Janice F. Wiesman, MD, FAAN
Janice F. Wiesman, MD, FAAN, clinical associate professor of neurology at New York Grossman School of Medicine in New York City and author of Peripheral Neuropathy: What It Is and What You Can Do to Feel Better.
Nerve damage can be both mysterious and maddening. It’s mysterious because about one-third of those with neuropathy never discover what’s causing the pain, tingling and numbness. It’s maddening because damaged nerves recover slowly—if they recover at all. Even when an underlying cause of neuropathy is identified (diabetes, for example, is a big one) and corrected, the symptoms may persist for months, years or a lifetime.
About one in every 15 American adults has experienced some form of neuropathy, also known as peripheral neuropathy. The symptoms vary widely—from sharp, shooting pains that feel like jolts of electricity…to burning sensations…tingling…numbness…muscle fatigue…and/or a lack of muscle strength in the feet. Symptoms typically start first in both feet, then slowly move up the legs and to the hands. Nerves that control functions such as sweat, blood pressure, digestion and bladder control can be affected as well.
There are hundreds of different causes of neuropathy. Diabetes, mentioned above, accounts for about one-third of all cases. Elevated blood sugar damages nerve cells and blood vessels and can cause numbness and other symptoms.
Other common causes of neuropathy: Heavy alcohol use, rheumatoid arthritis, vitamin deficiencies (including vitamin B-12) and certain medications, especially some chemotherapy drugs.
Important finding: One-third to one-half of patients with neuropathies of unknown origin have inherited neuropathies—that is, they’re genetically susceptible to nerve damage, even in the absence of a specific disease/injury, according to research conducted at Mayo Clinic.
A few medications are FDA–approved for neuropathy, but the side effects may be more uncomfortable than the condition itself. Fortunately, there are some surprisingly effective nondrug therapies.
It can be a challenge for doctors (usually neurologists) to identify what is responsible for neuropathies. But it’s worth making the effort because treating the cause early can stop ongoing damage and potentially allow injured nerves to regenerate. When nerves repair there may be some increased sensitivity, but this is usually temporary.
When the cause of neuropathy can’t be identified, the symptoms can still be treated. If your symptoms make you very uncomfortable, there are medications that can help. The drugs that have been FDA-approved for neuropathic pain include pregabalin (Lyrica), also often used for seizures…and duloxetine (Cymbalta), also used for depression. Lyrica can cause drowsiness and weight gain…and Cymbalta can cause drowsiness as well as sweating in a small number of people. Gabapentin (Neurontin) and tricyclic antidepressants, such as amitriptyline (Elavil) and nortriptyline (Pamelor), are used off-label for neuropathy. Neurontin is similar to Lyrica with the same side effects…and the antidepressants can cause sedation, dry mouth and, in high doses, arrhythmias.
My advice: If you’d describe your symptoms as uncomfortable and annoying—but not debilitating—you might want to start with nondrug treatments. They probably won’t eliminate the discomfort altogether, but they can make it easier to tolerate. Plus, if you do decide to use medication, these treatments may enable you to take it for a shorter time and/or at a lower dose. Try one or more of the following at a time…
• Natural fix #1: Vibrating footbath. Most patients will first notice tingling, numbness or other symptoms in the feet. Soaking your feet in a warm-water vibrating footbath (available in department stores, pharmacies and online) for 15 to 20 minutes dilates blood vessels and increases circulation in the affected area. More important, the vibrations are detected and transmitted by large-diameter sensory nerve fibers. Because of their large size, these fibers transmit signals very quickly. The sensations of vibration reach the spinal cord before the pain signals from damaged nerves, which blunts the discomfort.
The pain relief is temporary but reliable. You can soak your feet as often as you wish throughout the day. Helpful: Soak your feet just before bed—the pain relief you get will help you fall asleep more easily.
For discomfort in other parts of the body, you can get similar relief from a whirlpool bath or a pulsating showerhead.
Important: Some people with neuropathy are unable to sense temperatures and can burn their feet in too-hot water. Test the temperature with your hand first (or have someone else test it).
• Natural fix #2: Menthol cream. The smooth muscles in arterial walls are lined with receptors that react to menthol. When you rub an affected area with menthol cream (such as Bengay), the blood vessels dilate, create warmth and reduce discomfort. Creams labeled “menthol” or “methyl salicylate” have the same effects. These creams can be used long-term as needed.
• Natural fix #3: Transcutaneous electrical nerve stimulation (TENS). This therapy delivers low levels of electric current to the surface of the skin. It’s thought that the current stimulates nerves and sends signals to the brain that block the discomfort from damaged nerves.
How well do the devices work? The research is mixed. In 2010, a meta-analysis of TENS in patients with diabetic neuropathies found that the treatment led to a decrease in pain scores. Other studies, however, have shown little or no benefit.
Battery-powered TENS units cost about $30 for low-end models. The treatment is largely without side effects, and some people have good results. Treatments are typically done for 30 minutes at a time and can be repeated as needed throughout the day. Treatments should not be done on skin that is irritated.
My advice: If you want to try TENS at home, start using it under the direction of a physical therapist so that he/she can suggest the appropriate settings and amount of time for treatment.
• Natural fix #4: Percutaneous electrical nerve stimulation (PENS). Percutaneous means that the electric current is delivered under the skin, using short needles. Studies have shown that the treatments, done in rehabilitation/physical therapy offices, decrease pain, improve sleep and may allow patients to use smaller doses of painkilling medication. After each treatment, the pain relief can potentially last for weeks or longer.
The treatments take about 30 minutes per session and are generally repeated three times a week, until the patient achieves the desired amount and duration of pain relief. The risks are minimal, although you might have mild bruising or a little bleeding. Infection is possible but unlikely. Most patients have little or no pain during the treatments. PENS is not advised for those with pacemakers and should not be done on areas of irritated skin. The treatments might or might not be covered by insurance—be sure to ask.
• Natural fix #5: Self-massage. Firmly rubbing and/or kneading the uncomfortable area is another way to block pain signals. You don’t need to learn sophisticated massage techniques—but you (or a loved one) must use enough pressure to stimulate the big nerves that carry the pressure sensations. A too-light touch won’t be helpful. Caution: If you have a history of deep vein thrombosis, ask your doctor before massaging your legs.
• Natural fix #6: Relaxation techniques. Stress and anxiety do not cause neuropathy, but patients who are tense may feel pain more intensely. A multiyear study found that patients with chronic pain who completed a mindfulness/stress-reduction program reported significantly less pain—and the improvement lasted for up to three years.
Helpful: Meditation, yoga and other relaxation techniques. Most large medical centers offer programs in anxiety/stress management. Excellent guided meditations are also available on YouTube.
