Symptoms of Neuropathy-It’s More Than Numb Feet!

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There are two major misconceptions about neuropathy.  The first misconception is that diabetes is always the cause of neuropathy. While diabetes can cause neuropathy, there are least 20 other conditions that can cause neuropathy. Some of those include: spinal problems, thyroid conditions, auto-immune disease such rheumatoid arthritis or lupus, alcoholism, HIV/AIDS, chemotherapy, nutritional deficiencies such as a lack of vitamin B-6 or B-12, injury to the nerves, exposures to toxins such as mercury or inherited conditions such as Charcot-Marie-Tooth Disease.

Another misconception is that neuropathy always causes numbness in the feet. In fact there are a myriad of symptoms ranging from complete numbness to extreme pain. The following are a list of symptoms that  are associated with neuropathy: Some of the symptoms that people with the most severe peripheral neuropathy experience:

  • Dizziness-Often people with neuropathy experience walking difficulties and balance problems which can cause dizziness.
  • Numbness-the most common symptom of neuropathy. This is due to injury to the nerves which blocks nerve impulses to the brain and spinal cord.
  • Problems of the muscles and tendons of the feet-which can lead to drop-foot deformity. Typically the first type of nerve that is damaged by neuropathy-are the sensory nerves. These nerves are responsible for sensation such as pain, hot/cold and pressure. As the condition advances the motor nerves can then be affected. The motor nerves are responsible for movement of the muscles, tendons and ligaments. A serious consequence of neuropathy is condition called drop-foot. In this case the person with neuropathy cannot lift up the ankle walking-causing the foot to drag when walking.

A feeling that the body has turned to cement from the waist down, especially upon climbing stairs

  • Sexual problems
  • Sensations of electric shocks and pins-and-needles over the body. This is due to abnormal nerve impulses. People with neuropathy often experience more severe symptoms at night.
  • Severe loss of stamina and chronic fatigue-peripheral neuropathy is a chronic condition. Chronic pain (called neuropathic pain), is wearing on the body from physical and emotional basis. Neuropathy affects what is called proprioception-this is the ability to be aware of the position of the feet relative to the ground. Impaired proprioception contributes to poor balance. The constant struggle to remain upright and to prevent falling takes its toll on the body-causing exhaustion
  • The feeling that the feet are burning up. This is due to impaired transmission of nerve impulses to the brain and spinal cord.
  • “Ice-cold sensation” in the feet and toes
  • The feeling that the feet are swollen or that a person is wearing socks or shoes-when in fact they are barefoot
  • The feeling that a person with neuropathy is walking on sandpaper or an uneven surface
  • The feeling that the skin is tight

 

 

Making Sense of Neuropathy Symptoms

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Peripheral neuropathy is a chronic condition affecting mostly the nerves in the feet. It can be caused by diabetes but there are at least 15 other cuases of neuropathy including, autoimmune diseases, alcoholism, spinal problems, nutritional deficiencies and hereditary conditions such as Charcot-Marie-Tooth disease.

Sensory symptoms can be highly variable, and may include pain, insensitivity or loss of sensation (hypesthesia or anaesthesia), spontaneous sensations (paresthesias), unpleasant altered sensations (sysesthesias), or hypersensitivity (hyperalgesia) to pressure or touch.

Pain is normally a protective sensation, providing a warning of existing or pending injury. People who are insensitive to pain may be unaware that  they have burned themselves on a hot stove or with hot water; they might step on a nail or another sharp object without feeling any pain. It is not unusual for such people to report that they did not realize they were injured until agter they took off their shoes at night and found their foot bloodied.

Parethesias are variably described as numbness, pins and needles, stinging, prickling, crawling, burning, cold, itching, buzzing, vibrating, aching, tearing, squeezing, stiff, and deadened, or encased in cement, among others. They can occur alone or in combination, and are typically more bothersome at night when there are few other sensory stimuli or distractions, and make it difficult to fall asleep. These symptoms sound bizarre and people who complain of them oar often not taken seriously; they may be considered depressed or hysterical by those who are unfamiliar with neuropathy.

Disruption of joint or position sensation prevents the flow of information about the position of the body or limbs in space, resulting in impaired balance or coordination. Symptoms include a widened stance, unsteady or less fluid gait, a tendency to fall, or difficulty with fine manipulations such as tying a shoelace, turning the pages of a book, or buttoning a shirt. The eyes can compensate to some extent by providing visual cues, but balance is rapidly lost in the dark, or in the shower when closing the eyes.

