Peripiheral neuropathy
Managing the pain and frustration
Source: November 1998 Mayo Clinic Health Letter

The burning sensation in Esther's feet is getting worse. What started out as a mild tingling in her toes has turned into searing pain. Now, her feet feel so "hot" she dreams of soaking them in cool water all day or even walking barefoot in the snow.

Like more than two million other Americans, most of whom are older adults, Esther has peripheral neuropathy (pe-RIF-er -ul ner-OP -ah-thee). Peripheral neuropathy (also called peripheral neuritis) is a frustrating and painful nerve condition.

However, with diagnosis and treatment, the pain from peripheral neuropathy can usually be managed – and, in some cases, eliminated.

Easily damaged nerves
The pain of this condition results from damage to peripheral nerves in your body – those nerves that branch out from your spinal cord to connect every part of your body to your central nervous system. Because peripheral nerves are long and fragile, they're susceptible to damage from many things.

Common causes of nerve damage that results in peripheral neuropathy include diabetes, alcoholism, autoimmune diseases (such as rheumatoid arthritis and lupus) and exposure to toxic substances.

Viral and bacterial infections, cancer, use of certain medications (such as drugs to treat cancer), vitamin deficiencies and conditions that result from pressure on a single nerve (such as carpal tunnel syndrome) can also cause peripheral neuropathy.

So can kidney disease, liver disease, an underactive thyroid and inherited genetic abnormalities. Often, though, no cause can be found.

Recognizing symptoms
Whatever the cause, peripheral neuropathy usually starts with numbness or tingling in your toes, then slowly spread upward. Occasionally, it affects the front of your thighs or starts in your fingers and moves up your hands.

At times, symptoms may be barely noticeable. At other times, especially at night, they may be almost unbearable. For some, symptoms are constant.
Common symptoms include:
• Tingling, prickling or numbness
• The sensation that you're wearing an invisible "glove" or "sock"
• Burning or freezing pain
• Sharp, jabbing or electric pain
• Extreme sensitivity to touch, even light touch
• Muscle weakness
• Loss of balance and coordination
Symptoms can also include a fall in blood pressure when standing up, constipation or diarrhea, night sweats, incontinence or impotence.

Tailored treatment
The success of your treatment often depends on the cause of your neuropathy.
For example, if a medication is triggering the condition, your doctor may be able to eliminate your symptoms by prescribing another drug. Peripheral neuropathy from a compressed nerve is often treated with medication or by immobilizing the affected area.

If a chronic disease, such as diabetes, is causing your symptoms, controlling the disease might not eliminate the neuropathy, but it may play a key role in managing it.

However, peripheral neuropathy can be frustrating to treat, particularly if no reversible cause is found. Control of symptoms then becomes the goal. Common treatment includes:
• Pain relievers - Over-the-counter pain relievers, such as aspirin and acetaminophen (Tylenol), usually help mild symptoms. For more severe pain, your doctor may prescribe other medications.
• Tricyclic antidepressants - These medications, such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), often provide relief for mild to moderate symptoms, particularly burning pain.
• Antiseizure medications - Drugs developed for epilepsy, such as gabapentin (Neurontin), carbamazepine (Tegretol) and phenytoin (Dilantin), are often prescribed for jabbing pain.
• Other drugs - Mexilentine (Mexitil), a drug used to treat irregular heart rhythms, is sometimes used to treat burning pain. The blood pressure drugs clonidine (Catapres) and phenoxybenzamine (Dibenzyline) are also sometimes used.

On the horizon
Research continues to find more effective therapies for peripheral neuropathy. Early studies suggest these show promise:
• Nerve growth factors - These are manufactured forms of naturally produced chemicals that signal the body to repair small nerve fibers.
• Alpha -lipoic acid (thioctic acid) - This antioxidant is being studied for diabetic neuropathy.
• Other therapies - Calcium channel blockers and drugs to treat Parkinson's disease may help slow nerve damage. For diabetic neuropathy, two classes of drugs -- selective serotonin reuptake inhibitors (SSRIs) and aldose reductase inhibitors -- may offer hope.
Linda here- I know this is fairly basic for some of you who have been searching for pain relief for years but there are also many who are new to CMT pain and by knowing what's in this article they can begin to look for relief in the right places and do the right things. It sometimes takes years to find relief and sometimes it doesn't happen but you have to keep trying.

Self-care tips for managing the pain of peripheral neuropathy
Source: November 1998 Mayo Clinic Health Letter
Tips to manage peripheral neuropathy include:
• Take care of your feet - Tight shoes and socks can worsen pain and tingling. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop (available in medical supply stores) to keep bed covers off hot or sensitive feet.
• Soak feet or hands in cold water - If you have burning pain, cool your feet or hands in cold (but not icy) water for 15 minutes twice a day. This is particularly useful at night. After soaking, rub on petroleum jelly to soften skin.
• Massage limbs - Massaging feet or hands helps improve circulation and stimulate nerves. This may temporarily relieve pain.
• Move around - If your feet hurt, get up and walk around. