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

[london81]

Happy with my result at least! Before and after comparison.

[sl]

Thank you London.

 

Yes I read what Dr.F said with interest and would say it is rare to have as you have. I have had 7000 FUE and 1400 beard FUE and had post op neuralgia only the first time and that was in a different clinic and it came 6 days post op and worse at night and went day 12 or so and I have spoken to a good few who have had this but never one in 6 years who had it as you have manifest later on as you have.

 

I hope the medication works for you and feel free to email me and I can go over what I do for head nerve pain but my cause was after an accident so is post concussion syndrome and different to your cause but I've been studying nerve pain a lot since then and found what to avoid if possible and triggers etc.

 

The meds may really help to calm things also and glad you got a good result from the ht, that's a positive and for sure this will come good in time also and avoid things that can trigger pain if possible, stress, coffee, alcohol, de-hydration etc I found all exacerbate nerve pain.

[sl]

Photos look very good!

[london81]

Thank you Steven, by the sounds of it you really have been through the mill yourself . Hope your pain is under control and gets better. Your knowledge knows no bounds!

 

Thanks. Yeah I'm please with the result. Let's just hope I don't develop another rare side affect and it all falls out!

 

Best wishes

[Dr Blake Bloxham]

Hey London,

 

Glad you're pleased with the results! Definitely makes the situation a more positive one all around. I don't think you have any sort of dermatitis either. I posted that pic to show you what true seborhetic dermatitis looked like. If you had this -- at any point -- you'd know it. It sounds most consistent with FUE neuralgia. I think talking to the surgeon and the doctor who prescribed the neuropathic pain medication is a good idea. Best of luck!

[HairsGone]

Yes Gabapentin and Amitriptyline are different medications completely but both are used for neuropathic pain. Here in the UK we tend to use Amitriptyline first line as its cost effective and often tolerated at lower doses and usually quite effective. I think the reason your GP didn't prescribe you is as you're taking sleeping tablets and Valium. You need to see your GP to discuss different treatment options, probably Gabapentin. Best of luck.

[bricvic]

Hi London,

 

If the pain persists much longer, maybe your GP can refer you to a physician or clinic that specializes in chronic pain. Also, you may be interested in this article about a hair transplant patient who was treated for Occipital Neuralgia. Occipital Neuralgia after Hair Transplantation and Its Treatment

Hope you feel better soon

[london81]

Hi Bricvic,

 

Thank you very much for that. I will read now with interest!

[Matt27]

It is possible that the surgery triggered something called myofascial pain in which trigger points develop in muscles and refer pain around the head. There are a lot of nerves on the sides and back of the head and the donor region also corresponds to the classic "tension headache" pattern because of this.

 

I would look into a muscular cause. If you really do have sharp shooting pains though then that's neurological.

[london81]

Thanks Matt I will look that up. The pain is all different kinds of sensations. It feels like it's coming from deep within the scalp and pulsating outwards. I can feel strange contractions also. I mentioned about the shooting pains and burning pains too, it's a mixture of all those feelings. Wouldn't wish it on anyone ( well maybe my worst enemy ) Thank you for the info though it helps me to look into it all and help tell my GP about it as she has little idea and my surgeon doesn't know but he's in Belgium anyway so realistically I'm going to have to get this investigated here and hopefully sorted. Thank you Matt.

[matt3480]

Take some Vitamin B6 pills.....they are for nerve growth and health. I also had some bad pain in the donor for a couple weeks after FUE and read here on the forum that someone had taken B6 and it helped them a lot. It helped mine a lot, too.

 

The tough part was sleeping. In my opinion, you want to take pressure off the painful area (so the nerves aren't firing) and that's impossible almost if you are a back sleeper like me. It's odd that it reappeared but I wonder if you aren't irritating it enough nightly while sleeping (which isn't letting the nerves heal).

[london81]

I have vitamin B Complex is that ok or would you get some pure B6? I'm on pregablin which is helping dull the pain down a bit especially during the day but at night it gets stronger for some reason. It's kinda taking the edge off the pain though I think but it's hit and miss at the moment. One minute it can be ok then suddenly flare up so I'm taking nothing for granted. I sleep on my side, is that better for it?

[Matt27]

Thanks Matt I will look that up. The pain is all different kinds of sensations. It feels like it's coming from deep within the scalp and pulsating outwards. I can feel strange contractions also. I mentioned about the shooting pains and burning pains too, it's a mixture of all those feelings. Wouldn't wish it on anyone ( well maybe my worst enemy ) Thank you for the info though it helps me to look into it all and help tell my GP about it as she has little idea and my surgeon doesn't know but he's in Belgium anyway so realistically I'm going to have to get this investigated here and hopefully sorted. Thank you Matt.