Normal stimuli, such as touch or pressure, can at times cause altered unpleasant or disagreeable sensations called dysesthesias. These sensations have variably been described as a feeling of sandpaper rubbing the skin, burning, itching, stinging, ice cold, or lingering, among others. Dysesthesias can be elicited by such ordinary stimuli as light touch or pressure, the feel of clothes against the skin, or light breeze. Hypersensitivity to touch or pressure can also cause severe pain, especially in the feet. Tight socks or shoes are particularly a problem, and the pain can make it difficult to walk. Wearing socks without elastic bands, shoes that are soft and roomy, and orthoses that keep pressure off sensitive spots can often bring relief.

 

Beware of So Called Neuropathy Cures

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 Neuropathy is a chronic condition. It presents all sorts of challenges and it can be extremely frustrating. Unfortunately there a number of unethical individuals that play on the fear and desperation on those with neuropathy. Hear about a miracle treatment that sounds too good to be true? It probably is. Unfortunately, there are people who prey on the hopes of the chronically ill, peddling useless treatments and miracle cures. Be a smart consumer and stay alert to these red flags of quackery

Beware of the following statements with regards to neuropathy:

New treatment (pill, therapy) will cure neuropathy.

There is currently no cure for neuropathy or diabetes. Neuropathy is due to damage to the nerves innervating the feet. Presently there is no treatment that will reverse nerve damage. There are treatments that provide temporary relief from neuropathy pain and discomfort-but   there is no known cure. Anyone who claims their product does so is not being honest.

Misleading statements I have been treating neuropathy for over 30 years and I am the leader of the Neuropathy Support Group in Orange County, California. Since I am so involved with neuropathy, I have heard bodacious claims with regards to neuropathy. A common “pitch’ that I have heard countless times goes as follows: “I have neuropathy or my relative or friend has neuropathy-since there was no cure I invented one.”  Advertisers who offer testimonials and “expert” commentary instead of clinical studies probably don’t have the scientific research to back their product.

Beware of Buzzwords. If the ad includes words like “amazing,” “life-changing,” and “miraculous,” be careful. These are often a smokescreen for a lack of valid research on the efficacy of a product.

Everything but the Kitchen Sink. Products that claim to treat everything from bunions to bursitis will most likely only help empty your wallet.

If you have questions about the effectiveness of a treatment, supplement, or other therapy, talk with your health care team before making the purchase.

Question of the Day-Will Neuropathy Pain Get Better, Stay the Same or Get Worse

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Neuropathy is a complicated condition. Neuropathy pain is due to nerve damage-mostly innervating the feet. Of course there is no simple answer to the question. Many factors are involved in determining the ultimate course of neuropathy.

The chances of improvement depend on the extent of the injury to the nerve. If the injury is mild and the cells that support the nerve are left intact – the neuropathy should improve as the verve heals. Many times the nerve is injured by a something that can be treated or reversed, i.e. a compressed or pinched nerve, chemotherapy or exposure to a toxic chemical. In these cases, whatever is the culprit can simply be removed from the equation and allow the nerve to heal. However, if the injuring agent is still present, it is harder for the nerve to heal. In fact, if the nerve stays injured for too long, the damage can be irreversible. The most important thing to keep in mind is the sooner a neuropathy is treated, the better the chances to have a good recovery.

Will my symptoms get worse and progress?

Neuropathic pain left untreated will undoubtedly get worse. The longer it is left untreated, the harder it is to get it to manageable level even once the appropriate plan has implemented. Unfortunately, even some patients who are under the care of a skill pain physician from the start will get worse. There is no way to predict who these patients will be or why so many others were successfully managed with the same therapies while others fail. As with any field in medicine, there are always exceptions to the rule. Compared to other specialties, pain medicine is relatively new and there is much we are still learning. With that, there are always new treatments being discovered

Do a lot of your patients use multiple therapies for relief for their neuropathic pain? E.g., prescription medications, acupuncture, and physical therapy?

Treating pain should be thought of like climbing stairs. The first step should include the most basic therapy, like PT, and an over-the-counter pain reliever. As more care is needed, we climb to the next step. With each successive step, the more we add. By the third step, a patient may need to be on two different neuropathic pain medications. PT, and be scheduled for an injections. Treatments like acupuncture are not unusual to incorporate early on, as well. We call this a multidisciplinary approach.” The idea is to not assume there is simply one main contributor to the pain and subsequently place all the focus on that. By spreading out the focus, the patient benefits from the idea of “casting a large net” and seeing which treatment works best, not to mention saving time early on.

