Has Anyone Seen this Article on Post LASIK pain?

[texaseyes]

I don't know why my cut and paste doesn't keep the below path as a link...
And apologies if this article has already been discussed here on the DEZ.

The article talks about post LASIK nerve pain and treating it with a tricyclic antidepressent (I thought those CAUSED dry eye), but it seems that the theory is that for someone who has normal appearing tears but still has pain that this kind of drug can keep the abnormal nerves from sending so many pain signals. I have dry eyes, but I often wonder if my tear film is actually just about the same now as it was before LASIK (nearly two years ago), but that they just HURT now and they didn't have the symptoms before LASIK. It also mentioned very high correction patients, but I don't know why it wouldn't also be true of anyone with LASIK hacked nerves, (or even PRK).

I'd be curious to get feedback from the very knowledgeable post LASIK folks on this site about whether this tricyclic AD drug thing is worth pursuing. I know they have more side effects than SSRI's, so it's kind of risky, but I do often wonder why my pain seems so out of proportion to my 'findings', as my doctors tell me.

http://www.journalofrefractivesurger...sp?thing=14986

[alywankin]

The article talks about post LASIK nerve pain and treating it with a tricyclic antidepressent http://www.journalofrefractivesurger...sp?thing=14986

If I remember correctly from recent research the "tricyclic antidepressents" are also known as "sodium channel blockers" which has had a recent post from someone for treatment of their "abnormal nerve regeneration"? However, one of the most common of these drugs has many many side effects.

Not sure where I found this online but....
Sodium channel blockers in neuropathic pain.
Subtypes of tetrodotoxin resistant voltage-gated sodium channels are involved in the development of certain types of neuropathic pains. After nerve injury hyperexcitability and spontaneous firing develop at the site of injury and also in the dorsal root ganglion cell bodies. This hyperexcitability results at least partly from accumulation of sodium channels at the site of injury. The facts that these sodium channels seem to exist in peripheral nerves only and that they can be blocked at the resting state (use-dependent block) offer the possibility to develop drugs, which selectively block these damaged, overexcited nerves. At the moment no such drugs are available. However, some of the most potent drugs that are currently used to manage neuropathic pain e.g. amitriptyline and other tricyclic antidepressants, also block these channels in addition to having several other mechanisms of action. Also most anticonvulsants that are used to alleviate neuropathic pain are sodium channel blockers. Lidocaine, the prototype drug, has been shown to be effective in peripheral neuropathic pain. Its use is limited by the fact that it cannot be administered orally. An oral local anesthetic type sodium channel blocker, mexiletine is an antiarrhythmic agent that is effective in neuropathic pain. However, effective doses may be difficult to achieve because of adverse effects.

[Rojzen]

delighted to see research on use of tricyclics, etc.

Thank you, Texaseyes, for posting this fascinating article that considers post-Lasik eye pain to be neuropathic, in the sense of phantom pain. I won't belabor the many things I've written previously here at DEZ about my dramatic benefit from amitriptyline, some years ago, but I'll focus instead on conveying that the fear of side-effects from tricyclics, or from the anticonvulsants used for nerve pain, can needlessly keep patients away from the life-restoring benefits of these drugs. (I am, btw, not post-Lasik, but my symptoms were close to those suffered by many post-Lasik patients.)

Yes, there are patients who will get drier on certain doses of these drugs, but there is no way to know how you will react until you give the approach a try. I have never read anything to suggest that drying or other side-effects from these classes of drugs tend to be permanent. . There are many reported cases of Accutane (an irrelevant drug, in this context) inducing irreversible dryness, but by and large, tricyclics and anticonvulsants produce rapidly side-effects.

Certain antipsychotics, btw, like Abilify and older drugs of this class, do produce potentially permanent side-effects (such as tardive dyskinesia), but I have never heard of any of these being used for neuropathic pain.

Something else to consider here is that pain is a mysterious problem, in many ways. There is a phenomenon, for example, in which by simply breaking a pattern of persistent pain, that pain remains different or lessened, even after treatment ceases. This, to me, is an incentive in its own right for addressing chronic pain quickly and effectively, whenever this is possible and safe.