Is it ok to take a pain killer for neuropathic PA pain ?

[LuceyLocket]

My newly diagnosed husband is having a lot of pain and I'm wondering should he take something for the pain. He's having B12 shots every 2nd or 3rd day. He now has 7 shots taken. Symptoms are not easing. His B12 was under 50 when diagnosed.

Thanks for your much needed help so far.

[clivealive Forum Support]

If you can't get to see a doctor have a word with your pharmacist.

It is not uncommon for some symptoms to appear to get worse before they get better as the B12 you are having starts repairing the damage done to the nervous system and your husband's level was very low.

I'm not medically trained.

[pvanderaa]

Pain is sometimes a side effect of healing nerves after getting B12. The brain has effectively turned the volume control up on the damaged nerves. When the nerve begin to heal, the signal it carries gets stronger. Initially the brain interprets the stronger signals as pain.

The way to get over the pain is to stimulate the nerves to repair and convince the brain that the pain is an illusion. You do this with gentle range of motion exercises. The movement of muscles stimulates the nerves to work and the body repairs the damaged sites as the nerve is stimulated.

Trying to convince the brain is a harder task. Worry and stress about the pain make the brain sort of dig in it’s heels and take longer to recalibrate.

Getting started with the exercises is therefore the worst part. Once the muscles get moving, the brain recalibrates in about 3 days.

Start a logbook of all symptoms and assess his own severity score to each. Monitor between injections and reset the time counter to day zero after each injection.

You and he will see a pattern emerge over three or four days after the injection. These symptoms or sequence of symptoms are “good” and arise from the B12. As you get closer to the next injection you will see “bad” symptoms that arise from the deficiency.

The crazy part is that the “good” and “bad” symptoms are very similar. Hence as Clive says symptoms appear to get worse before getting better.

The pain after the jab is highly counterintuitive and so convincing the brain that it is good and working through the pain is hard to do but if he can manage it, the pain disappears as the brain recalibrates sooner.

I find that once I get going and I pace myself, I can physically work all day in the garden or around the house.

Tooth pain or headache have been particularly bad for me after the jab and so I do take neurofen for these.

[fbirder]

Normal painkillers like aspirin, paracetamol and ibuprofen will do nothing at all for neuropathic pain. Nor will ‘stimulating’ the nerves.

Get him to see his doctor and ask for pain relief. This is normally a low dose of an antidepressant - amitriptyline or an anti-epileptic like gabapentin or pregabalin. Nobody really knows quite how these work, but they do.

My neuropathy isn’t caused by B12 but it is similar. If I miss a dose of gabapentin then I notice it a few hours later.

I used to take codeine at night if the pain got bad enough to keep me awake. But I started taking alpha lipoid acid (bought from Amazon) after reading about how it can help with diabetic neuropathy. Since I started taking that (3 x 600 mg per day) I rarely need the codeine (down from five or six times a month) to every six months or so).

See the doc and ask about pregabalin or gabapentin.

[spacey1 in reply to fbirder]

GPs will usually start with amitriptyline, which can often be effective in quite small doses. Only if that doesn't work, or causes too many side-effects, will they think about pregabalin or gabapentin.

These medications work by 'calming down' the amount of pain signal sent to and received by the brain. Less signal = less response (ie less registering of pain). And fbirder is right, 'ordinary' painkillers won't touch neuropathic pain; it simply isn't the job they do.

[fbirder in reply to spacey1]

My GP suggested amitriptyline, but I said I would prefer gabapentin. No problem.

But I do have a good relationship with my doc.

[spacey1 in reply to fbirder]

I suspect the general offer of amitriptyline first is entirely down to cost; it is much cheaper than the anti-epileptics!

[fbirder in reply to spacey1]

Gabapentin, 300 mg capsules, are 4.8p each.

Amitriptyline, 20 mg tablets, are 3.6p each.

I doubt that a penny a day will do much to sway the decision.

[LuceyLocket]

Hi all, Thanks to all who tried to help with answers.

It turn out that the pain and stiffness that my husband was experiencing is Polymyalgia. This is another autoimmune disease. He was diagnosed a few days ago. He also of course has the antibody for intrinsic factor which was diagnosed a few weeks ago. His B12 was under 50 when diagnosed. However all his symptoms seem to be from Polymyalgia. Hes on steroids now and is feeling much better.

I just want to let people know as perhaps others might miss the fact that they might have a secondary problem such as this.

Thanks.