Q. After months of painful burning in my feet, I was diagnosed with peripheral neuropathy due to my diabetes. The pain can occur at any time, but it seems worse at night. Tylenol helps a little, but is there anything else I can try?
A. Peripheral neuropathy, which is also known as polyneuropathy, can be a vexing problem, but there are a few things you can try for relief. The term neuropathy simply means nerve problem. It is considered to be peripheral when it is located outside the brain and spinal cord. So a diagnosis of peripheral neuropathy doesn't explain much; it just means that something is irritating a nerve and giving you trouble. It can sometimes be difficult for a doctor to pin down a cause of peripheral neuropathy. There is no apparent cause in some cases. In others, it can be caused by diabetes, too much alcohol, a side effect of medication, vitamin deficiency, HIV infection, Lyme disease or some types of cancer. As the broad list of possible causes might suggest, it can sometimes take some detective work to uncover the cause of peripheral neuropathy. In your case, however, it is likely due to your diabetes, which is one of the most common causes. With diabetics, the ailment results from the toxic effect of high blood sugar levels over a period of many years. What are the symptoms of peripheral neuropathy? It typically causes a burning, tingling or stabbing pain. It can also cause numbness or a sensation like your skin is crawling. Peripheral neuropathy in diabetics usually starts at the ends of the nerves, and so it often first shows up in the feet as a burning pain or numbness along with decreased sensation. In fact, one of the reasons people with diabetes develop serious foot infections is that they can't feel small sores on the bottom of their feet. If you have diabetes, keeping your blood sugar under control can slow the development of peripheral neuropathy and other complications. But if you already have painful neuropathy, there are several treatments you can try. First, see if simple pain relievers like Tylenol help. You can also use topical treatments, like capsaicin (Zostrix) cream. Some people find that light pressure helps--such as from custom-fitted orthotic shoes, pressure dressings or even special skin dressings that are designed to treat open wounds. Lidocaine, an anesthetic, can be helpful when applied topically or given intravenously. If these treatments don't work, you can try one of several classes of prescription medicines: * Antidepressants, known as tricyclic antidepressants. Amitriptyline (Elavil) is the one most often used for peripheral neuropathy. You typically take a dose much lower than that used to treat depression. * Anticonvulsants (anti-seizure medicines). Carbamazepine (Tegretol) and phenytoin (Dilantin) have been used for years to treat the pain of peripheral neuropathy. A new anticonvulsant, gabapentin (Neurontin), also shows promise. * Anti-arrhythmia drugs. Mexiletine (Mexitil) has shown some success, but because of potential side effects it's probably not a drug to try first. An initial study has shown that the class of blood pressure drugs known as ACE inhibitors may help ease the pain of peripheral neuropathy, even in people with normal blood pressure. And on the horizon is a new class of drugs for diabetes known as aldose reductase inhibitors. These may help reduce the symptoms of peripheral neuropathy and other complications of diabetes. For more information, contact the Neuropathy Association, 60 East 42nd St., Room 942, New York, NY 10165; the association's telephone number is 1-800-247-6968; its Web site address is http://www.neuropathy.org You can also search for the word "neuropathy" on the American Diabetes Association's Web site, http://www.diabetes.org Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered personally.