 

Alternative Treatments for Neuropathy Pain

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The “big three” medications are most widely prescribed for neuropathy pain-that is Neurontin, Lyrica and Cymbalta. There are many other approaches in reducing neuropathic pain inclusing:

Topical Treatments

Lidocaine patch (5 percent)

Lidocaine patches are useful for treatment of localized neuropathic pain, particularly post-herpetic neuralgia. They can be applied for 12hours at a time to the affected areas. They have few systemic effects because very little of the lidocaine is absorbed. On occasion, they can elicit a local skin reaction.

Capsaicin (Zostrix® .025 percent, .075 percent)

Capsaicin is the substance in chili peppers that makes your mouth sting. It does so by releasing substance P from the nerve endings. Depletion of substance P prevents subsequent pain. Repeat local applications, at least four times a day, are required so the substance P does not re-accumulate, in which case it can cause stinging after each application. Uneven results have been reported.

Treatment of Depression or Anxiety

Several of the medications used for neuropathic pain are also antidepressants, and have added beneficial effects. Bupropion SR (Welbutrin®), at 150 mg twice a day, is another antidepressant with some efficacy against neuropathic pain. For anxiety, many patients are helped by clonazepam (Klonopin®), 0.5 or 1 mg per day

Treatment of Muscle Cramps

Muscle cramps, particularly in the calves and at night, are common manifestation of peripheral neuropathy. They almost always respond to quinine sulfate, approximately 300 mg, one or two tablets in the evening. Ringing in the ears or reversible hearing loss are rare side effects.

Interventional Therapy for Neuropathic Pain

 Interventional therapy for neuropathic pain includes local anesthetic blocks, spinal cord stimulators, and intrathecal pumps that introduce pain medication directly into the spinal canal.

Nerve blocks inject local anesthetics and anti-inflammatory agents directly into the painful area: the nerve root, compressive lesion, or sensory or autonomic ganglia that provide pain fibers to the affected region. They provide temporary relief that can break the cycle of pain and reduce muscle spasm. Complications can arise from accidental nicking of the nerve, or if the drug is inadvertently injuected into a local blood vessel.

A spinal cord stimulator is usually implanted under the skin in the back, with the electrodes placed next to the spinal cord. It delivers an electric current to the spine, which is perceived as a tingling sensation.
The stimulator blocks other pain signals from below, and can be programmed and controlled remotely with an external device. Potential complications include infection, abnormal repositioning, discomfort, and nerve or spinal cord injury.

Intrathecal pumps can be implanted under the skin in order to deliver low doses of pain medications, usually narcotics, continuously and directly to the spinal fluid. This allows for higher concentrations at the target site and avoids systemic side effects. The reservoir is refilled periodically by subcutaneous injection. Potential complications include infection, spinal cord damage, or respiratory depression.

 

 

A quote from Lincoln: I can’t think when my feet hurt”

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 In my 38 years in my podiatry practice I constantly hear the expression: “when my
feet hurt, I hurt all over.” Headaches, back aches and foul moods can be
attributed to foot pain. Why are feet so vulnerable to pain and malfunction?
From an engineering perspective feet are marvelous structures. The human foot
is comprised of 26 bones and hundreds of muscles, ligaments and tendons.
Additionally there are literally millions of nerves to help us navigate and
propel us when walking.

With so many delicate structures, it is no wonder that humans
are prone to all sorts of foot problems. To name just a few: bunions, calluses,
corns, heel spurs, plantar fasciitis, arthritis and tendonitis and peripheral neuropathy.

The following tips can help avoid serious foot problems:

1       It is important to wear comfortable
socks and shoes. I discourage heavy cotton socks as they promote heat buildup-leading
to excessive seating for a propensity for the development of athlete’s foot.  The present thinking is that socks should be
made of a polyester blend to help wick away moisture.

2        Shoes should fit properly and be made of soft
leather or other materials, also without inside seams. They should leave the
toes in a natural position, provide good arch support, and not rub or press
against any part of the feet. Cushioning or shock-absorbing insoles can also
help reduce the discomfort or pain. A proper fit is essential to avoid blisters
corns and calluses. Often one foot is slightly larger than the other-it is recommended
to fit to the larger foot.

3  Avoid high impact
activities, such as running, which can traumatize the foot. Participate in low
impact exercise such as swimming or cycling instead.
4 Wash your feet in warm water, dry them thoroughly, and use moisturizing cream to prevent drying
or cracking. Treat excessive seating with foot powder.

5   Inspect your feet
daily for cuts, ulcerations, fissures, pressure sores, blisters, corns, or
calluses, and signs of trauma, such as redness or swelling. Seek prompt
treatment if any are found.
6     Use a nail file keep the nails trim and without sharp edges. Avoid sharp instruments, such as
scissors or nail clips that might cut the skin; promptly treat ingrown toenails
or fungal infections.

7    Avoid high impact activities such as jogging-lower impact activities such as swimming, cycling is recommended

8     If you sprain your foot make sure you get medical attention because you may need a cast to avoid development of traumatic arthritis

9    Do not self treat.
Ingrown toenails, plantar warts should be treated by a podiatrist. Never use a
razor to trim corns and calluses. Never use medications or plaster to “burn off”
corns, calluses or plantar warts

 

Treating Peripheral Neuropathy Using Neurontin, Lyrica and Cymbalta

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The technical term for pain associated with peripheral neuropathy is neuropathic pain. Neuropathy is considered a chronic condition. This means that in most instances neuropathy is not curable and the discomfort is often ongoing. There are a number approaches to neuropathic pain. From a medication standpoint the anticonvulsant and antidepressant drugs are quite popular for treating chronic neuropathy pain.. The following is information on these medications:

 Neuropathic Pain Drugs with Anticonvulsant Actions

Pregabalin (Lyric®)

Begin with 5 or 150 mg/day and increase by 75mg every 4 days, up to 300mg/day or 300 mg twice a day. Potential side effects include dizziness, sleepiness, difficulty concentrating, forgetfulness, weight gain, ankle edema, dry mouth, and blurred vision.

Gabapentin (Neurontin®)

Gabapentin is usually started at 300 mg day and increased by 300 mg every 5 days. A benefit is commonly seen at total doses of 2,700 mg/day or higher, taken in three divided doses. There is little added benefit seen at dosed higher than 4,500 mg/day. Side effects include dizziness, sleepiness, unsteadiness, forgetfulness, and fluid gain or ankle edema.

Oxacarbazine (Trileptal®)

Begin with 75 mg at night increase by 75 mg every 5 days, up to 600 mg twice a day. Side effects include gastrointestinal irregularities, unsteadiness, skin rash, and low serum sodium.

Topiramate (Topomax®)

Begin with 50 mg at night and increase by 50 mg/week, up to 1000—400 mg twice a day. Side effects include kidney stones, fatigue, dizziness, memory impairment, word-finding difficulties, anxiety, depression, visual problems, tremor, glaucoma, gastrointestinal pain, poor appetite, and weight loss. Topiramate is removed by the liver and kidneys, and these functions should be tested before its use.

Lamotrigine (Lamictal®)

Begin with 25 mg/day and increase by 25 mg every 5 days, up to 250 mg twice a day. Side effects include a severe rash or Stevens Johnson syndrome, headache, and muscle aches.

Neuropathic Pain Drugs with Antidepressant Activity

 Duloxtine (Cymbalta®)

Begin with 30 mg/day and increase by 30 mg every 4 days, up to 60 mg twice a day. Side effects include nausea, dizziness, sleepiness, fatigue, dry mouth, Constipation, loss of appetite, excessive sweating, insomnia, and sexual dysfunction.

Amitriptyline (Elavil®)

Begin with 10 or 25 mg after dinner and increase by 10 mg every 3 days, or 25 mg/week, up to 150 mg/day in three divided doses. Helps sleep if taken after dinner. Side effects include drowsiness, dry mouth, arrhythmia, urinary retention, sexual dysfunction, and orthostatic hypotension.

Nortriptyline (Pamelor®)

Begin with 10 or 25 mg after dinner and increase by 10 mg every 3 days, or 25 mg/week, up to 150 mg/day in three divided doses. Nortriptyline has the same side effects a amitriptyline, but with less drowsing effect or postural hypotension. It can be taken in combination: nortriptyline during the day and amitriptyline after dinner.

Venlafaxine (Effexor®)

Begin with 37.5 mg/day and increase by 1 tablet every 4 days, up to 375 mg/day. Side effects include nausea, sleepiness, insomnia, dizziness, headache, hypertension, and sexual dysfunction.

 

 

 

 

 

 

 

For Improved Balance-Try Tai Chi

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Neuropathy not only interferes with the sensation to the feet, it also affects one’s balance as well. Problems with neuropathic pain well documented. Neuropathy sufferers experience a wide range of symptoms including pain, burning, pain pins and needles sensations and the feeling of “electric shocks.”

