Treating Nerve Pain: Featuring Dr. Heather Finlay-Morreale

Even during a pandemic, pain happens. I’ve recently fielded calls from patients suffering with shingles and sciatica, both nasty forms of nerve pain. Luckily, Dr. Heather Finlay-Morreale, Umass Memorial Medical Center pediatrician and neuropathic pain management expert, was a recent guest on my show. Her expertise is based on her personal experience: She suffered for years, decades really, with unexplained pain. She had excruciating episodes of head and facial pain (later diagnosed as occipital and trigeminal neuralgia), as well as a horrific bout of shingles and resultant nerve pain (aka postherpetic neuralgia). It was only after a more advanced evaluation with specialists that a biopsy confirmed small fiber polyneuropathy, an inherited nerve disorder, underlying it all.

Dr. Finlay- Morreale shares her tips and treatment recommendations for managing chronic nerve pain, and she emphasizes that most people need a multi-modal approach. We covered three main areas: lifestyle and psychology, over-the-counter and topical treatments, and prescription medications, and she recommends trying combinations of these for best effect.

Here’s the big-picture breakdown (for details, watch the show!)

Lifestyle and Psychology: These are the basic building blocks for better pain control, things that should be incorporated daily at baseline.

• An anti-inflammatory diet is good for so many issues, not just chronic pain. This means limiting processed foods and instead making meals with fruits and veggies, beans and legumes, nuts and seeds, and whole grains.
• Activity is critical, but it can be gentle activity, like yoga and stretching.
• Mindfulness meditation can be very helpful. We’re fans of Jonathan Kabat-Zinn’s books and programs.
• Pain psychologists are a thing! Dr. Finlay-Morreale speaks very highly of Western Massachusetts psychologist Elizabeth Austin, PsyD.
• Creative expression has also been shown to help, and this can include writing such as journaling, or art, or anything! Dr. Finlay-Morreale shares some of her paintings with us towards the end of the show:

Over-the-counter and topical treatments: These are generally benign and well-tolerated, inexpensive, and widely available. But, none of these works miracles and for best results, should be cycled as tolerance seems to develop.

• Topical lidocaine 4%, which is inexpensive, but can only be used on a small area and has to be reapplied multiple times a day.
• Capsaicin cream: This is literally red-pepper cream, and it causes a mild “burny” sensation before it starts working to calm the nerve endings. It must be applied 4 or more times a day to be effective. And it’s essential to keep it out of your eyes!
• Camphor/menthol topicals: Dr. Finlay-Morreale is a fan of Biofreeze, but others in this family include Tiger Balm (my favorite), Icy Hot, and Ben Gay.
• Ted’s Pain Cream: This arnica and salicylate cream is only available online. The touted resveratrol component probably doesn’t do anything, it’s the topical aspirin-like compounds that are the active ingredients.
• TENS units. This is transcutaneous electrical nerve stimulation, and is available over-the-counter rather inexpensively. We demo this on me on the show! Dr. Finlay-Morreale has found one or two 20-minute treatment sessions daily to be helpful for pain.

Prescription medications: These are systemic medications that are far more likely to have side effects, more than are listed here, for sure.

• Tricyclic antidepressants like nortriptyline can help many chronic pain patients, but side effects include sleepiness, dry mouth and possible weight gain.
• Gabapentin and pregabalin (AKA Neurontin and Lyrica) are similar and can also be helpful. These are sedating at minimum and are also associated with weight gain. Some feel they are habit-forming as well.
• Anti-seizure medications such as Lamotrigine and Carbamazepine (AKA Lamictal and Tegretol) are sometimes helpful but can cause sedation, nausea and dizziness.
• Duloxetine (aka Cymbalta) can cause blurry vision, dry mouth, and constipation.
• Opioids are sometimes indicated for nerve pain, but only for occasional use. These could be used once every few weeks for breakthrough pain or an extra layer of pain control, for example if someone needed to attend an event. Obviously tolerance and addiction are major problems with this class of medication.

Dr. Finlay-Morreale is a wealth of hard-earned knowledge and I am so pleased that she was able to share her personal experience with us. I hope you find the show helpful!