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Conditions and Diseases > Neurological Disorders Forum > Neuropathy symptoms and treatment options
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Q: Neuropathy symptoms and treatment options
asked by: DoctorQuestion on May 27th, 2009
Three months ago I fell off my horse and shattered my left clavicle, the next day I had surgery and had a plate and four screws put it. Five weeks later my surgeon took my arm out of the sling and I slowly went back to work with little to no pain but some weakness in the area. The skin above and below the incision as well as the top of my left arm had become cold to the touch and lost all feeling of touch. Now 3 1/2 months later the area is hot, with a constant ache and a feeling of 'pins and needles'. The strength is back at 85-95%
My plate comes out this time next year but I don't think I can handle this pain for another 12 months if it is related to the plate.


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Dr. Bruce Harrow , MD
replied on June 2nd, 2009
Neurological Disorders Answer A6710
The coldness, heat, and "pins and needles" sensations you are experiencing sound like pain coming from nerves themselves rather than damaged bone, muscle, etc, so called neuropathy.

It is not uncommon for nerves to be damaged in traumatic events, even if the broken bone(s) get more of the attention.The areas you describe sound like superficial sensory nerves may have been damaged, which is almost unavoidable during surgical incisions. This diagnosis is testable with a Nerve Conduction Velocity study but your description is so on target that I personally would not do one.


Nerves heal more slowly than bones and soft tissues and it is possible that it may very well take a year for them to resume normal operation (and quit hurting). In the meantime, many people find relief from any of several interventions.

Accupuncture/accupressure is demonstrably effective for neuropathic pain. Topical capsacin is also helpful. These approaches have minimal to no side effects. So called tricyclic antidepressants (TCAs) in low doses, 1/10th to 1/4th of their antidepressant doses, are effective and inexpensive; different people do not tolerate the anticholinergic (Benadryl-like) side effects. Gabapentin (Neurontin) and pregabalin (Lyrica) work by a different and complementary mechanism (you can use a TCA with either of them) and are expensive but have fewer side effects. Methadone is an opiate that has neuropathic pain suppressive activity. It is very cheap but tricky to use (not to mention the hassles that come from any use of opiates). It should only be prescribed by someone with appropriate training and experience.
Hope this helps and good luck!




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