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Posts for tag: numbness

  Peripheral neuropathy, as we have spoken about before, is a gradual degenertaion or deterioration of the nerves, especially the small nerves of the feet.  It is most commonly seen in people with diabetes, but there are many other causes as well.  This can include idiopathic (where there is an unknown underlying cause, but many things have been ruled out), as a result of chemotherapy for cancer, vitamin deficiency (especially B12, although Thiamine and other vitamin deficiencies can also be to blame), heavy metal toxicity (mercury, lead, and even arsenic), and several others.  No matter what the cause of the neuropathy, the result is often the same.  There is usually numbness, tingling, pins and needles sensations, paresthesias (crawling sensations or other feelings of things that are not there), burning pain, sharp shooting electrical shocks, muscle abnormalities (causing hammertoes, change in muscle tone, muscle wasting, etc.), and autonomic changes (decrease in sweating, dry skin, discoloration, cold or hot feeling, etc.).  A person may have NONE or ALL of these findings.  Much of this will depend on how long the problem has been present (Diabetics, for example, may show no changes or have no symptoms at first, but the longer they are diabetic, the more of these problems may present themselves).  

   Once the diagnosis of peripheral neuropathy is confirmed, there are a number of treatment options.  Many drugs can be used to treat the symptoms of peripheral neuropathy.  The problem with drugs is that they just treat SYMPTOMS.  For the most part, these reduce the pain and burning, but really do little or nothing for the numbness or lask of sensation, which can be worse for the patient in the long run.  Narcotic medication is often the worst, because in addition to just masking the pain, the patient can suffer from sedation and constipation, and can, and often does, become addicted to the narcotic.  

     There are a number of vitamins that can help, and often help quite a bit, not only with the pain and burning of neuropathy, but also with the numbness and tingling that occurs.  These vitamins, in some cases, can actually result in the growth of new small nerve fibers within the skin.  One of these that has shown great promise is alpha lipoic acid.  Taking up to 600mg of this vitamin, up to three times per day, has often been shown to be beneficial in treating neuropathy in the diabetic patient, and the non-diabetic as well.  A lower dose is often advised to start with, and many pharmacies sell the vitamin in as low as 100mg.  B vitamins, such as B6, B9, and B12 have also shown beneficial effects in treating neuropathy.  A prescription medical food, known as Metanx, can also be prescribed if the over the counter vitamin therapies are not working.  One must understand, that none of these vitamin therapies will show results quickly.  A month is often the minimum amount of time needed to see any change at all, and in many cases it may take 2-3 months to see a significant improvement.  The advantage to using these vitamin therapies is that there are typically NO side effects, little or no drug interactions, and often the cost is significantly less.  In many cases, the beneficial effects of these can be measured OBJECTIVELY using an ENFD - or epidermal nerve fiber density test.  This is a skin biopsy, usually done just above the ankle, to measure how many nerve fibers are present within the epidermis (the outer layer of the skin) BEFORE the vitamins are prescribed, and can be repeated  AFTER (usually six months) treatment has been started.  This can often show a significant increase in the number or density of nerve fibers.

     In an upcoming blog, we will be talking about the use of LASER for peripheral neuropathy, another NON-INVASIVE treatment that is showing great results for a number of people with peripheral neuropathy.


Richard S. Eby, DPM

7348 East Brainerd Road

Chattanooga, TN.  37421

(423) 760-3115

March 08, 2015
Category: F.Y.I.
Tags: foot   numbness   burning  

   For many, peripheral neuropathy is a painful, nagging, debilitating, and even dangerous condition.  Periperal neuropathy refers to progressive and degenerative changes that take place in the hands and feet off a growing number of people.  The feet, and especially the toes and ball of the foot, are affected sooner and more severely than the fingers and hands.   The most common underlying cause of these nerve changes is from DIABETES.   There are many other causes, however, including the use of -statin (cholesterol  lowering) medications, chemotherapy agents, vitamin deficiency, alcohol abuse, exposure to toxic chemicals and heavy metals (including lead, mercury, and aresenic), and the list goes on and on.  Surprisingly, the second biggest cause of peripheral neuropathy is IDIOPATHIC, meaning no underlying cause can be identified.  This is often seen in otherwise healthy individuals who have family memebers that are diabetic, people often labeled "prediabetic" (who show signs and symptoms of diabetes years later), and others for whom no underlying abomality is seen.