Neuropathy which is nerve damage often affects the nerves responsible with good balance.  This is due an inability to feel one’s feet when the foot strikes the ground.

Tai Chi is an excellent exercise/discipline that can improve balance.

Tai Chi is a training exercise involving slow, graceful movements that are derived from the movement of animals and follow a natural, relaxed pattern. They increase the body’s range of motion and are said to exercise the internal organs.  According to practitioners, the slow meditative routine aids stress reduction and promotes relaxation, improved balance and better posture while increasing blood flow.

Since the publication of the original Numb Toes, Dr. Li Li of Louisiana State University (LSU) has been studying the effect of physical activity on people with peripheral neuropathy.  The LSU Peripheral Neuropathy Studies have investigated a number of exercises, including tai chi, assisted walking, and focused exercise.  Dr. Li has published a number of interesting results from these programs including reduced pain, improved sensation, improved balance, ability to walk, and maybe most important of all, better quality of life.

Dr. Li, a kinesiologist (specialist in the study of movement and gait), became interested in the unique problems posed by peripheral neuropathy when he noticed an LSU facility services worker using a can in a unique way.  “Charlie “ carried a can but he did not use it to walk, only to stand.  When Dr. Li asked why, Charlie told him that he had a condition called peripheral neuropathy.  Dr. Li was confused because conventional medical teaching implies that one cannot walk if one cannot stand

Dr. Li began his neuropathy study in 2004.  Now, he has approximately 75 individuals enrolled, with groups meeting three times a week for tai chi lessons.  The tai chi exercises have been modified to suit people with peripheral neuropathy.  They are even slower than what you would find in the general public market for tai chi exercise classes.  Participants started with a modified beginner’s class, many of them holding onto chairs to keep their balance.  Classes were typically two to three times a week for 60-minute sessions.  Remarkably, weeks later in the sessions there were “no more chairs” says Dr. Li.  In fact, Dr. Li’s classes have become so popular that there are over 150 people on a waiting list for admittance.

As noted in the comments from participants, the results that Dr. Li and his team are seeing are encouraging.  Many people start the program unable to stand up for more than five minutes at a time.  Yet, after as few as six weeks, many of them can stand unassisted for long periods of time.  Man of these people were previously told to expect to be in wheelchairs by this point.  Dr. Li believes that the tai chi training improves dynamic balance.  He also believes that continued practice increases awareness of the body’s position and orientation, helping PNer’s take control of their balance and prevent falls.  As a result, many participants are back to doing things they used to take for granted, like being able to stand in a shower and wash their hair with their eyes closed.

These results are confirmed by Dr. Li using standardized testing such as balance, timed get-up-and-go, mobility and knee strength tests.  For example, the mobility test involves nonstop walking for six minutes and the timed get-up-and-go test measures the overall time taken to complete a series of functionally important tasks. Overall, Dr. Li has found that practicing tai chi excercises can result in far greater levels of improvement than pursuing more conventional methods of treatment.  To rule out the placebo effect, Dr. Li compared tai chi to other types of interventions including strength training, walking and infrared light therapy.  So far tai chi is still the undisputed winner.

Exactly how tai chi benefits neuropathy sufferers is not clear.  Dr. Li believes there might be a link between tai chi and nerve re-growth.  Many of his participants have been able to give up their canes and walkers.  One participant reported that after two weeks he could feel his toes again, something he had not been able to do for the previous five years.  Dr. Li’s preliminary results indicate there might be a link between tai chi and nerve growth, and he hopes more studies will prove a definite connection.

Treating Neuropathy-the Natural Way

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Some people call it pain while others call it discomfort-regardless how you describe it, neuropathy can be extremely difficult to live with.  Neuropathy pain (also referred to as neuropathic pain) presents in many ways including pain, burning, numbness, cold sensation, “pins and needles” sensation or a tightness of the skin on the feet and toes.

One common approach to reducing neuropathic pain is the use of prescription drugs. This would include Neurontin (gabapentin), Lyrica (pregabalin) or Cymbalta (duloxetine). For extreme neuropathy pain, stronger medications such as codone (Oxycontin) or opiods.

Alternative remedies.

