriptaline. I am so confused drowsy and in pain.. please can anyone help!

I have a 1 year old baby and full time job, I am struggling to cope. Pain is too much..

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14 Replies

  • Posted

    Hi Sandie. So sorry to hear about your pain. I am praying for you. Have you tried seeing another doctor for a second look. I did that about a year ago and it has helped to a  manageable pain level some of the time. 
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  • Posted

    Dear Sandie.  So sorry to hear....Meds do not work for me.  I am severly allergic; so they were not an option; also then I could not have coped with everyday life and work and such.  However, it is different for others.  I hope You find some answers; especially with a baby and working too.  Drowsy is a problem, and not much help from the meds.    Finding a good Dr. is key.  My best to You.  Keep in touch.  Sincerely.      Paula
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  • Posted

    Sadie

    I feel your pain, and can understand your trauma.

    Could I suggest a topical treatment that will relieve your pain and allow you to function reasonably well, without the need for excessive analgesics that can have adverse long term affects.

    My formula is as follows:

    250 grams of Invite Vitamin E cream( contains 5 percent glycerol ).

    Two 5 gram tubes of Acyclovir cream ( cold sore anti-viral cream ).

    60 grams of Dencorub Heat Gel ( 26 percent Methyl Salicylate, 7 percent menthol ).

    Mix thoroughly, apply sparingly to the affected area, as required for pain relief.

    This treatment is inexpensive, as this quantity should last 2 to 4 months, depending on frequency of application. 

    This is a very debilitating long term complaint, with no apparent cure, so any help is worthwhile. 

    Kind regards Ray.

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  • Posted

    I thought when I got the shingles I was in for pain, suffering, nothing that was going to hurt that bad. I have MS so I am dealing with double trouble. I want to tell you that if the pain goes away in a year or feels better after three, count yourself blessed. I had it in on my waist on one side. The rash went away, the pain went from a 7 or 8 to a five. It has stayed that way for four years. I have done all that they can do. MS is nothing compared to what this has done to my life. If we could get together and talk face to face? We could share the stories. I got this when i was 49 in Dec.I got MS when I was your age.  I am now 54, Be  thankful its just in your hand. I am thankful i have it on one side of my waist. Just be thankful its not on your face, like many on here. 
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  • Posted

    I am surprised you ar not taking Garbapentin. That's usually the first line of defense. Drowsyness is a side effect of all these drugs. Keep occupied by concentrating on some activity lke Facebook or this forum. Suck it up.

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  • Posted

    Hi Sandie,

    Many of us on this site have had PHN for years, 27 years for me.  I have also worked with patients with chronic pain as a psychologist for 40 years, now retired. 

    I'm not sure what AHN is.  I googled it but found nothing. 

    Most PHN patients I've talked to, and this has been my experience also, find prescription pain drugs can be helpful but are quite limited.  I was on carbamazepine early on and found it minimally helpful.  I since avoided all oral pain meds but have used topical creams/gels, and have found them much more helpful...and cheaper. 

    To summarize what I hear from most people on this site, gabapentin seems to be the most useful of the oral meds.  Lyrica and Neurontin also. 

    Creams and gels:  For me Aspercreme helps a lot.  It has 10% salicylate, and other products like Denco Rub also have it.  Look for what is available in your country.  I found lidocaine gel helpful years ago, and a lot of other people on this site have found it helpful.  Do not expect anything to get rid of your pain.  It will not happen.  Look for things that knock the pain down a notch or two.  That is a reasonable expection. 

    Antidepressants:  I am extremely familiar with these, having worked for 40 years with thousands of patients on them, and having read a good deal of the research literature.  The newer antidepressants, like Sertraline, seem to be very effective with depression, IF the patient and doctor work together over a period of months to get the best dosage and IF the patient is taking the medication every day.  Wellbutrin is what I have been on for years, and I love it.  I saw many patients do quite well on Celexa, which is not as energizing as Sertraline.  Sertraline can make some people a bit nervous. 

    Your pain management consultant's recommendation to change to amitriptylene:  In the 40 years I've worked in pain management, I've seen only a couple people helped by amitriptylene.  Placebo would be better than this.  It is extremely sedating.  Worse, it has a very long half-life [stays in your system a long time], and most everyone has a groggy "hangover" the next day.  I know why your consultant recommended it:  There is some research that says it's effective.  Again, I have just not seen that.  Depression and amitriptylene:  It is not effective in my opinion.  I've seen very few people helped.  It is an old medication, a tricyclic, and is not used much anymore. 

    Best for depression:  Cognitive Behavior Therapy [CBT].  The literature is quite clear on this.  More effective than antidepressants [and I think the newer ones work well], and more resistant to relapse.  With patients with moderate to severe depression my team usually used both modern antidepressants and CBT.  I use CBT every day, and used it with my patients.  I saw most people helped by it, and they typically learned to use it independently, without me, after a few sessions.  Look for a therapist who specializes in it. 

