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sandollar 06-28-2005 10:53 AM

Radicular Pain & Topamax?
Hey Guy's :wave: ,
My Surgeon told me this morning that what I am experiencing is Radicular Pain and put me on Topamax for the pain. I cannot even lift a laundry Basket with only socks in it, That's how bad the pain is.
Will Topamax work? And is this pain permanent?
He did a Transforaminal Lumbar ESI Injection AKA [U]SELECTIVE NERVE ROOT BLOCK[/U] 2 weeks ago and said it can only be done 2-3 times a year and VERY far apart because he said it can cause an infection in the leg. Has anyone heard of this?
What causes Radicular pain?
Any information would be helpful.
Thank You :) ,

nsmatch 06-28-2005 11:18 AM

Re: Radicular Pain & Topamax?
Radicular pain is pain that can be attributed to a single nerve root that comes out of your spinal cord. There are many places along the nerve it can get pinched, but right at the opening of the spinal cord where people have degenerative discs are very common. If you do a google search on "back pain" or something similar you can find millions of articles on it.

Topamax is traditionally an anti-seizure medication, but I'm guessing like Neurontin, they are both being used "off-label" (a.k.a. not FDA approved) for neuropathic pain, as they work on a GABA channel (part of how your nerves work). It helps relieve the pain in some people.

Nerve root blocks try to go right at that nerve root and try to decrease inflammation or block the pain right at the site. Of course you can't be doing this every week, because of the risks of bleeding and infection, which in the spinal cord region would not be good.

Hopefully the pain is not permanent, but your doctor is going through different steps to see what works for you, as surgery should always be the last option.

jdlfmc 06-28-2005 03:20 PM

Re: Radicular Pain & Topamax?
Stardust, I have tried a few of the anti-seizure meds they are using for PM now and didn't have any luck, but have heard such good things about topomax that I am going to ask my PM to RX it and give it a try.
My nerve pain is permanant and I just had to have the SCS removed and am now trying to find a new cocktail of meds to help with the nerve pain.My pain comes from the S1 nerve and at time the pain is unbearable so far nothing has taken it away the closest I cam was with the SCS.
Topomax may cause you some side effects to begin with but from what I've heard the effects are worth waiting them out.
Best of luck.

mkf 06-28-2005 07:01 PM

Re: Radicular Pain & Topamax?
I've tried neurontin for nerve pain and didn't have any luck with it. I'm on topamax now - have been for a few months. I'm not having much luck with it either but better luck than with the neurontin. Hang in there. I'm told it gets better with time.

jdlfmc 06-28-2005 08:40 PM

Re: Radicular Pain & Topamax?
I have been on methadone for a couple of yrs now and take percocet for the Bt pain and bacoflen for muscle spasms.
The meth and percs do help with a lot of the pain I have from cord comp. at the T7-8 but really doesn't do a whole lot for the nerve pain.
I was on oxycontin and the patch before and they didn't do much for the nerve pain either, I have to say though the meth has worked better on the other pains then any thing else has.

sandollar 06-29-2005 12:10 AM

Re: Radicular Pain & Topamax?
[B]NSMATCH[/B] I have already had a Spinal Fusion of the S1 & L5 the 2nd of February, but he had to go back in on May 4th because of severe pain and it got to where I could no longer walk. He found a piece of bone stuck into the Sciatic Nerve and removed it. I was doing great and then it all began again. He has done everything he knows to do and is almost to the point of giving up. From what I feel, it's like a pinched nerve, but I can't seem to get him to do the test where a dye shows the nerves and find out.
[B]jdlfmc[/B] I have been on Topamax twice before and within the first few weeks everything tasted really bad and my feet were tingling (which was fine), but at 3 months the tingleing turned to severe foot pain and I had to be taken off of it. The last time I was on it was last summer. I hope it works, but I cna't help but be doubtful. What is an SCS and how did you find out your Nerve pain was permanent? I am going to fight this with everything I've got before things get worse. If he gives up, I'll find someone else. My pain seems to be coming from the S1 & L5 area where the surgery was and then to my hip, down the middle of my left butt cheek and down my left leg to my foot. I am no longer able to take my Lortabs, they began causing severe nausea & vomiting.
[B]RiteofSpring[/B] I asked him about Methadone and he said it is only to be used in Mental Health Hospitals for withdrawal, so from the way he talked, that was a big fat no. It sounds good though, I would love to be able to even do just HALF of what I used to do. He thinks in another 6 months the Nerve should calm down and the pain should stop. BUt my gut feeling still tells me the nerve is pinched, I just wish I could get him to order the test to prove it.
[B]rsrush[/B] Thank You, Since this is my 3rd try with the Topamax, it will aslo be my last. He HAS to find out what is going on before it's too late. I really don't think asking him to order the Nerve test was asking too much.

