Does anyone know of medications besides Neurontin, Elavil and Topamax
for the burning pain caused by multiple sclerosis? Do any docs
prescribe narcotics for this condition?

Hi yesmam,

A page on the National Multiple Sclerosis Society web site shows a
table containing the various types of pain associated with MS and the
treatments for those types of pain:

Brochures: Pain - The Basic Facts (the table is near the bottom)
http://www.nationalmssociety.org/Brochures-on%20pain.asp

The following pains (which can burn) and their medicinal treatments
are included in the table:

Tonic Spasms
- characterized by "brief muscle twitching or sudden, sharp muscle
spasm; may also burn or tingle"
- can be treated with the following medications (which may be
combined): carbamazepine (Tegretol/Epitol/Atretol/Carbatrol),
gabapentin (Neurontin), lamotrigine, misoprostol, phenytoin
(Dilantin), baclofen (Lioresal)

Paroxysmal Limb Pain
- characterized by "painful burning, aching, or itching of any part of
the body but more common in the legs"
- can be treated with the following medications: the same medications
used to treat Tonic Spasms, as well as amitriptyline (Elavil),
clonazepam (Klonopin/Rivotril), diazepam (Valium), Capsaicin ointment

Dysesthetic Extremity Pain
- characterized by "chronic burning, tingling, tightness, or
pins-and-needles feelings; a dull warm aching; worse at night and
after exercise, aggravated by temperature and weather"
- can be treated with the following medications (which may require the
maximum dosages): the same medications used to treat Paroxysmal Limb
Pain; a "dull aching pain responds best to tricyclics such as
amitriptyline [Elavil]"


Another page on the National Multiple Sclerosis Society web site
states that acetaminophen (e.g. Tylenol) can be used to treat burning
pains:

Sourcebook: Pain
http://www.nationalmssociety.org/Sourcebook-Pain.asp

"Burning, Aching, or 'Girdling' around the Body are all neurologic in
origin. The technical name for them is dysesthesias. These pains are
sometimes treated with antidepressants such as amitriptyline (Elavil)
because such agents modify how the central nervous system reacts to
pain.
 
Other treatments include wearing a pressure stocking or glove, which
can convert the sensation of pain to one of pressure; warm compresses
to the skin, which may convert the sensation of pain to one of warmth;
and over-the-counter acetaminophen (Tylenol and others) which may be
taken daily, under a physician’s supervision."


The following page shows various symptoms of MS (including pain) and
their medicinal treatments:

Multiple Sclerosis Drug Treatments
http://www.mult-sclerosis.org/mstreatments.html


There are some doctors that prescribe narcotic medications for certain
types of pain (including those associated with MS), as you can see
from the following articles:

"An Aetna InteliHealth/Harvard Medical School Look At The News -- The
Controversial OxyContin" by Howard LeWine, M.D. (Harvard Medical
School)  January 24, 2003.
http://www.intelihealth.com/IH/ihtIH/WSIHW000/29721/34966/360415.html?d=dmtICNNews

"Doctors will sometimes need to prescribe narcotics for a prolonged
painful illness, postoperative pain, or a chronic pain syndrome. The
patient may become dependent on the drug, but dependence is not always
a bad thing as long as the gains are worth it. Doctors do pay
attention to the possibility that healthy dependence could become
unhealthy abuse."


"Pain, Narcotics, and MS" by David Squillacote, MD.
http://www.msfacts.org/pain.htm

"My mentor did not like giving narcotics, whereas I am very liberal. I
get patients off short-acting narcotics like codeine and
percocet/vicodin/lortab etc. and get them on to sustained release
forms.

There are a couple of long acting narcotics that will get your pain
down to reasonable levels (at least 2-3/10 on the pain scale where 0 =
no pain, and 10 = just shoot me. There is a patch called Duragesic and
2 pills called Oxycontin and MScontin (this stands for morphine
sulphate, not multiple sclerosis). These require experienced docs to
manage them."


However, the use of narcotic medications can be dangerous, as the
following news release indicates:

"FDA Warns OxyContin Maker Over Ads."  January 23, 2003.
http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/8146/360335.html?d=dmtICNNews

"OxyContin is a long-lasting version of oxycodone, a narcotic
considered important therapy for many patients suffering long-term,
severe pain from cancer or other illnesses. When swallowed whole, the
tablet provides 12 hours of pain relief.

But if chewed, snorted or injected, OxyContin produces a quick and
potentially lethal high. It has been linked to more than 100 deaths
and bears the FDA's strongest warning label, which says the drug is as
potentially addictive as morphine."


I would like to remind you of the Important Disclaimer that appears at
the bottom of this page:

"Answers and comments provided on Google Answers are general
information, and are not intended to substitute for informed
professional medical, psychiatric, psychological, tax, legal,
investment, accounting, or other professional advice."

If you need medical advice, please consult your doctor.


Regards,
sldreamer


Search strategy:

"multiple sclerosis" site:gov
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22multiple+sclerosis%22+site%3Agov

"multiple sclerosis" neurontin elavil topamax
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22multiple+sclerosis%22+neurontin+elavil+topamax

"multiple sclerosis" (narcotic OR narcotics) (prescribe OR
prescription)
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22multiple+sclerosis%22+%28narcotic+OR+narcotics%29+%28prescribe+OR+prescription%29

Dear yesmam-ga 
As a fellow sufferer I know exactly the pain to which you are
referring.
I tried carbamazepine (Tegretol) and baclofen at first without
success. Then my consultant pescribed Dantrium capsules (dantrolene
sodium.) They took two weeks to kick in for pain relief and one month
to remove a lot of spasticity. Pain has been reduced by at least 85%.
My consultant indicated they work on a small percentage of patients.
Download information from the US site of Procter & Gamble
Pharmaceuticals
http://www.pgpharma.com/pi/US-Dantrium.pdf
I hope you find relief soon.
Best wishes.
answerfinder-ga

Thanks answerfinder. It seems as if your pain is from spasticity where
mine is called central pain.
It is the pressure of lead casts on my legs, plus the feeling of being
bitten by a 1,000 bees at once. On top of that it feels like two
turnequets tied around my thighs 24/7.
My neurologist is indifferent to pain and I will be seeing a pain
specialist who I understand will prescribe narcotics when indicated. I
have already tried every anti-convulsent plus tricyclic anti-Ds like
Elavil. Have tried Baclofen even though it is indicated for
spasticity, not central pain.
The psychological ramifications of pain are indescribable.
Continued success with your treatment and lets hope for a cure.

You might discuss the appropriateness of these drugs (some still under
investigation) with your pain specialist.

Pipeline drugs:
http://www.abpi.org.uk/publications/publication_details/targetPain/tp4d_pipeline.asp

Neurodex:
http://www.avanir.com/product/product.php?ID=3

Dexanabinol:
http://www.mult-sclerosis.org/news/Jan2001/CannabisDerivativeStudyonSCI.html

Fentanyl/Duragesic patch:
http://remedyfind.com/rm-942-Duragesic.asp

Lignocaine:
http://www.jr2.ox.ac.uk/bandolier/booth/painpag/Chronrev/Other/CP078.html

Memantadine:
http://www.abipm.org/future.htm

Mechanisms of pain:
http://www.virtualcancercentre.com/asp/documents/pain_patient.asp

Discussion on pain:
http://www.spotlighthealth.com/common/chat/ChatTransDetail.asp?m=2&cid=41

Central pain:
http://www.painonline.org/cause.htm

Best of luck to you,
V

Thanks so much for all the links Voila.
Yesmam