Brachioradial Pruritus

[CKINCS]

Thanks for all of the suggestions, everyone.

Ckincs

[Garth Wood]

Well, I promised that I'd report back when I got some more info.  So, here goes:

First, the article I was trying to hunt down about cervical spine manipulations sometimes helping people with BRP arrived.  The information in it was decoded by myself and my chiropractor, who realized that the spinal adjustment (which was described in a way typical of how an osteopath would do it) was identical to the kind of adjustment he routinely does on clients' necks.  So, he'd already been doing the adjustment on me, but it didn't seem to be having any dramatic effect on me.  Of course, I stopped going to him for a couple of weeks while awaiting my meeting with the neurologist.  I'll be starting back up again now -- I wanted the neuro's opinion on whether it was safe to have this adjustment continued.  He indicated that it shouldn't be a problem.

Second, I've discovered that BRP is one of a group of skin itching disorders which go under the more general banner (sometimes) of "neurodermatosis."  Why "sometimes"?  Well, because the MDs who diagnose a person as having a neurodermatosis (rather than BRP specifically) believe the itch to be strongly involved with the patient's emotional state, and there's some evidence for that.  MDs who give a more specific diagnosis (and BRP really isn't a diagnosis so much as a "label" -- it translates as "itchy forearm"!) tend to believe that there's a physical/biological explanation for the disorder.  But in the end, they may be talking about the same thing, and the cause of BRP or neurodermatosis may be multi-factored.  Emotional state, physical injury to or irritation of the skin (which starts an itch/scratch cycle that quickly becomes pathological), injury or compromise to the peripheral nervous system (the nerve fibers branching out from your spinal cord to your arm) and/or excessive exposure to sunlight on the forearm may all be contributing factors.  Quite the witches' brew, hmm?

Third, I popped for the expense of having an MRI of my cervical spine done back on December 1st.  Not unsurprisingly, it does show that the cervical disc between C5 and C6 (nerve root of C6) was bulging slightly and may possibly be impinging on the nerve root, contributing (at least) to the itching sensations and the lancinating pain in my right forearm.  However, in a chat with the neurologist (a really nice guy, and quite candid, too), he was unconvinced that the amount of bulge and impingement was sufficient to be causing any kind of radiating itch sensation, at least by itself.  He raised one possibility that I hadn't run into before and therefore hadn't considered -- he said it was also possible that I may have had a viral infection in the nerve root or the peripheral nerves which triggered the sensation of itching.  This is nothing more than a guess -- he freely admitted that this couldn't be confirmed without extensive (and mostly unnecessary) testing.  He was pretty upbeat about my continuing on with the gabapentin (Neurontin) treatment for the time being, as he believed it to be a relatively benign and effective drug for the symptomatic treatment of neuropathic itching.

As for the physical therapy, I'm continuing with the neck traction, although I may have to switch from using an over-the-door device to another type soon, since excessive over-the-door use (which involves a chin strap) has been linked to developing problems with the temporomandibular (jaw) joint.  So far, it appears to be helping somewhat -- the intensity of the pain and itch has lessened considerably.

If I'm still on the gabapentin, how do I know that the diminished itching/pain's not due to the action of the gabapentin?  Easy.  I stopped using gabapentin for several days to get a "bead" on how my arm was coming along.  It seems to be better -- though I'm still getting "breakthrough" episodes from time to time.  At present, I've switched to taking gabapentin once a day, approx. 90 minutes before bedtime, because gabapentin takes 60 to 90 minutes to be absorbed (this happens in the small bowel, not the stomach, so it's not as fast as some other oral medicines).  This worked really well for about two weeks, but I've now noticed that I probably need to adjust the dosage and timing again.  So I'm going to go to a twice-a-day regimen starting today, first dose of 300mg at around 5 P.M. and second around 9:30 P.M.  Hopefully, this will give me enough of a loading (and a long enough lead time) that I won't be awakened at night with any breakthroughs.