I really don't know what else to do. He believes the patient should have a say in thier treatment and yet he won't check to see if the nerve is pinched. I didn't even get a return appt this time, he just said his scheduler will call me in about 5 weeks to see if I need another Selective Nerve Root Block.

jdlfmc 06-29-2005 05:06 AM

Re: Radicular Pain & Topamax?
Stardust, I feel so bad for you, it doesn't sound like your dr is really ding what he says he believes or he would do more and listen to what your saying and asking.
It sounds to me like you are still seeing the surgeon , right??
Surgeons are a different breed and for one thing they do not like to prescribe anything for pain, it sounds as if you might want to start looing for a pain management dr, that way you can get treated for the pain while the dr tries to find the source of it.
I have been on methadone for 2 yrs, it is being used more and more for pain management.
I had a EMG done and wish the drs had done it yrs ago I played havoc trying to get the drs to believe how much pain I was in.
SCS is a spinal cord stimulator, it is a stimualtor placed in your spine area and instead of feeling pain you feel a tingling or vibrating sensation, my leads wouldn't stay in place so I had to have it removed.
I wish you the best of luck, I know to well what it's like to live in pain and no one wanting to listen.

nsmatch 06-29-2005 12:05 PM

Re: Radicular Pain & Topamax?
The problem with doing the dye test after a fusion is

1) you've got all that metal instrumentation in the way to get a good look at the nerves

2) theoretically after a spinal fusion, that entire area should be widely open. the dye test is probably useless. What may be happening is that your nerve is getting pinched somewhere else along the tract of the nerve (and not originally in the spinal cord area), which may explain why the surgery itself did little to fix the pain. Good luck to you, and I hope your doctors can help find out where this pain is coming from.

sandollar 06-29-2005 03:45 PM

Re: Radicular Pain & Topamax?
The Surgery was a minumlly Invasive one, I only have 2 tiny marks on my back, one on each side of the spine. The Surgery for my back was a complete success. I have not had any back pain like I did before the surgery. However after removing the piece of bone from the nerve is when all the pain got bad. It's not in the surgery area. It's in the upper left hip/back area, throught the middle of the left buttock and down the leg.
I called this afternoon and requested a EMG & Nerve Volosity Test. I have never had one before and only heard about these on this site. However my Doctor did not call me back today. I have an appt with my Family Doc in the morning and will ask him to order the tests. I think it might help pinpoint the problem. I hope.

BettyJ 06-29-2005 04:44 PM

Re: Radicular Pain & Topamax?
Hey Stardust, I had a tumor removed from the L5 S1 region 18 months ago, and I still have nerve like pain in my right buttock near the tailbone.....Like you, I have asked dr's for info on tests that could prove nerve impingement, but cannot get anyone to entertain the idea.....perhaps that area is difficult based on what others on here have said....however, I too want I know how you must be feeling right about now....and never never give up on yourself even if your dr does.....I also believe that most dr's want to either the solve the problem or have patient complacency, which is impossible when your life has been altered by pain and confusion over why.....Hang in there and try to find a good PM dr......they may be more patient with the treatments that fail.......they are used to patients going through many methods before finding the right mix.....