    Something very important to keep in mind about PHN:  It does decrease in severity over time.  It usually takes years, but it does fade some.  So my PHN was quite severe in the first few years, but now is what I would describe as an annoyance.  Some of that is that it has decreased in severity, some of it is that I have learned to manage it better. 

    Please let me know if you have questions. 

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    • Posted

      Charlie, my doctor prescribed Duloxetine about a year. It is still sitting on my nightstand as I cannot bear to pop yet another drug. I did take it for about a week and stopped. I'm well aware that most chronic pain patients suffer depression because the quality of our lives are so diminished that we have a tendency to stay to ourselves as not to be a burden to others, at least that is my situation. I am still using opiates as minimally as possible, also gels/creams and ice. I'm really working on the mind-body connection. I had a relapse with my back a few weeks ago and was unable to walk for two weeks, now in physical therapy and improving. Can now walk without a cane finally. In terms of depression I don't find it particularly disabling or severe and it seems to be intermittent, that is as I have identified it. I utilize all of my senses to find joy in things that I had never considered before and take the time to care for me. That is always been a foreign concept to me as I've been busy being a wife, mother, career professional in addition to helping my elderly parents and have always put me last, hence illness. I spend much of my free time researching ways to help my body heal itself. Pain, is horrific in my situation, my body has abandoned my mind but I refuse to succumb. I will continue to find a ways to challenge the ravages of aging and the breakdown of the body coupled with the intense pain that I endure daily and hope that everyone will consider how important that is to take care of themselves first so that there well enough to take care of others. 🤗

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    • Posted

      Sheila,

      So why not actually take charge of things and treat the depression rather than limp along forever?  You're willing to take drugs with far more severe side effects, but won't take the one that has minimal to no side effects and will actually change your life for the better. 

      A week of duloxetine, or any antidepressant, is a waste. It doesn't begin to kick in until 3 weeks or more. If you really want a better life, take it!  As it is prescribed!  

      Your doc probably prescribed 30 mg, which is half the normal dose that works for most people. That's standard. Then after a week the doc usually ups it to the usual effective dosage of 60 mg. 

      Read your post here and look at how negative it is. This is typical depressive thinking and it will make you more depressed. More depression will result in you focusing more intently and more negatively on your pain, which will magnify the pain. That's how depression works. To stop it, you are going to have to decide to make some changes and stop letting depression beat you up. 

      As a psychiatrist friend of mine says, "The medication doesn't work when it stays in the bottle."  So first, take it and keep working with your doc on dosage until you get a good effect. Then get some CBT, or at a minimum get a good book on it and start practicing it. 

      Depression is treatable. There is no excuse for letting it keep bruising us and putting up with it. 

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  • Posted

    I am so sorry to hear that you are a fellow sufferer. It is a miserable condition. I am in my eighth year of PHN with damaged to nearly 80% of my torso. I live in a world of drugs and have tried nearly every option available. I still hold out hope that physicians will somehow find a way to help us. Do not give up. Put an ice pack on your pain areas when it gets really bad, it does make a difference. Keep checking this forum because there's a great deal of information and good advice. We must support each other. Keep the faith. 🙏🏼

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  • Posted

    Hi sandie

    I had shingles 4months ago in my palm and was on gabapentine and tramadol. Pain has reduced considerably but fingers are still weak and I can not use my left hand. Doing massage and hot water therapy but fingers are not bending. Hope some one has a solution. Hope you get better.

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  • Posted

    Hi, I have recently seen a neurologist privately as suffered shingles 5 times in 12 months. After trying several antidepressants, gabapentin, Pregablin I have been taking Duloxetene (30 mg) and carbazepam (100 mg in morning and 100mg evening) , just this week the constant nerve pain has dulled down a great deal and I'm starting to feel less anxious. Hope this info helps - I know how hard it is trying to be a mum in constant pain!! Xx

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    • Posted

      Hi Heather,

      I've seen very good results with those meds in the past, working as a psychologist with chronic pain patients. 

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    • Posted

      Duloxetine [Cymbalta is the brand name] is an excellent modern antidepressant.  It has the reputation of also countering nerve pain, which makes it a good choice for people with PHN.  I was on it about 15 years ago and found it did knock the PHN pain down a bit, as well as managing my depression well.  Most docs start people on 30 mg. and then increase dosage to 60 after a week.  60 is the usual dosage. 

      Carbamazepine is another nerve pain med.  Glad the combination is working well for you! 

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  • Posted

    Hi sandie.  This may be of interest to you and others.  I am 67, and had  one mild case of shingles when I was 55.  Nothing since, however, I've also been taking a lot of Vitamin C for years for my asthma, which has helped, but, now I read it may be helpful for shingles too.  This is a link, if you care to look it up. 

    Moderator comment: I have removed the link(s) directing to site(s) unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

    http://patient.uservoice.com/knowledgebase/articles/398316-adding-links-to-posts

    http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

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