Signs of pain caused by peripheral neuropathy

foot pain

Do you know if your pain can be caused by peripheral neuropathy? An article titled “How Bad Can Peripheral Neuropathy Get?” lists some warning signs of neuropathic pain.

One can feel numbness or paresthesias (the feelings of pinpricks or tingles’) but also aching pains. People who have advanced peripheral neuropathy sometimes not only have those feelings, but also feelings of burning pain. Sounds scary, and in fact, it is. There are even cases where patients have such acute cases of peripheral neuropathy that they don’t notice open sores or cuts on their feet.

In Reader’s Digest “4 Natural Remedies to Try If You’re Experiencing Peripheral Neuropathy“describes what the pain feels like.

Peripheral neuropathy symptoms can seem scary, painful, and difficult to deal with. They include numbness and a prickling or tingling sensation in your feet or hands, which can spread to the legs and arms. Other signs are sharp, throbbing, freezing or burning pain, extreme sensitivity to touch, weakness, and a lack of coordination that can lead to falls.

The article cautions about the possible severe side effects of medications, such as Neurontin (gabapentin), Lyrica (pregabalin) and Cymbalta (duloxetine) commonly prescribed as a first-line treatment options. After a thorough consultation with a physician, the article suggests the following gentler alternatives for coping only with the symptoms.

  1. Capsaicin
  2. Water Aerobics
  3. Acupuncture
  4. Wraps

The items above will not cure the disease, but may provide temporary relief. Keep your physician informed about your current state at all times to prevent any further deterioration of the disease.

The following description gives a brief summary of this perplexing condition.

Neuropathic pain does not start abruptly or resolve quickly; it is a chronic condition which leads to persistent pain symptoms. For many patients, the intensity of their symptoms can wax and wane throughout the day. Although neuropathic pain is thought to be associated with peripheral nerve problems, such as neuropathy caused by diabetes or spinal stenosis, injuries to the brain or spinal cord can also lead to chronic neuropathic pain.

For further details continue reading here.

Study finds patients may be taking pregabalin at lower levels than possible to reduce neuropathic pain.

Doctors often prescribe pregabalin, also sold as Lyrica, to help their patients with diabetic neuropathy, to get relief from pain.

A team of researchers found, “Higher doses of pregabalin have been shown to be more effective in improving pain outcomes but, in practice, failing to appropriately increase the dose can leave patients under-treated.”

One source lists the currently recommended dosage levels as, “50 mg three times a day (150 mg/day). The dose may be increased to a maximum dose of 100 mg 3 times daily (300 mg/day) after one week.”

In this study, the doctors used levels up to twice that amount, “150 mg/day only; 150 to 300 mg/day; 150 to 300 to 450 mg/day; 150 to 300 to 450 to 600 mg/day; 150 to 300 to 600 mg/day; 300 to 600 mg/day.”

When the dosages were compared to the amount of pain relief from each amount, everything else being equal, the graph below illustrates the clear-cut benefits of the higher doses.

pregabalin dosageImage and text below courtesy of Dove Medical Press Limited 

“Estimated change in pain score from baseline by marginal structural model showing that increasing doses of pregabalin result in a greater reduction in pain score.”

The evidence above contradicts the generally held consensus amounts seen elsewhere.

“Although LYRICA was also studied at 600 mg/day, there is no evidence that this dose confers additional significant benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 300 mg/day is not recommended.”

For people taking, or thinking of asking about pregabalin, consult with possibly several professionally licensed physician regarding the maximum amount that can be safely tolerated without severe adverse effects.

This latest study concludes,

“Many patients who do not respond to lower doses of pregabalin will respond with notable improvements in pain outcomes when the dose is escalated.”

“These data should encourage physicians treating patients with neuropathic pain to escalate pregabalin to the dose that delivers optimal analgesia and tolerable side effects.”

Each case presents its own challenges since patients often take numerous other medications, including supplements, which could create dangerous interactions when combined with Lyrica.

Your physician has the final say on the safest dosage after he or she weighs all the possible outcomes of risk versus reward.

Relief from neuropathic pain with phenytoin cream according to new study

phenytoin cream in jar

Phenytoin provided temporary relief from neuropathic pain reports a recent study in the Journal of Pain Research.

The doctors, Jan M. Keppel Hesselink and David Kopsky, from the Institute for Neuropathic Pain in Amsterdam, summarized their findings on the benefits of a 10% topical cream with phenytoin as the active ingredient as follows.

“We, therefore, developed a new topical cream based on 5% and 10% phenytoin and described three successfully treated patients suffering from neuropathic pain.”

“All patients were refractory[resistant] to a number of other analgesics.”

“In all patients, phenytoin cream was effective in reducing pain completely, without any side effects, and the tolerability was excellent.”

“The onset of action of the phenytoin creams was within 30 minutes.”

Looking further into the details of the study, the subjects applied the cream on their body several times a day in a maintenance program.

Case #1:  diabetic neuropathic pain

“The pain reduction appeared within 5 minutes after application and was maintained for at least 12 hours. The patient applied the phenytoin 10% cream two times daily during a period of 3 months.”

Case #2: chemotherapy-induced polyneuropathy

“The patient applied the cream three times daily during a period of 2 months.”

Case #3: chemotherapy-induced polyneuropathy

“The patient applied the cream two times daily during 1 month.”

The pain from the neuropathic conditions returned  once the daily applications ended. However the cream provided temporary relief for the patients cited above.

Another paper titled, Dilantin (Phenytoin) for Pain Management in Multiple Sclerosis, reviewed the traditional use of phenytoin for MS patients living in a state of constant pain.

“Dilantin (phenytoin) is a hydantoin anticonvulsant that is commonly used for the management of epileptic seizures.”

“In MS patients, it is used for pain management to reduce painful sensations caused by demyelination in the sensory pathways in the brain and spinal cord.”

However the topical cream avoids the many harmful side effects which present themselves when the drug travels throughout the entire body.

Common Dilantin side effects include nausea, vomiting, constipation, tremors, slurred speech, loss of balance or coordination, rash, headache, confusion, dizziness, nervousness and/or sleep disorders.

Phenytoin isn’t sold over-the-counter, and must be prescribed by a licensed doctor. For more on the benefits of applying phenytoin as a topical cream, read the article Topical Pain Creams for Management of Acute, Chronic, and Neuropathic Pain, which describes its advantages and the challenges of overcoming pain from neurological conditions.

“Neuropathic pain is an extremely difficult type of pain to manage. The symptoms experienced by the patient with neuropathic pain differ from those experienced by patients with acute pain. Neuropathic pain usually fails to respond to standard analgesic interventions. Opioids may provide a degree of relief, but only at doses impractical for what may become lifelong therapy. People with neuropathic pain can experience anything from mild discomfort to excruciating torture.”