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ASK THE DOCTOR: Easing the pain of neuropathy
By DR. JIM MITTERANDO

Q. My father suffers from a constant tingling and burning sensation in his feet and hands. He has tried several creams, such as Diabetaid, but nothing seems to work. Is there anything he can do to help lessen the pain?

A. Often found in diabetics, neuropathy is nerve damage that most often affects the feet, legs and hands. Over years, high blood sugar levels damage blood vessels and nerves, resulting in pain, numbness and sometimes weakness.

A trial-and-error approach is usually taken to treat neuropathy pain because each person responds differently. Be patient - medications take one to two months to fully work.

Diabetaid (capsaicin cream .025 percent) is made from chili peppers and treats nerve pain and and arthritis. It needs to be applied many times a day and used for several weeks. It burns at first - better to start with a small amount and gradually increase as much as you can tolerate. Zostrix (capsaicin cream .075 percent) is a higher dosage.

Tip: Wash your hands after application to avoid getting any residual cream in the eyes or wear latex or vinyl gloves to avoid this.

Since this medication did not help your father, he can talk to his doctor about the prescription medications mentioned below. Often capsaicin can be added with these medications.

  • Tylenol (acetaminophen) is always worth trying for pain relief and may be helpful in combination with other medications.
  • NSAIDS (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can also be used if he does not have any kidney problems.
  • Antidepressants: Older antidepressant drugs such as amitryptiline, nortriptyline and desipramine used in low dosage can reduce the pain or tingling. Amitryptiline is one of the most studied and most effective medications for neuropathy pain. It is affordable and functions as a sleep aid as well. Side effects include dry mouth, fatigue and confusion. Other antidepressants such as Paxil, Celexa and Wellbutrin may be helpful, though more studies are needed. Prozac does not help.
  • Anti-seizure medications: Neurontin (gabapentin) is an anti-seizure medication that also reduces symptoms. It requires three daily doses and is expensive. It also has few side effects. Other anti-seizure medications are Tegretol, Dilantin, Depakote and Lamictal. Some of these require blood test monitoring because of rare side effects. Ultram (tramadol) is another non-sedating pain medicine that can be added. Occasionally, narcotic pain medications are required to control severe pain but can cause sedation and constipation.

If medications do not help, consider consultation with a pain clinic to discuss TENS (transcutaneous electrical nerve stimulation) units that can relieve pain with a small continous electric current to the skin.

Diabetics need to maintain normal sugar levels that may reverse neuropathy or, at least, prevent further symptoms. Reduce alcohol and consider a B-complex vitamin since B12 deficiency can also cause neuropathy.

People with neuropathy should also:

  • Check the feet every day. You may need to use a mirror to check the bottoms of your feet. Call your doctor at the very first sign of redness, swelling, infection or new pain.
  • Check inside your shoes every day for things like gravel or a torn lining. These things could hurt your feet and you may not feel them because of the neuropathy.
  • Never walk barefoot.
  • Have your doctor check your feet.
  • Choose the right shoes. Buy shoes that fit properly, have a wide toe box and have a good arch support.
  • Use moisturizing cream if the skin is dry or thin.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, May 25, 2004