Q: Since a circumcision eight months ago I suffer constant pain which is eased a bit by Pregabalin tablets. My GP says my nerve ends may never heal, but is there any other effective treatment of any kind?
A: Any surgical scar has the potential to cause persistent pain but it is a rare complication and the causes are poorly understood. It is postulated that the scar or the surgery interferes with the normal function of the nerves that supply the area. Those nerves would normally register normal sensations of touch, temperature, pressure and pain.
For some reason the pain-sensing nerves behave abnormally and constantly register pain for which there is no apparent cause. It often has an unusual quality and is referred to as “neuropathic pain”. Standard painkillers are usually ineffective but a group of drugs which alter nerve function can ameliorate the pain to some degree. Pregabalin is one of these and it is worth trying others in the group as individuals can react differently to specific drugs.
I have several patients in whom the intensity of the pain has slowly faded over a long period of time when medication can then be withdrawn, others are not so fortunate. So your pain may settle yet.
Q: I've suffered with night sweats since I was a young man. The latest bout followed a severe virus, which caused acute anaemia. This has now been treated with iron tablets, but the sweats are a big problem. Tests for malaria and TB were negative.
A: Night sweats are quite common even when there’s no known cause. Some people sweat very easily and temperature control through the night is not always consistent. Other possibilities include a wide variety of infections, sarcoidosis, overactive thyroid, cancers (particularly lymphomas), drug therapy (many of the antidepressants), nervous system diseases, low blood sugar and many many more. You can see the problem: the only way to make progress is to take a full medical history and examination and then tailor any investigations to the clues revealed.
The fact that you have had the sweats for many years without any serious disease becoming apparent is, of course, reassuring.
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