I don't want to go back to gabapentin full-time, because it makes me "foggy," and I don't want to increase my dosage, so I'm hoping this modification will work well.  Don't get me wrong -- without the gabapentin, I might have gone truly deeply mad from the itching, and I'm glad I live in a world where it's available, but I'm a big believer in using no more pharmaceuticals than is absolutely necessary, and I'm not afraid to stop or adjust dosages (usually with a doctor's or pharmacist's advice) to suit this ultimate end.

Anyway, that's about it for now.  If anyone has any questions, I'd be happy to try and answer them.  If not, have a good Christmas, everyone, and I'll try to report on progress occasionally.


Garth

[morgan]

hi everyone,

I haven't been here for a while so i thought i'd drop by and let you know what i've been doing about this condition.  Since my original post I went to my chiropractor with this information.  He had never heard about this condition but said it made sense that this would be the cause of my itch.  My x-rays show a thinning of the disc between C5 and C6 along with some spurring, but the big culprit is that my neck curves in the wrong direction which causes this problem inC 5 and C6.  A -20% curve, which he said is one of the worst necks he's seen in his 25years in practice.
He's been telling me this is a problem for years but because I had no pay coming from my neck i've concentrated on my lower back problem L5.  I have a traction device i have been advise to use for years (but stopped awhile ago) at least 20 minutes a day.
I lay down and put my head in it and strap in my forehead and neck.  The neck section pumps ups with the attached hand pump.
I have been doing this twice a day in the morning and evenings, 20 minutes each, religiously.  Also getting chiro adjustment once a week.  And a massage weekly.  Since i've started to do this i haven't had a serious episode.  I may occasionally get a little itch but it stops there.   Knowing what the cause is and doing something about it really helps.  I know my healing is really up to me, I've made a commitment to it and I want to thank you all for helping find out what this itching was and where it was coming from.  Merry Christmas and Happy Holidays.

PS:  the apparatus I'm referring to is called Posture Pump Neck Exerciser (Professional Model). I got mine from my chiro. but you may find it cheaper online.  Go to google and search posture pump there is alot of info there on it.  Garth this may be you answer.  Its helped me alot and had i used it on a regular basis when I was advised to I would not have had this problem now.

[morgan]

More on the Posture Pump.  The model i use is cervical only there is a Full spine model which is more expensive but may help those with lower back problems as well.  I paid $150.00 years ago for mine.  Ebay has a few for auction so you may be able to pick this up for much less on ebay.  

[Garth Wood]

Morgan:

Thanks!  I've been investigating various pump-action models that apply traction by trapping the sides of your head, rather than the over-the-door chin-strap type I'm using now.  That sounds like one of the ones I've been researching, and yes, they're considerably more expensive now than they used to be.  However, it's possible to get my GP to write me a prescription for this machine (or whatever others I finally settle on), so I can get insurance to pay for most of the pop.  Heck, I've paid into insurance schemes for 25 years -- it's about time to see some payback!  ;-)

I'm also glad it's helping you.  My condition's a bit more enigmatic, and I'm assuming it's multi-factorial, so I'm working on several fronts at once.  My GP's kindly prescribed 100 mg capsules of the Canadian generic form of gabapentin (Apo-gabapentin, made by Apotex Pharmaceuticals), which allows me to finesse my dosage more during the day.  Chiro and massage is going to be standard, and here in Edmonton we have several MDs trained in Western medicine who are also acupuncturists, so I can communicate what's wrong to them in Western medical terms and they can do the appropriate Eastern interpretations.  They're my next stop after Christmas.  I'm continuing with the traction for now, as well.

Merry Christmas, everyone.  I hope all this info has assisted.  In the New Year, I'm going to be building a website devoted to this condition because I've learned a lot about it (and related issues) in the last two months, and there's no other place on the Web that I can find that has all of this info in one location.  I'll post the link when I've got the website built.


Garth

[Garth Wood]

Hi all.

Well, since Christmas I've been working on getting my dosage of gabapentin lowered, and have stabilized (for the moment) on 200mg twice daily and 300mg just before bed at night.  This seems to allow me to work normally during the day and sleep well at night, with a minimum of daytime "fogginess."  I've also started acupuncture treatments (two so far -- my third is tomorrow morning), and I'm cautiously optimistic about the results, though there's nothing dramatic to report as yet.

I'm also in the midst of building my own website on BRP, and have most of the text written.  Now I'm just plowing through the research available to make sure I've covered most of the bases, and I'm not propagating any out-and-out bulls**t.  The final step is to give it a coherent logical structure -- I hope to have it up and running by the end of February 2004.

The fresh information I've found in the last two months confirms what I'd already learned earlier -- BRP's definitely a weird condition and there's lots of controversy about what causes it.  "Can't we all just get along?"  Apparently not.  

Enough.  Just a brief update.  Hope everyone monitoring this thread is doing well, and here's crossing my fingers for spontaneous resolution of symptoms for all of us.


Garth

[kneecapper]

Hi Garth,

I must admit that I have found this thread to be very interesting. I do not have your condition but I am familiar with the itch and know what it is like to just want to keep on scratching. The derm has diagnosed mine as prurigo nodularis. It has a very different etiology than your own.

Also, I have neck problems and I have some arthritis in the neck (it has not gotten any worse over a period of 5 years). At the same time I suffer from fibromyalgia and I have responded very well to the gabapentrin (Neurontin) which keeps the fibromyalgia and the neuralgia at bay. Neurontin is very expensive in this country but I am kept going with the starter packs from the doctor. I take 600 mg per day - 300 mg in the morning and another 300 mg in the evening. I raise and lower the dose as necessary and with my doctor's permission.

Anyway the thread itself has been really quite interesting.

Maggie
(Sydney, Australia)

[Diane7272]

Hi:
I'm new to the site.  I just found it.  I have had BR for approx 5 years with some periods of remission.  After 4 dermatologists, 2 allergists and my own 3 Dr.'s, I found this diagnosis on the internet.  i HAVE TRIED EVERYTHING!!  All oover the counter topicals along with prescription topicals, steroids and one of the derms had me on Atarax at 400 mg a day.  Could not function and it really wasn't working all that well.  Since  I have taken this info to my GP he  gave me the elavil.  I also have been going to a chiropractor and having acupuncture without much success.  Today has been a bad day for me and I get so frustrated which I think makes it worse.  The only way I can sleep through the night is 2 mg. Ativan.  I hate to be a druggy, but when you go through this you will try anything.  Dr. said next is Neurotin.  Has anybody tried it?  
Thanks for any advice you can give.

[Gobe]

 

Welcome to Skincell Diane!

 

[Garth Wood]

Diane:

Yes, I use Neurontin.  It's the trademark name for gabapentin, which is an anti-seizure drug first made by Pfizer Pharmaceuticals in the U.S.  If you're like me, you'll be started at a dose of 300mg 3 times per day.  I asked my doctor to prescribe in 100mg pills so that I could vary the dose.  On some days, I can take as little as 100mg twice a day plus the 300mg dose at night (for some reason, the itching sensation's always more "profound" at night, so you need to tweak the dosage a little).

Gabapentin's a remarkably safe drug with very few side-effects and almost no interactions with other drugs.  You should avoid taking magnesium supplements or magnesium-based antacids within two hours either side of a gabapentin dose, as magnesium blocks its action.  So Tums, but no Rolaids (assuming you live in an area of the planet that sells these brand names).  Anyways, read the labels.  You can take gabapentin with or without food, but some people have reported that taking it during or close to meals with a high fat content seems to lessen gabapentin's effectiveness.

The first few days, you're very drowsy.  This may not be such a bad thing -- if you were like me, you needed the sleep.  Most people adjust to their doses after several days to several weeks.  I find a couple of strong cups of coffee in the morning almost completely negates the "dopey" effects of gabapentin, without changing how it suppresses the itching sensations.  For me, gabapentin's been a God-send.  I'd talk to your doctor about switching you over -- Elavil (the trademark name of a tricyclic antidepressant drug) has way more side-effects than gabapentin does.  

