Dysesthesia Treatment Using Oral Pain Medications and Adjuvant Medications

Dysesthesia is treated with medications, physical therapy and nerve block. Physical therapy is advised when muscle spasm or atrophy is observed. Nerve block is suggested for severe pain. Cortisone injection often gives pain relief for over 6 to 12 weeks. Injection can be repeated as necessary. Most of the Dysesthesia is treated with oral pain medications and adjuvant medications.

Dysesthesia is a chronic pain with moderate to severe intensity. Dysesthesia is a neuropathic pain and often does not respond to opioids or NSAIDs (anti-inflammatory pain medication). Dysesthesia may respond to anti-neuropathic analgesics. Anti-neuropathic analgesics that are most commonly used are antiepileptic analgesics (Neurontin and Lyrica) and antidepressant analgesics (Cymbalta). In few cases combination of opioids or NSAIDs and anti-neuropathic analgesics gives better pain relief.

NSAIDs – One of the following three NSAIDs are tried. There are several
other NSAIDs available in the USA, which need doctor’s prescription.

• Motrin- 600 mg to 800 mg, 3 times a day or every 8 hours 
• Naproxen- 375 mg, 3 times a day or every 8 hours.
• Celebrex- 100 mg twice a day or every 12 hours.

Opioids – Opioids are used for severe pain not responding to NSAIDs. Opioid treatment is continued if pain relief is adequate. Since opioid often is unable to relieve severe neuropathic pain, the chance of opioid dependence and addiction is high if dosages are escalated for non-responding neuropathic pain. Rapid escalation of opioid dosage causes addiction with opioid dependence. Low dosage of opioid is frequently prescribed with anti-neuropathic analgesics and response often is satisfactory pain relief. Opioid side effects such as addiction is difficult to treat and sleep apnea can be life threatening.

1. Hydrocodone– 5 to 10 mg every 6 hours, available in combination with Tylenol (Vicodin, Lortab or Norco).
2. Oxycodone–
   • Short acting- 5 to 10 mg every 6 hours, available with (Percocet) or without Tylenol (Oxy-IR).
   • Long acting- Oxycontin prescribed 10 to 20 mg three times a day.
3. Morphine–
   • Short acting- Morphine IR 20 mg three or four times a day.
   • Long acting- MS Contin 30 mg twice a day
4. Fentanyl Patches: 25 to 50 microgram patch changed every 3 days.

Neuropathic pain resistant to NSAIDs and Opioids are treated with anti-neuropathic analgesics. There are two types of anti-neuropathic analgesics, they are anti-depressant analgesics and anti-epileptic analgesics.

• Anti-depressant Analgesics
  • Cymbalta- 30 mg twice a day or 60 mg once a day.
  • Savella- 25 mg twice a day
  • Elavil- 25 mg twice a day, maximum dose is 100 mg per day.
• Anti-epileptic Analgesics
  • Neurontin- 300 mg twice a day, maximum dose 1500 mg. In the past up to 3000 mg per day were used.
  • Lyrica- 100 mg three times a day.

In few cases anti-anxiety medications are tried as an adjuvant medication with other analgesics. Dysesthesia is often difficult to treat in presence of anxiety. Patient who may need higher dosage should be aware of drug interaction with opioid and other analgesics, which could result in life threatening side effect. Patient should be seen by psychiatrist to adjust dosage to prevent side effects. Anti-anxiety medications prescribed for anxiety are as follows-

• Antianxiety Medications Prescribed To Treat Dysesthesia Are–
  • Klonopin (Clonazepam)- 0.25 mg three times a day
  • Xanax (alprazolam)- 0.25 mg three times a day.
  • Valium (diazepam)- 2 to 5 mg twice a day
  • Ativan (lorazepam)- 1 to 2 mg twice a day
• Muscle Relaxants Prescribed To Treat Dysesthesia Are–
  • Baclofen- 5 to 10 mg twice a day depending on side effects.
  • Skelaxin- 800 mg twice a day
  • Flexeril- 5 mg twice or three times a day. 

All the medications suggested for treatment of dysesthesia can cause addiction and sleep apnea. Larger dosage should be closely observed by a specialist. The dosage and medication may not be appropriate for pain because of complication associated with cause of pain. Most of these medications can be life threatening in patients when pain is caused by diseases which may not tolerate these medication and dosage.

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Also Read:

• Q and A On Dysesthesia: Types- Somatic, Visceral, Cutaneous, Occlusive, Symptoms, Causes