Recurring pain after injection
Dear Dr Bland,
I had an injection in my right wrist as part of my carpal tunnel treatment on 26th July 2012. I had some pain in the wrist last week and it has become much worse since then. I have difficulty doing anything with my right hand at the moment (including typing this message!) and I am worried as to why this pain has come about again so quickly.
The first injection I had was in 2010 and I did not experience any pain or numbness for at least a year and a half after that despite being pregnant in that period, which I know can aggrevate CT. Furthermore, during my last examination I still had stage 2 carpal tunnel, so I am surprised that the pain and numbness have come back so quickly.
The pain I am experiencing now is mainly in my right thumb (and middle finger in the mornings) and although the numbness is intense, I have not any any pain higher up my arm. Also my right thumb seems to be very itchy.
Can you please help?
Thank you.
Anna
Thank you Doctor!
I have had a very painful weekend. The swelling around my right wrist increased and Saturday afternoon I could not feel 4 of my 5 fingers as they were completely numb. I ended up going to A&E and the doctor prescribed Gapapentin which I understand is a painkiller that numbs the nervous system. It has worked (I have numbness but little pain) but I am weary that it is a very strong painkiller and has bad side effects.
I am free to come in tomorrow (Monday) whenever you can fit me in. My number is 07973 506 893 but I will also remain on-line so we can arrange an appointment over the forum.
Thank you again for getting back to me so very quickly!!
Anna
We've just arranged an appointment for tomorrow over the phone. The reaction to gabapentin is interesting. It is not really a painkiller as such. It is an agent which was originally devised for use in epilepsy but which seems to be effective in pain of nerve origin too. If one assumes that the pain of CTS does actually originate in the nerve itself then it might make sense to try things like gabapentin and amitriptyline (an antidepressant which is also useful in nerve pain). So far however trials of gabapentin in CTS have not found it effective. JB
It's not that unusual a story. It seems as though, with every time you inject CTS, you are essentially starting again with an equally random chance of good or bad response to injection and knowing how it has responded to a previous injection does not really help you very much to predict how it will respond to a second one, especially in terms of how long it will last. Nor does the severity grade on the NCS help a great deal. Some recurrences are quite sudden and some gradual. Sometimes there seems to be an obvious precipitating cause for the relapse, sometimes it seems to be purely spontaneous and random - I wish I knew the answers to how to predict these things but that's life I guess. The most obvious thing we should do with you is get you back in to see me, test again and perhaps take a look at the ultrasound - then we can decide how to proceed. I'll see what spaces I have next week when I get into the office on Saturday morning. JB
I can fit you in on Monday morning. I'll try to call you during the weekend to see if we can arrange a suitable time. I see that we also have two patient records for you in the system under different versions of your surname. I'll have to try and join them together. JB