 

Honestly a GP isn't likely to know about it. Even neurologists don't. You'd have to see a chronic pain physician (who are normally trained as physiatrists or anesthesiologists).

 

In my experience, myofascial pain can feel like "tingling" and can be sharp. The sure fire ways to differentiate it from neuropathic pain are whether you have numbness or 'pins and needles.' The latter of which occur only in neuropathic pain.

[london81]

Would myofascial pain be able to be cured or would I be stuck with it for life?

[Matt27]

It can be cured. It's the cause of like 98% of chronic pain. It's just generally unknown to doctors. And I have heard of surgery triggering cases of it.

[london81]

That's good news then. When I have another FUE in the future do you think I'll get the same thing again?

[london81]

Doc gave me some Fluoxetine too she said it can help with pain also and the stress of it.

[Matt27]

That's good news then. When I have another FUE in the future do you think I'll get the same thing again?

 

I can't say that it's for sure what you have. But it should be at the forefront of any chronic pain investigation.

 

Generally myofascial pain is triggered by one thing (eg surgery) and perpetuated by something else. If it is myofascial, you'd have to find out why it's being perpetuated.

[Dr Blake Bloxham]

Matt,

 

Tenderpoints and myofascial pain is something covered in medical school. However, London's pain sounds far more consistent with neuropathic pain very likely secondary to the FUE procedure.

 

I highly recommend he discusses this with his surgeon and the physician who prescribed the neuropathic medications.

[Matt27]

Matt,

 

Tenderpoints and myofascial pain is something covered in medical school. However, London's pain sounds far more consistent with neuropathic pain very likely secondary to the FUE procedure.

 

I highly recommend he discusses this with his surgeon and the physician who prescribed the neuropathic medications.

 

True; however, med school is only 4 years long and there are way too many things to cover. I spoke with a med student I know and he said they spent like 2 hours on it. I have seen dozens of doctors and their (outside of pain clinics) knowledge on the subject is poor at best. Basically they're aware that it exists and that's it.

 

Tender points are actually associated with fibromyalgia, not myofascial pain. So... yeah. The 'points' associated with myofascial pain are called trigger points.

 

He may very well have neuropathic pain. Sometimes our description of pain can get lost in translation (it can be very difficult to put into words) so I was trying to be open minded despite his mention of sharp shooting pain.

Edited July 27, 2015 by Matt27

[GRIGRIMAN]

Hi London81

 

I had 3,000 FUE and experienced the same symptoms as you from around day 7 to 14, which also got worse at night. My UK representative (SL who has also posted on this thread) suggested pain medication to ease the pain. I remember worrying if the use of medication would have a negative impact on my result but it didn't and helped. I think I took Ibuprofen.

 

I hope you get better soon and it's nice to see the rest of the community on this forum offering you support.

[london81]

Thank you Grigriman, hope your please with your result

[OneMission06]

I am currently about 11 days post op from a 1500 graft FUE procedure. I had minimal pain for the first few days, but beginning on post op day 5 I began experiencing moderate to severe pain in my donor region with very similar symptoms to what you describe. I did not want to take narcotics and Aleve wasn't doing it for me. My wife happens to be a pain doctor and she prescribed Emla cream, which is a lidocaine cream. I applied it copiously to the area about 2x/day. It absolutely took the edge off, and seems to have calmed the nerve endings. I have been using it for about 3 days now. While I can still feel the symptoms, I no longer consider it painful. Your pain sounds more severe and chronic, but it might be worth a shot if you haven't tried it yet.

[london81]

Just to update - I've been taking anticonvulsant medication which is also used to treat neuropathic pain for the last 3 weeks now and the pain has been getting better on it. I have to take it regularly throughout the day or the pain flares up again. It's good news In terms of confirming its nerve damage related but my GP ( family doctor ) doesn't know if this pain will go after I stop the medication. It's trial and error really. I am 12 months post op now and the pain guys mention getting 5/6 days after FUE that lasts a week or so well I have that daily. The medication I am taking is Gabapentin, I was on pregabalin but side effects to were quite heavy on that. I do get side effects from Gabapentin which are not nice but I've no choice right now. I just hope I'm not stuck on this for life because that would mean I've been left with permanant nerve damage. It's like having permanant tooth ache but in all of the donor area. Imagine life like that daily. It's pretty grim for me.

 

Something I've been researching is PRP for healing purposes. I've been reading it can be helpful in the healing process and athletes use it to help repair tissue injury and also for chronic pain. I wish I'd had it done after the FUE but I forgot to ask for it on the day. I've nothing to lose so will make enquires about having it done. Hopefully i'll be able to find a good doctor for a decent price In London.

 

I will keep updated on any progress but for now I guess it's sticking to the painkillers and Neuropathic medication.

 

Thanks for all advice.

Edited August 9, 2015 by london81

[Dr Tejinder Bhatti]

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.

 

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