As for brachioradial pruritus, well, I've been promising to set up a website with everything I've learned over the last five months (which is quite a bit, actually).  The actual cause is unknown, but there's a bunch of theories (and it's very possible that all of these theories, alone or in combination, are correct for at least some of the people who suffer from BRP).  These theories are:

1. BRP is sunlight-induced.  This theory is largely discredited now, simply because BRP has shown up in people who have little or no exposure to sunlight (night-shift workers who sleep during the day, people who live in far northern climates or in areas where there's lots of rain and little sunlight, etc.).  I would be one of those people.  Also, for many people, BRP is not seasonal.  Mine showed up in October of 2003 and is still going strong, and I live in the Northern Hemisphere.

2. BRP is psychological in origin.  While no-one seems to buy this in isolation, it's suggestive that for some folks, BRP is triggered by stressful conditions, and is alleviated by antidepressants such as Elavil.  It may be that BRP gets "help" from a person's emotional state.

3. BRP is caused by a viral infection.  Central or peripheral nervous system viral infections seem to normally cause some form of a palsy in the people who are suffering from them, but as one neurologist said to me, it's not outside the realm of possibility that a peripheral nervous system viral infection could pass unnoticed except for paresthesia (changed sensation) in a limb or extremity.  Extreme itching certainly qualifies as a "changed sensation."  If it is a viral infection, only time will help.  If your BRP keeps coming back, it's unlikely that an infection is the cause.

4. BRP is caused by a pinched, compressed or otherwise compromised cervical nerve root (most likely at C6).  An MRI can help determine this, or in some cases, a plain ol' X-ray (if you can see bony spurs or growths at C6 on the films).  Sometimes the soft pads between the joints of the neck portion of the spine bulge out, and one can be compressing the nerve root.  If this is the case, it's possible that neck traction and/or chiropractic manipulation of the neck can help.  Neither treatment actually worked for me (acupuncture was largely a bust, too, although it was fascinating).  Unsurprisingly, my MRI showed no "smoking gun," in the words of my neurologist.

5. (This one's a leap of logic): BRP is a neurological outcome of Thoracic Outlet Syndrome (TOS) or injury to the brachial plexus, which is the network of nerves that exit from your neck and upper thoracic spine and head on down your arms.  While TOS is somewhat difficult to diagnose properly (like BRP, TOS is controversial and seems to come in various "flavours"), if your BRP symptoms also include some kind of itching or burning sensation in your wrist, or if your arm or hand seems to go to sleep in the evening (or threatens to), it's possible that some of the nerve fibers in the network branching out through your neck are being pinched somehow, and this is causing the changes in sensations.  Your doc should at least be alerted to the possibility of TOS or a brachial plexus injury of some type.  Apparently, it's possible to damage the brachial plexus simply by sleeping incorrectly on your side, which can stretch or compromise the nerve network in your neck.  This damage is largely reversible by exercise and range-of-motion exercises, by the way.  TOS can also be brought on by certain types of repetitive work, such as overhead work (arms raised above your head) that's done by an electrician or plasterer, people who stock shelves, etc.  Working long hours at a computer can also bring on TOS (because people tend to hunch forward, tuck in their arms and drop their head when working at a keyboard, which can also narrow the thoracic outlet).

In my own experience, I've ruled out possible causes 1 through 4, so I'm working on the theory that my BRP (and other symptoms) is largely due to 5 above.  I've already had some success with exercises specifically designed to strengthen my neck muscles, and I'm dieting to lose weight (weight gain can cause TOS).  I'm hopeful, but cautious -- it's been a slow road eliminating the other possibilities (and rather expensive, too -- anybody wanna buy a neck traction device?).

