Continued Donor area pain 11 months post FUE, any advice?

[london81]

Hi everyone,

 

I've posted on here before about donor area pain after my FUE procedure. Initially it started 5 days post op then went away after about 10 days. After that I would get the odd sudden 'twinge' and electric shock type pain and tightness now and again but no prolonged pain as such.

 

After about 6 months the pain returned out of the blue and has been pretty much with me since. Especially the last 3 months where it has been almost constant. It's a burning sensation that is very intense. It feels very sore and painful. Also very itchy, tingly and some electric shock type shooting/ stabbing pains. It's really starting to get me down. It's only in the donor area. I've tried everything from oils to shampoos yet nothing is getting rid of it. I can't concentrate on anything as I'm in pain constantly throughout the day with it worsening in the evening and night.

 

I went to see my Surgeon and he said the donor had all healed very well and there was no sign of infection ( good news ) and it was probably dermatitis and not from the FUE or nerve related. I'm not sure, I never had no pain pre transplant. I've been using Nizarol, prescription scalp application, oils, aloe Vera, etc etc you name it I've tried it and it hasn't worked. The surgeon has never heard of post op donor pain at this stage he said nor has other surgeons he talks with.

 

I've been to my GP today and she said mild dermatitis wouldn't cause such pain and it would be painful in other areas of scalp also which it isn't, it's only in my donor area. Down the centre of the donor and also to the left of centre. She's given me some pregablin tablets to try. It's used to treat nerve pain. I'll see how that goes. I'm writing this at 01:39am in bed and in pain.

 

I just pray I'm not stuck with this pain forever

 

Any suggestions on what's going on and possible treatments are most welcome.

 

As of now, no one seems to be able to work out what it might be.

Edited July 22, 2015 by london81

[Yonex]

man that is tough going, sorry mate i can't offer you any advice but it's got to be surgery related surely? It maybe a particularly severe case of nerve damage, is there even a test that can measure that?? I don't see how a doctor can just look at your scalp and say it's not nerve damage, obviously something is amiss underneath your skin?

 

Perhaps another doc will read this and chimes in

[Sean]

Hi everyone,

 

I've posted on here before about donor area pain after my FUE procedure. Initially it started 5 days post op then went away after about 10 days. After that I would get the odd sudden 'twinge' and electric shock type pain and tightness now and again but no prolonged pain as such.

 

After about 6 months the pain returned out of the blue and has been pretty much with me since. Especially the last 3 months where it has been almost constant. It's a burning sensation that is very intense. It feels very sore and painful. Also very itchy, tingly and some electric shock type shooting/ stabbing pains. It's really starting to get me down. It's only in the donor area. I've tried everything from oils to shampoos yet nothing is getting rid of it. I can't concentrate on anything as I'm in pain constantly throughout the day with it worsening in the evening and night.

 

I went to see my Surgeon and he said the donor had all healed very well and there was no sign of infection ( good news ) and it was probably dermatitis and not from the FUE or nerve related. I'm not sure, I never had no pain pre transplant. I've been using Nizarol, prescription scalp application, oils, aloe Vera, etc etc you name it I've tried it and it hasn't worked. The surgeon has never heard of post op donor pain at this stage he said nor has other surgeons he talks with.

 

I've been to my GP today and she said mild dermatitis wouldn't cause such pain and it would be painful in other areas of scalp also which it isn't, it's only in my donor area. Down the centre of the donor and also to the left of centre. She's given me some pregablin tablets to try. It's used to treat nerve pain. I'll see how that goes. I'm writing this at 01:39am in bed and in pain.

 

I just pray I'm not stuck with this pain forever

 

Any suggestions on what's going on and possible treatments are most welcome.

 

As of now, no one seems to be able to work out what it might be.

 

London, i am surprised to hear the pain is still there for you, even after 11 month mark. Just out of curiousity, have you spoken to your docs about other causes? It may be good to check and see if another issue may be exasperating the pain in the donor. Ask your doc if there are other conditions with similar symptoms such as Occipital Neuralgia: Symptoms, Causes, Diagnosis, Treatments, and More

It is good to get screened to see what could be doing this. Very rarely have i heard of long term pain. I heard of numbness but sharp pains is something alarming. Hope it resolves for you. Keep us updated. Wish you well.

[gillenator]

london81,

 

Every now and then I hear about a case such as yours. The tingling shocking type of sensations are a sign of the severed nerve ends healing. And they do regrow.

 

The scalp is enriched with both nerves and blood vessels and with FUE, especially the larger cases, many nerves can be severed in the extraction process.

 

You may find that it will take over one year, possibly even 18 months or so post-op for the discomfort to subside.

 

I truly hope the nerve pain medication will help.

[london81]

Gillenator thank you, I've been on the pain medication for about 24 hours and it seems to be dulling the pain a bit although I don't like to speak too soon! I've got some coconut oil spray also which offers a cooling effect on the scalp. I hope you are right and it does go thanks for taking the time to reply.