    Symptoms of neuropathy include NUMBNESS, PINS and NEEDLES sensation, BURNING, SHARP PAINS,  LACK OF COLD AND HOT DISCRIMINATION, PARESTHESIAS (unusual feeling such as "crawling sensations" or feeling things that aren't really there).  All of these are classified as SENSORY neuropathy - meaning things that you feel and should not feel, or (more importantly) NOT feeling things that you should feel.  Many people with neuropathy develop slow healing and non-healing ulcerations and infections because of cuts, puncture wounds, pressure from poor fitting shoes, and other external agents.  They may have good circulation, and if diabetic, their blood sugar may be under good or even excellent control, but they may lose a toe, foot, or leg because of NOT feeling something they should feel.  I have seen many bone infections, known as osteomyelitis, that resulted in amputation of a toe (at best), to loss of a leg (much worse), to loss of life (eventually) because of waiting until it was TOO LATE to get treatment.  This is often simply because "it didn't hurt" and the patient down-played the importance of that cut or ulceration until a spouse or other family member noticed blood, or drainage, or a bad odor.  Before it ever got that far, the "normal" non-neuropathic patient would have been in so much pain, they could not sleep at night, walk, or do anything other than "stop the pain!"

   There is no "cure" for neuropathy, but there are treatment options.  Often, a simple biopsy, known as an ENFD (Epidermal Nerve Fiber Density test) can be done to determine how much of the neuropathy is from the small (micrsocopic) nerve fibers.  A piece of skin 3mm in diameter is taken from just above the ankle, sent to a lab, and stained.  The number of nerve fibers per millimeter of skin is calculated, and this can give the treating physician valuable information in guiding treatment.  Nerve conduction studies or EMGs can also be done if the degree of large fiber neuropathy is to be determined.  Various drugs can be used for the PAIN of neuropathy.  These include over the counter pain relievers and anti-inflammatories such as tylenol, Aleve, or Advil.  Prescription drugs such as Neurontin (Gabapentin), Lyrica, and Cymbalta can also be used, and are often more effective for those with a moderate to moderately severe degree of neuropathy.  The bad thing is that all of these drugs can have side effects.  Many of them are dose-specific (Gabapentin for example has few side effects in low doses, but can cause memory loss, dizziness, and more in high doses).  Then...there are the narcotic drugs... best for those with SEVERE Neuropathy, because they are habit forming/addictive and have a whole host of possible side effects.  Constipation, respiratory depression, and much more is associated with prolonged narcotic use. 

   Safer, alternative treatments for peripheral neuropathy are becoming more common.  VITAMIN therapy is very helpful in many cases.  Alpha Lipoic Acid is one that I have found to be very useful.  It takes some time for this to help, but unlike many of the Rx. medications, this often reduces the numbness.   The "feeling" that has been lost in the foot or toes often returns.   I have found that many people using a combination of low dose gabapentin (for mild nocturnal pain), along with 600mg of alpa lipoic acid three times daily, can often keep their pain level low, and after 2-3 months see much of their "lost sensation" returning.  Benfotiamine is another vitamin that is often used successfully in many patients with neuorpathy.  A Thiamine blood level can be determined by a local lab, and if Thiamine is low, the use of Benfotiamine almost always helps.   A prescription "medical food" (classified that way by the FDA because it isn't a drug, but isn't really a vitamin either) known as Metanx is helpful also, especially in those where an ENFD is done and the nerve count is only mildly to moderately abnormal.  This actually will REGROW nerve endings in many people. 

   In my office, we are seeing great results also with LASER therapy for neuropathy.  This is a non-invasive therapy where a focused light beam is directed to the larger nerves in the feet, ankles, and sometimes lower legs, which can bring more circulation into the area, reduce inflammation, and actually heal damaged tissues at a cellular level.  The patient comes into the office for about 10 to 15 visits, usually spaced a few days apart, and receives treatments of each foot/ankle/leg for  10 to 15 minutes.  There are no side effects, and we have found that either a COLD (Class III) or HOT (Class IV) laser can be used for this condition.  In some cases, we use more than one frequency and "pulse" the laser for best results.   The treatment is relatively new, not available in many areas of the country, and is NOT covered by insurance.  Not only does this result in significant PAIN RELIEF, but also brings sensation back to previously "numb" areas, reducing the chance of infection, ulceration, and eventual amputation.  Of couse, this treatment can be combined with OTHER therapy - such as nutritional and vitamin therapy, for the best results. 

    As we see growing numbers of diabetics in the United States, and those individuals live longer because of better blood sugar control, successful treatment of related kidney and heart disease, there is bound to be MORE cases of peripheral neuropathy.  When we also take into account the cases of IDIOPATHIC neuropathy and those who have been successfully treated for cancer with chemotherapy and radiation, there is no question that neuropathy is going to be a problem for a lot more people.  Adequately evaluating and treating this condition becomes more and more important, so that people can lead happy, healthy, and active lives. 


Dr. Richard S. Eby

(423) 622-2663