Neuropathy, of all types, is one of the most common disabling forms of chronic pain that we see and treat.

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What is Neuropathic Pain?

Neuropathic pain is a complex, chronic pain state that is usually accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional, or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury.

Symptoms of Neuropathy in the Legs and Feet

Neuropathy in the legs and feet can manifest in various symptoms. These symptoms may vary in intensity and type based on the underlying cause and the nerves affected. Common symptoms include:

  • Numbness or reduced ability to feel pain or temperature changes
  • Tingling or burning sensation
  • The feeling of a tight band around the toes, foot, ankle or leg
  • Sharp, jabbing, or electric-like pain
  • Feeling like you are walking on sandpaper
  • Feet may feel like bricks or rocks
  • Extreme sensitivity to touch
  • Lack of coordination and falling
  • Muscle weakness or paralysis if motor nerves are affected
  • Symptoms typically, but not always, worsen in the evening or at night
  • Difficulty falling asleep or waking up at night from the symptoms becoming exacerbated at night

 

Causes of Neuropathic Pain

Neuropathic pain can be caused by a variety of conditions and factors, including but not limited to:

  • Diabetes: High blood sugar levels can damage nerves over time, leading to diabetic neuropathy.
  • Infections: Certain infections, such as shingles (herpes zoster) or HIV, can cause nerve damage and result in neuropathic pain.
  • Trauma: Physical injury to nerves, whether from accidents, surgeries, or other forms of trauma, can cause neuropathic pain.
  • Autoimmune Diseases: Conditions like multiple sclerosis or lupus can lead to nerve damage and subsequent pain.
  • Chemotherapy: Some cancer treatments can damage nerves, resulting in chemotherapy-induced peripheral neuropathy.
  • Toxins: Exposure to certain toxins, including heavy metals, can cause nerve damage.
  • Genetic Disorders: Some inherited conditions can affect the nerves, leading to neuropathic pain. These include conditions like Charcot-Marie Tooth Disease, Friedreich's Ataxia, Dejerine-Sottas Disease, and others.
  • Alcoholism: Chronic alcohol abuse can lead to nerve damage and neuropathic pain, believed to occur in between 25%-66% of chronic users in the United States
  • Medications: A multitude of medications can cause peripheral neuropathies, especially if taken at higher doses or extended periods. Anti-hypertensive drugs like Amiodarone, Antibiotics like metronidazole and nitrofurantoid, Biologics for Auto-immune Disease like etanercept and  infliximab, as well as many other classes of drugs.

Treatments for Neuropathic Pain

Treating neuropathic pain often requires a multifaceted approach. Here are some of the common treatments available:

  • Medications:
    • Antidepressants: Certain antidepressants, such as tricyclic antidepressants (e.g., amitriptyline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g., duloxetine), can help alleviate nerve pain.
    • Anticonvulsants: Drugs typically used for epilepsy, such as gabapentin and pregabalin, can also be effective in treating neuropathic pain.
    • Topical Treatments: Creams, gels, or patches containing lidocaine or capsaicin can provide localized pain relief.
    • Opioids: In severe cases, opioid medications may be prescribed, although they are generally considered a last resort due to the risk of addiction and side effects.
    • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): While not always effective for neuropathic pain, NSAIDs like ibuprofen can be used in combination with other treatments.
  • Physical Therapy: Exercises and physical therapy techniques can help manage pain and improve function.
  • Psychological Counseling: Cognitive-behavioral therapy (CBT) and other forms of counseling can help patients cope with chronic pain.
  • Nerve Blocks: Injections of anesthetic or steroids near affected nerves can provide temporary pain relief.
  • Transcutaneous Electrical Nerve Stimulation (TENS): This technique uses low-voltage electrical currents to relieve pain.
  • Alternative Therapies: Acupuncture, chiropractic care, and other alternative treatments may provide relief for some individuals. Please inquire with Dr. Biesinger if you have interest in alternative and advanced therapies as he has several to offer.
  • Surgery: In rare cases, surgical interventions may be necessary to relieve pressure on nerves or repair damaged nerves. Dr. Biesinger is trained in the lastest techniques to assist you in the reduction or elimination of your pain.

It's important to consult with Dr. Biesinger to determine the most appropriate treatment plan for your specific condition.