Summary

Introduction

Personal observations led me to suspect that the skin sensitivity might be a reaction to certain OTC medications.

I recently completed some experiments that confirm reactions to Ibuprophen (generic for Advil) and Famotidine (generic for Pepsid AC). Other NSAIDs (nonsteroidal anti-inflammatory drugs) and antihistamines are still suspect, but not confirmed. Naproxen Sodium (generic for Aleve) does not appear to cause this problem.

Symptoms

Symptoms start with an increase in skin sensitivity. Clothes irritate, with a feeling of being chafed where the shirt collar touches the neck, sleeves brush against the arms, and ankles touch high-top shoes. The back feels prickly, and then develops a feeling of being scraped and abraded. Think of having strong sunburn, where every touch is magnified.

As the attack progresses, the affected areas become larger, sensitivity increases in affected areas, and previously unaffected areas become sensitive. A delicate touch on the arm feels like a pummeling. The sensations from trivial cuts and scrapes are abnormally enhanced and prolonged. Sleep becomes difficult, because no position is comfortable; the weight of a sheet feels like lead plates pressing on the body.

When the condition reaches its peak, stimulation is no longer necessary. Pain abounds without need for trivial injury, or even light touch.

Unrelenting pain leads to psychological problems, chiefly depression. Suicide begins to sound attractive.

At no time is there a visible change in any affected area. The disorder is purely sensory.

The duration of the attacks ranges from a few days to many months.

Diagnosis

The condition was eventually named "idiopathic peripheral neuropathy." This is label restating the symptoms described by the patient, not a true diagnosis of the problem.

Relief Via Medication

Amitriptyline only alleviates the symptoms and not the underlying cause. When I stop taking Amitriptyline, eventually the pain comes back.

If Amitriptyline is taken continuously, it is impossible to determine if the neuropathic symptoms have gone into remission underneath the suppressing medication. In order to check for remission, Amitriptyline is discontinued. It takes about a week until the protection abates and skin sensitivity can be judged. In the event that the attack is still underway Amitriptyline is resumed and after about a week, the pain is suppressed.

Suspicion of OTC Medication

This theory fell into disfavor, because there was no obvious linkage between use of suspect medications and attacks.

I also noted that the first attack roughly coincided with the selection of Ibuprophen (generic for Advil) as my pain reliever of choice, but there was no obvious linkage between use of suspect medications and attacks.

Experiment #1 - Non-Blind Testing

The procedure was simple: consume a quantity of the suspect medication daily for a week, and record observations.

Here is a table of the results of this non-blind test:

Beginning date	Identity	Result
20011007	Ibuprophen	active
20011113	Pseudoephedrine HCl, Triprolidine HCl	inactive
20011211	Cyproheptadine HCl	active

(Cyproheptadine is not OTC. It is a prescription antihistamine. It was included so that both pain relievers and antihistamines would be represented. In addition to being an antihistamine, Cyproheptadine is known to have an antiserotonergic effect.)

These results support the hypothesis that some cold remedies may induce neuropathic pain. They also provide an explanation of why the link had not been noticed earlier: there is another time factor. From the time that the first dose is taken, a period of four to five days elapses before the onset of the first symptoms, and as much as a week before the symptoms are advanced enough to be sure that an attack is underway.

This is why previous attempts to identify triggers were inconclusive. When the attack is underway, one is likely to ask, "what might I have taken yesterday", not "what might I have taken a week ago?"

Experiment #2 – A Year Without Medication

Results were good: the pain stayed away.

It is difficult to get through flu season without drugs. In the long term, avoiding all drugs is not a viable strategy. It is necessary to conclusively prove which drugs should be avoided and which can be taken safely.

Experiment #3 - Blind Testing

More meaningful results derive from tests where the subject doesn’t know whether he is taking an inert substance or the true drug.

I decided to run such a "blind test" on myself. In brief, four sets of gelatin capsules were loaded with various compounds. I ingested the samples without knowing which was which.

The results were as follows:

Test Order	Beginning date	Identity	Result
#1	20030614	Famotidine	active
#2	20030705	Ibuprophen	active
#3	20030802	Naproxen Sodium	inactive
#4	20030906	Calcium Carbonate, sugar	inactive

These results complement the non-blind test results for Ibuprophen.

Discussion

• Naproxen
• Pseudoephedrine/Triprolidine

• Ibuprophen
• Famotidine
• Cyproheptadine

I may have a problem with NSAIDs in general, but only one of the two drugs in this category triggered symptoms.

The drugs that provoke my skin sensitivity problem are not necessarily defective, or troublesome to the public at large. It would seem that I have an underlying condition that predisposes me to react to these generally safe drugs. Perhaps others who suffer from neuropathic pain have a similar condition.

Suggestion for Neuropathy Patients

Those wishing to test themselves for reaction to these medications might do the following:

• Taper off and eventually cease use of any medication that contains the suspected compounds.
• Wait at least two weeks after taking the last suspect medication.
• Taper off the medication that provides relief from neuropathic pain.
• Wait at least one week after taking the last neuropathic pain medication.
• See how you feel!

Further Experimentation Is Necessary

Since I am both experimenter and the only subject, progress is slow. Those who conduct their own experiments are encouraged to communicate their results to this author and the Neuropathy Association.

The author can be reached at:

Dennis Griesser
8850 Knott Ave. #401
Buena Park, CA 90620