[london81]

Hi Sean, thanks for the info. I've looked up the condition you mentioned and I suspect it may be something like this. The medication I've received is to help neuropathic pain so I'm hoping it will work but the doc says it can take a week or so before I may notice so I will see how it goes. The pain has been bad though, it's felt like my scalp has been on fire for months at the back and stabbing/ electric shock type pains. I will update any progress

[london81]

Hi Yonex, yeah I think it's nerve damage as a mild dermatitis wouldn't cause this type of pain in only the donor area. I think it's from the FUE as I only had this after the op and it's only in the donor area I have the pain. I've started taking the neuropathic medication yesterday and it's eased off a bit today so I'm hoping it's working and actually if it does work then at least I know it's the nerves. Medication is quite heavy though and felt drunk all day but it's better than that pain! Thanks for the message.

[HairsGone]

I'm a Dr and your symptoms sound very typical of neuralgia pain. Dermatitis would not cause pain like this. Although I have no experience of treating patients with hair transplants it is very likely post surgical related. Pregabalin is a very good choice, give it time, even upto 4 weeks then reassess and some patients need to slowly titrate the dose up. Hopefully it will eventually settle.

[london81]

Hairsgone, thanks. Yes, it must be surgery related because I've had trouble with the donor area ever since the op. I never had any pain in my head before the surgery. I 'feel' like something is damaged, it's strange. It's been throbbing tonight. It's just awful pain. It's so intense. I don't know what I'm going to do if this pregablin doesn't work I was going to ask for Gabapentin but not sure. The Pregablin is making me really drowsy and feeling really spaced out and tired. It's 1am and I can't get to sleep because of the pain. It feels like I have suffered a head injury kind of feeling. I just hope I'm not stuck with this forever because it will be a miserable life in constant pain.

[HairsGone]

I would stick with Pregabalin for now as its early days. What dose are you taking?

[london81]

@ hairs gone I'm on 50 mg 3 times a day but think I need more. Also I was wondering if the PRP injected into the donor area might help?

[HairsGone]

If you're drowsy on that dose then no point increasing the dose. Would be better switching to Amitriptyline or Gabapentin - see your GP

[london81]

Thanks mate, do you know if Gabapentin will do with same but without the drowsiness? Feels like I'm drunk!

[HairsGone]

All 3 drugs mentioned can help for neuralgia pain and they can all cause drowsiness but often patients tolerate one better than another. So hopefully you will tolerate Gabapentin or Amitriptyline. The only way of knowing would be to try them, but bear in mind they don't work instantly like normal pain killers but take time to have an effect.

 

Ps I don't have a clue about prp injections and if they would help, that's beyond my expertise.

[london81]

Thanks so much for the advice! I'll keep the thread updated in how I get along. Have a good weekend buddy

[WHTC-7706631290]

Sorry for you troubles, London81. I don't know of any good dermatologists in London.

 

The sensations you are describing seem much like you may have seborreic dermatitis, which can cause you to fell tingling, sharp painful sensations when not adequately treated.

 

I wish I could say with certainty that it is as a result of nerve trauma, but FUE is typically a shallow surgery. The depth of a good FUE surgeon's extraction avoids the subcutaneous region.

 

Have you tried any prescription strength hydrocortisone topicals by chance? Triamcinolone could reduce the discomfort, but you may need to discontinue some of the shampoos and other current hair products until you can isolate this issue.

 

I hope you can find some relief.

[Dr Blake Bloxham]

London,

 

I wanted to clarify a few things:

 

Gabapentin and amitriptyline are two very different medications. Gabapentin (brand name Neurotin) is a neuropathic pain agent. This means that it is designed to treat pain associated with nerve damage. It often needs to be taken at large doses to be effective, and many patients -- even those with true neuralgias -- don't get much from it. Other medications in this class include pregablin or Lyrica.

 

Amitriptyline is a tricyclic antidepressant. It is a member of an old class of depression medications that have been replaced by modern antidepressants ("SSRIs," "SNRIs, et cetera) for one major reason: side effects. It's mainly prescribed today for neuropathic pain. However, it is generally associated with more side effects and is, therefore, usually second line after Neurotin and Lyrica.

 

What you're describing, unfortunately, does sound like "FUE neuralgia." Dr Feller describes this phenomenon here:

 

"FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it's counterpart in FUT surgery.

 

This is a condition that occurs after the donor area is harvested with a great number of FUE. It's symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years."

 

Here is a video he made for another member experiencing similar issues. He also does a good job explaining why this phenomenon occurs:

 

 

The depth we work in during FUE procedures is absolutely deep enough to damage nerves as well. The structures innervating the follicles, skin, and blood vessels in the region reside in the superficial subcutaneous fat and deep dermis, and these ares are absolutely affected in any type of hair transplant surgery. Even if the punch doesn't severe the nerves -- and it shouldn't be this deep -- they are still affected when grafts are delivered -- as the bulb of the follicle resides in the deep dermis/superficial subcutaneous layer as well.

 

Seborrheic dermatitis causes large, yellow, flakes to erupt on the scalp and often on the face as well. If you had SD now or before surgery, I think you'd see more of this than you would pain.

