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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17537
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have mucous membrane pemfoid on my gums. I now have it in

Customer Question

I have mucous membrane pemfoid on my gums. I now have it in my genatalia and I'm in agony. My g p has given me morphine anti inflamatories ,steroids and im taking amitriptilyne for facial pain. im in real great pain. This has gone on for three months now. I can't sleep or eat or function and the pain is severe now . It has come to a climax today and I can't take the pain any longer. It feels raw inside. I went back to see g p on Tuesday and said it is like having a baby but he said to just increase the tablets. I've done this but the pain is excruciating . What should I do?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
Do you mean pemphigoid?
Have you seen any specialists for this beyond your GP?

Customer: replied 3 years ago.
Yes that is what I mean. I have seen urologists with camera. swab. pee sample. gaenos ,ultrasound but never anyone who specialises in this desease. I am due to see a neurologist .My g p thinks it could be neuralgia but I've got that in my face and this is not the same. It feels raw down below.
Expert:  Dr. D. Love replied 3 years ago.
Thank you for the clarification.

There are several issues to consider in this situation.

The specialists that have the greatest experience with pemphigoid are Dermatologists. In your case, even though your primary manifestations are oral and vaginal, it still may be better to see Dermatologists, since they have the greater experience with the disease.

f there is concern about the possibility of neuropathy, then seeing a Neurologist would be appropriate. However, another specialist to consider would be a Pain Management specialist. A Pain Management specialist has more experience in assisting with control of pain, including performing nerve blocks, which can be very effective when pain medicines are not effective at controlling pain.

If you have any further questions, please let me know.

Customer: replied 3 years ago.

How do I get more pain relief now? Nothing is touching it.
Expert:  Dr. D. Love replied 3 years ago.
What dose of morphine have you been taking?
Do you have any pills available other than the morphine?

Customer: replied 3 years ago.
I have been taking 40 mg of morphine tablet firm and 30ml of oramorph. I take 6~ amitriptilyne at night but have been taking them during the also as I've been in so much pain. This I was told to take by my g p.
Expert:  Dr. D. Love replied 3 years ago.
For control of the current pain, there are only certain options that are available at home.

It is certainly OK to use any of the over the counter medicines, such as paracetamol, ibuprofen, or naproxen. These drugs are clearly less potent than the morphine, but by taking them in addition to morphine, they may augment the effect of the morphine, so that the combination is more effective. In fact, it would be OK to use paracetamol plus one of the anti-inflammatory medicines (ibuprofen or naproxen), as the paracetamol works by a different mechanism than the anti-inflammatory medicine. It also may help to use a higher dose of the ibuprofen or naproxen. Maximal doses of the ibuprofen is 2400 mg per day in divided doses and of the naproxen is 1500 mg per day.

From the perspective of the use of an opiate pain medicine, the usual approach for home management is what you doctor has recommended - to gradually increase the dose of the morphine. If gradually increasing the dose of the morphine is not able to achieve control of the pain, then the usual next consideration from the perspective of an opiate is whether to provide an injection of an opiate, but that would require being seen.

The amitriptyline is a reasonable medicine to take, but it takes so long for dise changes to become effective, adjusting the dose of the amitriptyline will usually not be helpful for control of pain today.

Some people may be able to get some relief by local care. For vaginal pain, it may help to soak in hot water. Some women find that adding salt or Betadine (povidone iodine) to the water may be more soothing. It also may be helpful to apply ice packs to the genital area. As with musculoskeletal problems, both cold and heat can be helpful. Some people find that one intervention is helpful while the other is not, and it is fine to continue the intervention that you find helpful.

If I can provide any further assistance, please let me know.

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