Anyway, good luck.  Hope this info helps -- it's a distillation of stuff I've been gathering for months now.  If the Elavil doesn't work for you, you should give the gabapentin a try.  I'd rather live in a world where I didn't need it, but since I need it, I'm glad it's available.


Garth

[xcubbies]

Hello, Garth,

Just this morning stumbled upon the skincell.org site.  I too have/am experiencing the deep itching on my forearms.  I had a bout of it when I was working in Belize '94-'97, and then it reemerged last October after I returned from Liberia. (I work for a UN agency.)  In January I was diagnosed with longterm Bilharzia and a few other parasites and was treated for them in February.  I was warned that it would get worse before it got better because of the treatment. Now, about six weeks later I'm beginning to think that the parasites may not have been the source of the deep itching in my forearms.
Anyone else out there have a tropical/Third World link with these symptons? Roy

[Gobe]

 

Welcome to Skincell Xcubbies!

 

[getreal52]

I'm new, and so glad to find this forum.  I've had this condition for about 10 years, and mine is definitely made worse by exposure to the sun.  I started having it when I had to drive a lot, and it was only in the left arm, the one in the car window.  It only happened in hot weather, still does.  It slowly spread to both arms.  I've gone from Aloe with Lidocaine to Maximum Strength Lanacane to relieve the itch.  Sometimes at night, the shooting pains are so bad I have to resort to ice paks to calm the nerves so that I can sleep.

I had a neck injury in a car accident about a year before this condition started, plus I was a chronic sunbather, so I don't know if mine is caused by cervical impairment or sun damage.   It's definitely aggravated by exposure to the sun.

I am researching and experimenting with natural and herbal remedies, and I've found that MSM works well to control the itching.  Since this supplement is used for arthritis pain as well as depression, it would make sense.  I'm also experimenting with doing neck stretches several times a day.

My BP has caused me to change careers, going from my horticulture degree, which I love, back into office work to keep myself out of the sun.

I was beginning to think I was imagining the whole thing!  I'm so glad to learn I'm not alone.

[sandylb]

 I've been reading threads regarding BRP and now I know what I've had for the last 7-8 years.  I've also had psoriasis for 35 years and I knew it was not that, but thought, maybe related?  So many skin diseases are related somehow.  Anyway, I now have a name for the maddening itch on my arms. 

I went to my dermo last year and she prescribed hydroxizine (sp?) but gave me no explanation for what was causing the itch.  Hydroxizine works for me after the itch starts (or if I can catch it when I first feel it coming on).  I take a pill and in about 30-45 minutes I begin to get relief.  It makes it stop itching for a few hours.  You can take these pills every 4 hours if you need to, but they make you sleepy.  When I'm taking them, I get lots of extra sleep! 

I get my episodes mostly in the fall and spring, but have gotten them all times of the year.  I usually have periods of remission, but it always comes back.  Any time my arms feel like they are going to itch, I get so sad, as I'm afraid it is coming back.  It always does.  I've put ice on it as well, and that works somewhat.  I get the itching on my forearms, and it jumps back and forth from my left arm to my right.  I also get it around my elbows and have had it on my upper arms and shoulders.  It jumps around at will!  I've rarely had the itching on both arms at once.  Usually only one at a time (thank goodness for small favors).

 As for my psoriasis, I've had it 35 years and have found nothing that works consistently except cortisone shots in the lesions, and not all dermos will do that.  The one I go to now, will not.  I don't know what caused my BRP, but suspect arthritis in my neck and lower spine.  Could be the sun as well, 'cause I've been in the sun a lot in my life, due to that also helps the psoriasis.  (Can't win for losing!!)  Oh well.  That's my story and I'm sticking to it.