 

Here is an example:

 

 

I'm also not confident that steroids (hydrocortisone and triamcinolone) would help with the pain, as it's likely caused by nerve damage and not inflammation around any structures -- and steroids are anti-inflammatory agents.

 

How many grafts did you have removed via FUE? Have you discussed this with your surgeon? Also, who wrote the prescription for the gabapentin? You may want to speak with this doctor again. Make sure all of this is being followed closely by a competent physician familiar with your medical history. Feel free to ask additional questions.

[london81]

Hello Blake thank you very much for your message. My scalp doesn't look anything like the picture you posted. It's just 'slightly' red but isn't flaking or anything. It's been slightly red for years. It's never caused me any trouble or pain though. I've only had this pain AFTER the FUE.

 

The pain started day 5/6 post op and lasted for around 6 days then the intensity of it went away for a few months yet I did get the odd stabbing/ electric shock type pain now and again but it wasn't prolonged. Then after a few months it started to become more frequent and more frequent and now it's constant and has been for 3 months. Worse at night. I take Valium and sleeping tablets to sleep and that's the only break I get. When I open my eyes in The morning I dread the day as I know it's going to be painful.

 

I don't see how a slightly dry scalp can cause this kind of pain in a localised area only where the grafts were removed. I think it would have to be a severe case of dermatitis to cause this kind of pain. I've been to a dermatologist and family doctor and both said it looks a bit red but said that was it. They said the scalp looked fine. Doctor Feriduni said the scalp looked a bit red that's all. I'll post a photo of the donor tommorow and you will see the scalp looks normal. Infact Dr Feriduni said it had healed lovely and there was no sign of surgery and the scalp was fine apart from being slightly red. He said it wouldn't be nerve related or from the FUE but didn't know what it would be and said he'd asked other surgeons and they all said they had never heard of this post FUE at 12 months.

 

I had 1800 grafts. I've had the steroid liquid and it didn't help. It irritates my scalp if anything, especially after I'd been off it for a week. My GP actually gave me Pregablin and told me to take 3 x 50mg per day which I've been taking for 5 days. The pain has eased off in the day but at night when it's at its worst is still causing trouble. Side effects are not nice as I feel drunk and unstable walking around and total memory fog with it. I was going to switch to Gabapentin but I'm not sure which is best.

 

The pain feels like I have a head injury. Like I've had trauma to the head. It's stabbing pain, electric shock type pain, throbbing pain, tightening feelings, intense burning sensations, shooting pains. It's hell to be honest with you. I just hope I'm not left with permanant nerve damage cause I dunno how I'm going to cope with that. Would you recommend asking for a referral to a neurologist? Or shall I see how the medication goes first? I just don't want to have to take that medication forever. Thank you for taking the time to reply Blake.

Edited July 25, 2015 by london81

[london81]

Hi WHTC, as Blake just said FUE is deep enough to cause nerve damage and I personally don't think that a slightly irritated scalp can cause this type of prolonged pain. I've never had is type of pain before. I think the dermatitis would have to be very severe to cause this type of pain, pretty much like the picture Blake posted and I'll post a pic of my donor tommorow and you will see it's nothing like that. The doctor said the scalp looked great if not a little red. I will look into the topical you mentioned. Thank you for your reply.

[london81]

I just got a comb to lift up hair at the back to show you my scalp. Hard to see it clearly really but it just looks slightly red and there are no flakes or anything. I've never had dandruff actually.

[london81]

Here is a pic of the donor on day 2 which looks fine.

[london81]

Here it is immediately after the procedure in the clinic.

[london81]

This was in the hotel in the evening a few hours after the procedure. Bloody but they cleaned it up the next day, ( sorry I've had to submit the pics separately as it won't let me attach more than one at a time on the iPad ) I'll try post another donor hair pic tommorow. Currently soaked in argan oil as recommended by the doctor. I wonder if minoxidil on the donor might help? It might increase circulation and help the pain?

[sl]

Hi London, I have to say it is strange to have this pain that some get post FUE re-surface as it has for you after this time. See a neurologist and have some scans done if possible.

 

I've had 15 months of head pain after an injury and tried the meds mentioned here but didn't like them so am now doing a hyperbaric oxygen chamber 2x weekly as I heard it can benefit nerve pain. I also take natural supplements for nerves and avoid coffee and alcohol also.

 

Hope it does improve for you and I find the HBO treatment helpful I will let you know as it may also benefit you. Keep positive.

[london81]

Hi Steven, thanks for your message. I remember all the excellent advice you gave me two years ago when I was consulting with BHR clinic. You are the best rep out there in my opinion. Well, I'm very pleased with the result of the procedure. I think it looks great however it's this pain that's excruciating. I was just reading a post from Dr Feller, quote

 

"FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it's counterpart in FUT surgery.

 

This is a condition that occurs after the donor area is harvested with a great number of FUE. It's symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years. "

 

This sounds like what I'm experiencing.

 

Thank you for your kind words.