Neuropathy Question To The Doctor

Today's post from dailymail.co.uk (see link below) is a question and answer piece from a regular national newspaper health section. The patient, who is older, asks if there is an alternative to his current neuropathy medication. The doctor's answer is a sensible one, in that he recognises that all the normal procedures have been covered and it may be time to refer the patient to a specialist and preferably a pain specialist, who will look at the medication but also at how the patient reacts to and deals with the symptoms. Often patients don't realise that certain aspects of their symptoms will not go away with neuropathy and therefore, they need not only drugs to help but good advice as to how best live with the discomfort. Worth a read.
 

Neuropathy Question And Answer
By Dr Martin Scurr Published: 00:28 GMT, 25 November 2014

I have been diagnosed with peripheral neuropathy after developing numb feet and painful lower legs, but have been told there is nothing I can do about it.

However, I am an active 73-year-old — I play golf and bowls twice a week, keep my garden in good order and do 50 star jumps a day.

I’ve started to have problems with my left knee, which is affecting my golf swing.

All I have been offered are opiate-style drugs, but these make me feel like a zombie. Is there anything else that can help?
P.B., Peterborough.

Dr Martin Scurr
 
How frustrating for you, especially for someone who is so impressively active — something that is to be applauded.

Yet your condition of peripheral neuropathy has started to hamper this.

However, hopefully referral to a specialist will help keep you on the golf course.

The condition causes damage to the peripheral nerves, which run from the brain and spinal cord to all parts of the body including the feet, legs, arms and organs.

This damage means the messages that travel along these nerves are disrupted, leading to pain (often a burning or uncomfortable tingling sensation) and numbness.

For reasons that are not clear, the nerves furthest from the brain are most affected, which explains why your symptoms are in your feet and lower legs.

The condition affects two in 100 people and there are a wide variety of causes, including diabetes (this is the most common cause, and is thought to be due to high blood sugar levels damaging nerves), alcohol abuse, viral illness (in rare cases, even a few days laid low by the influenza virus can cause nerve damage), exposure to solvents or poisons such as insecticides, or an injury such as a fractured bone.

It may also be linked to a family history of neurological disease such as ataxia (which causes problems with balance and gait).

It’s worth looking at whether the patient has started new medications, as peripheral neuropathy can be a side-effect (for instance, some chemotherapy medications are known to trigger it).

However, from your longer letter it seems all these factors have been eliminated by your doctor.

In half of all cases of peripheral neuropathy no cause is found — meaning we are left treating the symptoms, rather than the cause.

Unfortunately, nothing can be done about the numbness, as there is very little we can do to repair damaged nerves, but there are effective treatments available for the pain.

You tell me you have tried opioid-based painkillers — one common, weaker opioid is codeine; tramadol is stronger, and can trigger feelings of sleepiness.

But there are other options and I strongly advise you to seek referral to a pain clinic, where you will be seen by professionals who will be skilled at using drugs to control nerve pain.

These options include gabapentin, which substantially reduces pain associated with peripheral neuropathy.

The dose is usually started at a low level and then increased until there is effective pain relief.

Tricyclic antidepressant drugs have been used for many years for this condition and are almost always effective — again the dose must be elevated gradually until the symptoms are relieved. Patience is essential.

I hope that your GP has you under the care of a neurologist, who presumably made the diagnosis and investigated for causes, or perhaps you have now been referred to a pain clinic specialist.

If not, this could be a wise move.

http://www.dailymail.co.uk/health/article-2847765/DR-SCURR-new-health-MOTs-worth-having.html