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Harvard Medical School
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General Medical Questions
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Question : What treatments are available for a persistent painful neuropathy in my feet?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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May 24, 2011
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A:

"Neuropathy" means nerve disease. Symptoms can include pain, burning or tingling. There are many causes. Treatment may depend on the cause. For example, neuropathy due to not having enough vitamin B12 may only need a B12 supplement. But B12 won't help neuropathy due to diabetes.

Diabetes is a common cause of painful neuropathy. Aggressively treating diabetes can help prevent diabetic neuropathy. However, once the neuropathy starts, it is rarely reversible. By keeping blood sugars close to normal, it may be possible to stop the neuropathy from getting worse.

Another common neuropathy is carpal tunnel syndrome. This may be related to:

  • Wrist arthritis
  • Diabetes
  • Thyroid disease
  • Other medical conditions

Finding and treating any associated condition can reduce or even cure symptoms. However, many types of neuropathy are not readily reversible. In many cases, the cause of neuropathy is not known.

For these, a number of medications are available, including:

  • gabapentin (Neurontin)
  • pregabalin (Lyrica)
  • amitriptyline (Elavil)
  • duloxetine (Cymbalta)
  • carbamazepine (Tegretol)
  • phenytoin (Dilantin)
  • topiramate (Topamax)
  • capsaicin (Zostrix and others), which is applied to the skin in the area of pain
  • lidocaine patch, which applies an anesthetic to the painful area

Anti-inflammatory drugs, acetaminophen, and other pain medications (such as tramadol or narcotics) may be recommended.

Non-medication approaches to reduce pain include:

  • Not smoking
    Scientists are not exactly sure why smoking makes nerve pain worse in some people.
  • Splints
    For a condition such as carpal tunnel syndrome. This keeps the wrist relatively straight. It can help give the compressed nerve (the median nerve) more room
  • Transcutaneous electrical nerve stimulation (TENS)
    Electrodes are placed on the skin and a low electrical current is delivered
  • Cortisone injections
    These can help if there is swelling near a nerve or there is a compressed nerve
  • Nerve "blocks"
    These treatments can damage a nerve, which interrupts the pain signals it sends
  • Surgery
    If nerve pain is due to compression of the nerve (as with sciatica due to spinal disc disease), surgery may be suggested to remove the disc. This provides the nerve more space.

There is not a single, best treatment that works for every person with painful neuropathy. It may take time to find a drug or treatment that reduces symptoms without causing side effects. Be patient. Most people get at least some relief for their painful neuropathy with treatment.

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