[ginger57]

I am so sorry to find this site. i thought I was a liitle cuckoo. So itchy an no apparent cause. It makes so much sense now I have neck/back problems. Will continue to read and hopefully get information that I can then pass on to my Doc
Ginger

[ocdgirl2000]

     AHA!!! so this is what I've had all this time! And I'm a nurse "you would think" I would have done something about it by now!!! but I've had this thing for at least 10 years on and off and mostly ON these days!The funny thing about it is that I have been trying to hide it like it's a disease or something.I thought I had impetigo and skin infections so I didn't want anyone to think I was infectious!LOL Yes I'm a sun worshipper and if the sun is really strong and I get a good tan it actually heals it up.Afterwards I suffer when the tan starts to dissappear.I have started using the tanning beds and I think they don't do much but heal the open scratch marks.I too have used all the lanacaines in every form and the aloe form is the most soothing.I also use the 12 hour cortisone cream which helps a little.I tried the clearasil salicylic acid cream and I think that makes it worse!.I have had a history of neck problems for as long as I can remember and now my neck is very limited in range of motion so I am sure there is plenty of osteo going on in the entire cervical region if not in the entire spine! P.S.  I have the affected regions on my shoulders(backs of the shoulder regions) and the forearms and on the flank areas of my back as well as the center area of my back which I think has another name but is in the same family as BRP.Well now.It's good to know it has a name and it's got some better treatments out there as well!I think I will be trying the capsaicin cream 5 times a day to see what happens I'm not a big fan of taking medications especially if they make me tired.I will also be modifying the way I sleep since my sleep posture is all wrong and I use way too many pillows!Anyway it's great to meet all of you...my name is Lynne and I'm from Maryland, age 52!

[sandylb]

Hey Lynne,
     My middle name is Lynn and I am 61.  I wrote last year about my BRP and am still having episodes of it.  Last time was a few months ago and it was on my left arm around the inside of my elbow.  This time it is in the same place, except on my right arm.  It is so maddening.  I still take hydroxyzine, and it still makes me sleepy.  But it does work.  I need to ask my doctor if there is something that is the same as hydroxyzine but non-drowsy.  But if you can manage to take them at bedtime, it's not so bad, 'cause you're going to sleep anyway.  The creams don't do much for me, as the itch is under the skin in the nerves, and creams don't seem to be able to reach it.  This year it doesn't seem to be as bad as it was last year.  It's always different, you can't predict it.  I have had it on my shoulders, but never on my back.  I also sleep with more than one pillow and will try not doing that to see if it helps.  But if the neck is already damaged, it's probably too late for that.  Anyway, thanks for your suggestions.  It is great to have people with the same problems to bounce ideas off of and learn about new things to try. 

[hollyaimeemum]

  
 hya lynne i am a 35 year old female from uk just been diagnosed with bp,  ive been itching since i came back from holiday in july on both arms and am relieved it has now been treated  unsure how i got it as i do not really sit out in the sun especially as i have two young children how long does this last,  do you have it for life . does the medication have to get stronger as your body gets used to it, can it wear off     i hope so as it drives me mad     
                       thanks niki

[sandylb]

Hi Niki,
      I don't know how long it lasts or if it ever goes away.  I have had it for almost 10 years, off and on.  The good part is, it only happens a couple of times a year (in my case anyway).  The bad part is sometimes it can last on and off for a couple of months at a time.  I seem to get it mostly in the fall and the spring, which makes me think it could be related to allergies.  But I don't know that for a fact.  So I can't really answer your question.  I also don't know about the medication.  If it only occurs a few times a year and you're not taking the meds all the time, maybe your body won't get used to it, and you won't have to increase the strength.  One can only hope.  I know it drives you mad.  Sometimes I just want to scream.  Good luck. 

Sandy

[sandylb]

Hey Niki,
     I had another thought after I wrote the reply above.  Last spring, I had a really easy time of it.  It didn't seem to bother me as much as usual.  I usually get it again around August or September and it bothers me off and on until November.  Here it is November, and I've only had one episode that I had to take my antihistimine.  So, I'm thinking, maybe it is trying to either get better, or go away!!  That would be nice if it is true.  I can't say, because I have no experience to go on.  But I'll keep my fingers crossed, and hope that maybe it is going away.  I'm sure it is different for different people.  Has anyone else had it to go away after a period of time?   

Sandy