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Ask the doctor: Tips to reduce neuropathy pain

Q. Is there something to relieve severe neuropathy in someone’s feet?

A. You are not alone: neuropathy is a remarkably common problem. Fortunately, there are several treatments that bring relief to most people who suffer with this condition. There are different types of neuropathy (more formally called polyneuropathy). I’ll assume you have the most common type, called axonal neuropathy.

Neuropathy affects many of the nerves in your body. Each nerve is like a highway that connects your brain to the rest of your body. Signals from your brain travel down the nerves sending orders, such as the order for your muscles to move different parts of your body. Signals from your body travel up the nerves to your brain. For example, when your fingers touch something, signals from your fingers tell the brain how hot and how hard that thing is, and whether touching it causes pain. The longer a nerve is, the more likely it is to be affected by neuropathy. Since the nerves connecting your brain to your legs and feet are the longest, the symptoms of neuropathy almost always begin in and are worst in the feet, then the calves, and then the thighs.

The most common symptoms of neuropathy are numbness, burning, or very unpleasant sensations that people have a hard time describing. The loss of sensation in the feet can cause problems with balance when walking: if you can’t tell where your weight is being carried (is it on your heels or the balls of your feet?), your brain gets confused.

Image: Thinkstock

Symptoms of neuropathy usually
begin in the feet, where the pain can be most severe.

About 4% of people over age 55 may suffer from some type of neuropathy. Among the most common causes of neuropathy are diabetes, alcohol abuse, an underactive thyroid gland, and some types of cancer chemotherapy. However, about one out of every four people with polyneuropathy has none of the known causes: with this condition, as with many, we need more research.

If you have any of the known causes of neuropathy, the first thing to do is treat the cause: if you’re diabetic, do everything you can to lower your blood sugar; if you drink too much, cut down; if you have an underactive thyroid, be sure you take your thyroid pills as directed and get regular thyroid blood tests. The best medicines for reducing symptoms are gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), baclofen (Lioresal), and any of the class of drugs called tricyclics.

Not all of them help in everyone, and we don’t (yet) have the tools to predict which drug will work best in each person. But if you work closely with your doctor, the odds are good that you will get considerable relief. 

—Anthony L. Komaroff, M.D.
Editor in Chief
Harvard Health Letter

Posted by: Dr.Health

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