Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|haoch - Wed May 27, 2009 9:52 am||
I am a 51 year old female. In the fall of 2000 I noticed a rash on my right breast in the shape of an upside down "T". By the spring of 2001, one half of my right breast was flaming red with no blisters. I was placed on antibiotics with no help. There was no itching, burning or pain until the spring of 2001. I began to have stabbing pain in my right breast, as well as under my right breast across my ribs. I also began to have stabbing pain under my right arm as well as swelling. The pain then would radiate down my right arm, resulting in tingling fingers, then numbness in my fingers. The pain, swelling and numbness have continued since (I am unable to wear a bra...period), although the redness dissipated after approximately 5 years. Within the last year I have become extremely sensitive to touch (clothing, breezes) in the same area of my breast and underarm. The intense pain drops me to my knees and occurs approximately 3 - 4 times per week. I am in varying degrees of pain every single day.
So, 8 years and 24 doctors later, my primary physician and I are completely baffled. At first she thought I had inflammatory breast cancer (negative), another doctor thought I was having gall bladder attacks (negative), then we thought it might have something to do with my breast reduction, but it had been too many years since the operation. She now believes I had "internal shingles" and then developed Postherpetic Neuralgia. I have been bouncing between Percocet and Vicodin for years. My doctor wants me to wean off of the Vicodin, but there is no backup plan (I am taking Gabapentin, but it doesn't cut through the pain). We're stuck. She recommended yesterday that I reach out to other resources.
Is there a way to determine if that is the case? Is there a test for Postherpetic Neuralgia? I'm absolutely at the end of my rope. Any help you can give me is greatly appreciated!
Please know that I am grateful for your time and effort!
|John Kenyon, CNA - Wed Jul 08, 2009 10:20 pm||
Hi there --
What you describe does sound like classic post-herpetic neuralgia. This can often last for years, as in your case, and can be excruciating. There are more (and sometimes more effective) medical management approaches than what you've had so far, and sometimes something as simple as switching from gabapentin to pregabalin (brand: Lyrica) can cause an improvement. So can use of certain anti-depressant medications. Also often very helpful are lidocaine patches applied to the affected area.
Shingles may quite often not present in the classic fashion with blisters that crust over, basically an "internal" presentation as the one doctor suggested. You did have some initial dermatological sign at the onset, it was just somewhat atypical. This is not at all unusual.
If nothing else mentioned so far provides relief, sometimes epidural steroid injections (ESI -- usually in sets of three, several weeks to months apart) can often help a great deal. However, it seems there are a lot of other things that have not yet been tried. While Vicodin and other opioids may sometimes help with the superficial symptoms, they often do not because of direct nerve inflammation. They don't usually do any harm so long as taken as prescribed, but often don't help a lot except to dull the edge of the pain a little.
A trial of Lyrica as well as lidocaine patches would both be worthwhile before consideration of ESI.
I hope this is of some help to you. Good luck and hang in there. This is a problem that can be improved and which often can spontaneously go into remission even after years of pain. Please follow up with us here as needed.
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