Re: permanent nerve damage in foot
A 'break through med' is something extra for when the pain 'breaks through' (say due to time of day, activites) in spite of whatever treatment works on lowering pain levels the remainder of the time.
Eight years ago I broke my heel and damaged a nerve. I got the heel fixed the first year and the nerve five years later. since I got a lot of help on the boards I have stayed around to return the favor. Lately I have been conversing with members with broken heels on the "foot Problems" Topic and hopefully I can be of some help to you with the nerve damage issue.
The good news is that your sister's doctors are taking her seriously as many with nerve damage meet resistance since it doesn't show up on x-rays, MRIs etc. The docs have tried various types for your sister and have not run out of options there. The situation with medications is that there are a lot that might work but no way to know except trying each one. For me Vicodin (hydrocodone bitartrate and acetaminophen) and the similar Percocet did help as well as Tramadol (a synthetic version). Clonazepam (Klonopin) was the first thing that got the pain levels down so that I could sleep. While I had no luck with Neurontin, another AED (Anti Epileptic Drug) Phenytoin Sodium (Dilantin) was more effective but with more side effects. Also tried were: Nortriptyline, Methadone, Oxycontin and others. Various shots, blocks, and infusions also failed.
When as they say: "all other methods of treatment have failed " the SCS (Spinal Cord Stimulator) and Intrathecal Pump were the next possibilities. My doc felt that the best option was a PNS (peripheral nerve stimulator). When a specific pain site is involved and the pathway could be verified by stopping the pain with a direct injection of anesthetic to that nerve better results would be expected in stimulating that location than in the spinal area. It was explained to me that ans SCS has less than a 50% chance of relieving half the pain and a good chance that the leads or pain will change resulting in loss effectiveness. The PNS has a much better chance of working, being more effective and maintaining it's effectiveness. This is partly due to knowing the exact pain pathway and also because it is placed solidly in tissue near the nerve rather than 'floating' around in the spinal canal.
I've had mine for three years now. I went off of all drugs the day I got it and it works just as well today. It is the same hardware by the same manufacturers as the SCS, just the leads (electrodes) are placed more effectively. Your sister might want to ask her docs if they think it would be appropriate for her.