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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Nerve Damage In Shoulder. Using Diazepam For Sleep. Why Isn't Paracetamol Or Codeine Working?

I have nerve damage in my right shoulder (neuropathia?). None of the traditional pain relief drugs ( paracetamol , co-codamol, codeine ) are touching it. I went to A & E yesterday after breaking down at work (I haven t slept more than fitfully for six nights now) where they diagnosed my condition and gave me diazepam to help me sleep. Sadly this didn t work either: I was up at midnight putting an ice pack on it and, for the sake of doing something, taking more paracetamol; at 2 am making myself a hot milk (not a miracle cure!) and then listening to an MP3 player for two hours. Between 4am and 8am I think I got some kind of sleep. I called the pharmacy line and she said that not diazepam does not work with everyone. Someone at my wife s work who has had similar problems suggest I try the diazepam tonight again, perhaps earlier in the evening. I did also ask about the lack of effect of traditional pain killers. She said that this can happen with nerve damage. She suggested a couple of alternatives that may work to ease the pain: amitryptiline and gabapentin . What do you think? I am seeing a physiotherapist tomorrow - hopefully this will help. In the meantime I am in a bit of a state.
posted on Sat, 30 Jun 2012
Twitter Tue, 9 Apr 2013 Answered on
Twitter Wed, 10 Apr 2013 Last reviewed on
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General & Family Physician,  's  Response
Hi, thanks for answering in Healthcare Magic.

Combination of Codeine with Paracetamol or Aspirin is more effective than when given alone. Such a combination gives additional analgesia. Paracetamol is more effective for fever than for pain. Aceclofenac, Ibuprofen or Ketorolac are better analgesics than Paracetamol. But these drugs are not specific for neuralgia.

Gabapentin, is considered to be the first line drug in the treatment of nueralgias. Amitriptylline reduces neuropathic pain by 50%. Gabapentin is more preferrable than Amitryptilline because it has fewer side effects compared to Amitryptilline.

Diazepam may not be effective in long standing insomnia (inability to sleep) due to pain. Measures like mental relaxation, avoiding napping at day ti,me avoiding stimulants all may be more helpful to you.Newer drugs like Zaleplon will be more effective.

I hope this is useful to you.



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Nerve Damage In Shoulder. Using Diazepam For Sleep. Why Isn't Paracetamol Or Codeine Working?

Hi, thanks for answering in Healthcare Magic. Combination of Codeine with Paracetamol or Aspirin is more effective than when given alone. Such a combination gives additional analgesia. Paracetamol is more effective for fever than for pain. Aceclofenac, Ibuprofen or Ketorolac are better analgesics than Paracetamol. But these drugs are not specific for neuralgia. Gabapentin, is considered to be the first line drug in the treatment of nueralgias. Amitriptylline reduces neuropathic pain by 50%. Gabapentin is more preferrable than Amitryptilline because it has fewer side effects compared to Amitryptilline. Diazepam may not be effective in long standing insomnia (inability to sleep) due to pain. Measures like mental relaxation, avoiding napping at day ti,me avoiding stimulants all may be more helpful to you.Newer drugs like Zaleplon will be more effective. I hope this is useful to you.