Our expert says:
THis is a difficult problem for any doc to deal with, and unless one has worked in a clinic with a large number of different pain problems, its not one of the topics we normally get much teaching about.
Antidepressants like Wellbutrin don't actually stimulate nerves as such. What they do is where there appears to be a functional lack of certain of the chemicals which transmit messages between our nerves, they make the amount of the chemical act longer or more effectively, making up for the relative lack. And they vary to some extent between them as to which of the main neurotransmitter chemicals they facilitate most.
So trying a different AD, which might be known to improve the availability of a different chemical from whatever the previously tried ones did, might be worth trying.
Neurontin might well be worth trying, and is a much newer drug we haven't had available for long. (Chemical name Gabapentin). It was originally explored for use in epilepsy, but has been found to be of definite use in neuropathic pain of the sort you seem to be describing.
I amgree with him about not liking the long-term use of Rivotril, as it shares the capacity to produce drug dependency with the other drugs of its family. This is not a problem with other drugs, and not so far as I have heard, with Gabapentin, for instance.
In chronic pain one needs chronic treatment, so I'm not so keen on a system that requires efefctively a payment of R 500 a month for just getting a repeat prescription, though when using some of the riskier and more complex drugs, a re-assessment periodically makes sense.
Of course if he assesses you well, and tries, say, Neurontin, and you find it works, a GP or other doc should be able to write repeat prescriptions for it.
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