Neuropathy – Burning, Numb Feet – New Treatment
“Doctor, my feet burning and are numb.” That is a frequent complaint that I here from my patients. Peripheral neuropathy, a nerve condition, commonly starts in the toes or the feet. Affected individuals may feel this as a numbness, tingling, raw or burning sensation. These symptoms very slowly progress over many years. The most common type of neuropathy affects the nerves that supply sensation in the feet. As the condition worsens and spreads up the legs, it can start to affect the fingers and hands as well. Patients who present with these symptoms all need to be screened for diabetes and vitamin B12 deficiency. Other common causes for sensory neuropathy can include chronic, daily alcohol consumption, kidney failure and chemotherapy. For many patients that have sensory neuropathy, a cause is never found. There are two types of sensory neuropathy: painless and painful. While there is no cure for sensory neuropathy, it is rarely disabling. For patients with painless neuropathy, no treatment is necessary other than treatment of any condition that may be causing the symptoms (diabetes, stop alcohol, etc.) For patients with painful neuropathy, many nonnarcotic treatments are available.
Lyrica is a new antiseizure medication that was approved by the FDA for treatment of painful diabetic neuropathy. Many neurologist also use this drug for treatment of other painful neuropathies with great success. Many of the neuropathy treatment drugs are in the anticonvulsant (antiseizure) medication group. These include Neurontin (gabapentin), Tegretol (carbamazepine) and Trileptal. Some clinicians have had success with Topamax for certain neuropathic pain syndromes. If a patient has difficulty tolerating one drug or a particular drug is not working, then they can be switched to one of these other agents. The other class of commonly used medications used to treat symptoms of painful neuropathy are the tricyclic antidepressants. These agents have a mechanism that blocks pain impulses at very low doses. Since many patients are bothered more by their pain at night, these agents have the added benefit of assisting in going to sleep. They are inexpensive and not habit forming. It needs to be noted that although these medications are labeled “antidepressants” their use to treat pain and headache conditions has nothing to do with treatment of depression. Most patients that are on tricyclic antidepressants are not depressed.
A newer, novel approach to treatment of painful neuropathy is to use a patch called Lidoderm. This is a patch with a special form of Novocaine embedded in it. Patients can put the patches over the area of pain, frequently with good relief. One patch is good for about 24 hours. There is no additional numbing sensation from the patch itself. It is important that patients with neuropathy understands that there is no treatment that will give the the sensation back but only to control the pain or discomfort associated with the neuropathy. Lidoderm has FDA approval for treatment of postherpetic neuralgia, a very painful condition seen after an attack of shingles.
Combinations of various modalities of neuropathy treatment are frequently used to provide patients with an improved quality of life. There are other less commonly used drugs and treatments that sometimes help patients function better. It is important to note that narcotic pain medications are not mentioned here as this class of drugs is notoriously ineffective in treating nerve pain. Additionally, they are habit forming, addictive and tend to lose their effect after a while, requiring even higher dosages which lead further to addiction. In summary, if you or someone you know has painful neuropathy, get them in to see a neurologist that has training in treating this condition.