As for topamax.....the original question posted.....I just want to say that it made me extremely sick.....seemed ok for a week and then I became very dr's nurse said that many people like to take it because it makes them lose weight...I can see why.....but I wasn't take on the nerve meds is this.....they all have a very short life in the body.....once your body gets used to them, you either have to be willing to take large amounts of the med or go off of them...just my opinion based on my use and others who told me of their experiences.......but if you have not tried topamax.....what do you have to lose? maybe a few pounds?? ...good luck with it

sandollar 06-29-2005 06:56 PM

Re: Radicular Pain & Topamax?
No, As I mentioned earlier, this is my 3rd try on Topamax and I really don't like it, nor am I willing to stay on meds forever. I won't give up. But my Family Doctor has a good head on his shoulders and doesn't think people should suffer, so when I talk to him tomorrow I can tell you...He WILL order the tests I want done. I then will make sure the Surgeon gets a copy as well. (me too).
This is my life and not the Doc's. Funny how the hip & leg seem to act up more at home than in his office. I think because at home I try to be as normal as I can and end up hurting more. At his office my appts are always very early and the REAL pain is barely beginning for the day.
Yes, I still see my Surgeon, I do not have a PM Doc, nor do I want one right now, I fired her back in January for being an idiot. However my Surgeon does injections and I prefer him doing them since he is the one who put the hardware in and knows where things are.

pooby 06-29-2005 08:44 PM

Re: Radicular Pain & Topamax?
First surgeons are usually only interested in pain that can be removed by a surgical means. Surgery is probably not indicated as far as your surgeon is concerned. Nerves do continues to send out pain signals often long after the reason for their injury has been corrected. All you can do is wait until the nerve finally manages to settle down. Just read all the posts in here from people who continue to have pain long after the perceived reason for their pain has been corrected. I have been taking neurotin for the last 6 months for radicular pain which for me is permanent. The dosage of neurotin is the most important factor. 1800mg to 2400mg is necessary for radicular pain relief and one of the reasons for pain relief not being attained is because the dosage is usually too low to do anything. Neurotin makes you tired and dizzy and weight gain is common. The side effects do wear off after a few days. Topamax is a drug with similar properties. It may cause you to lose weight. I don't really know what dosage is necessary for pain relief.

Backspasms 06-30-2005 09:56 PM

Re: Radicular Pain & Topamax?
Hello all :cool:
I am on topamax 3 times a day for seizure and migraine control. Never heard it for pain but everyday they say something new. All I can say is that it is not helping at all for the pain especially when all I can do is lay in bed still at a 9 but not a 10 like in any other position! My L4-S1 and DDD plus radicular pain is almost to much to handle. I hope that the topamax works for you!

sandollar 06-30-2005 11:52 PM

Re: Radicular Pain & Topamax?
Thank You for the information.
I went to see my Family Doc today, he gave me Demerol for pain and told me not to take the Topamax, My Surgeon has the Topamax set up to continually go higher every few days and then, no refills and to drop it cold turkey. I DON'T THINK SO!
I've been on Neurontin before and cannot take it, it makes me really confused and I couldn't remember what I was doing most of the time. When driving, I would stop at green lights and run the red ones because I couldn't remember what to do, so I was taken off it before I killed myself.
I got a nice surprise at his office though, he has a new Pain Management & Florida Spine Care Specialist in his office now, he comes down 3 times a week from Orange Park. He is going to have him give me a call Tuesday and the new PM Doc is going to do the EMG & Nerve Conduction Study.
I was told that it CAN take months for the nerve to settle down, however if it is more than 6 months it is usually permanent.
But I really need to know for my own sake if it is aggravated, pinched, inflammed, What?
I will still see my Surgeon, but I am also going to keep this new PM Doc as well. At least until I know there is nothing else the Surgeon can do (no pinched nerves, ect).

pooby 07-01-2005 07:39 AM

Re: Radicular Pain & Topamax?
I will bet that most of the posters on here that say they have had no luck with neurotin have not been on a high enough dosage. A pain management doctor that I watched on a lecture said that 1800mg to 2400mg was necessary to be of any benefit for radicular pain and most doctors won't prescribe that high because of the sleepy side effect. I have upped my dosage with success.

Who cares whether you are tired at night when you can't get any sleep because of pain. At least I am getting some sleep even if broken rather than NO sleep at all because of leg riddling pain.

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