One of the goals in treating neuropathy is to attempt safer modalities with less side-effects. The following are alternative therapies in treating neuropathy:

  • Laser therapy-In treating neuropathy , cold laser is the laser of choice. The benefits of laser therapy include: Improved cell metabolism, improved circulation, analgesic effect (pain relief), and anti-inflammatory effect.
  • Infrared therapy-infrared uses light energy to promote certain beneficial effects. Infrared stimulates the production and release of nitric oxide-which can increased localized circulation to the nerves.

Although doctors don’t know exactly how it works, there is good scientific evidence that acupuncture can offer significant relief from chronic pain. Other alternative remedies proven to work against pain include massage, mindfulness meditation, spinal manipulation by a  osteopath, and biofeedback, in which a patient wearing sensors that record various bodily processes learns to control the muscle tension and other processes that can contribute to chronic pain.

  • Exercise. Low-impact forms of exercise like Walking, bicycling, swimming, and simply stretching can help relieve chronic pain. Some people find it particularly helpful to participate in a structured exercise program given by a local hospital.
  • Physical therapy. Pain patients who work with a physical therapist or occupational therapist can learn to avoid the particular ways of moving that contribute to chronic pain.
  • Nerve stimulation. Tiny jolts of electricity can help block the nerve impulses that cause chronic pain. These jolts can be delivered through the skin via trancutaneous electrical nerve stimulation (TENS) or via implantable devices.

Psychological Therapies

A form of psychotherapy known as cognitive behavioral therapy is particularly helpful for many people with chronic pain. It helps them find ways to cope with their discomfort and limit the extent to which pain interferes with daily life.

Unlike some traditional forms of psychotherapy, which focus on personal relationships and early life experiences, cognitive behavioral therapy aims to help people think realistically about their pain and find ways to work around physical limitations.

 

Common of Symptoms of Neuropathy

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Neuropathy is a unique medical condition in that there are such a wide variety of symptoms.  The following are some typical symptoms associated with neuropathy:

1                   The feeling as if the skin is “on fire” me to have these symptoms?

2                   “Pins and needles sensation”

3                   The feet feel extremely cold

4                   The skin feels tight-as if the skin is being stretched

5                   The sensation of walking on a rolled up sock-or the feeling as if one is walking on sandpaper

6                   Complete loss of sensation in the feet and toes-as if one is injected with Novocaine-causing total numbness

Typically, a healthy nerve will only send a signal when it is stimulated, e.g., a nerve in the hand that senses temperature will stay quiet until the hand gets near the flame on the stove. However, an injured nerve is like a broken telephone that rings when no one is calling (burning) and is unable to get a dial tone when you need to make a call (numbness).  Even when it has nothing of importance to say to the brain, the nerves will send a message and a confused message at that. The “confused” message can be interpreted by the brain as pain or strange sensations like “pins and needles.”

Over time, the spinal cord can become accustomed to getting bombarded by a nerve that never seems to turn off and makes adjustments to account for it.  So, even once the nerve manages to stop firing, the spinal cord has become so used to sending that signal that it will take over and keep doing it on its own.

Relieving neuropathy discomfort using medications

Most patients who suffer from neuropathic pain will tell that traditional pain relievers tend to be ineffective.  Medications such as acetaminophen and oxycodone combination (or Percocet) and acetaminophen and hydrocodone combination (or Vicodin) only “take the edge off,” but the burning and/or painful numbness seems to always be present, no matter how much they take. It is for this reason that opioids should not be considered as a first-line treatment option.  Medications such as anti-depressants (e.g., duloxetine) and anticonvulsants (e.g., gabapentin and pregabalin) have been the mainstay for the treatment of neuropathic pain for some time now.

Tizanidine (or Zanaflex) is another medication which has been used fairly frequently for neuropathy. It is a muscle relaxer which has been used to treat spasticity in patients with cerebral palsy and is effective in treating neuropathy with small doses taken once daily.  Methadone is also a particularly good medication as it not only acts as a powerful pain reliever but has been shown to be quite effective for neuropathic pain.  An older medication called ketamine has come back into relevance as physicians have found it to be extremely effective for neuropathy.  It can be used topically when added as the active ingredient in a cream or infused intravenously in a hospital setting under the supervision of your doctor.

The amount of relief varies from one patient to the next and it is nearly impossible to predict the degree of success one should expect.  Many of the medications mentioned will need to be titrated to an effective dose which means your doctor will need to start with a smaller amount and slowly increase it over time. Others simply need time to build up in your body. Hence it is important to ask your doctor to help you understand what to expect with the medication(s) being prescribed: dosing, side effects, degree of relief, improvement in quality life and physical function…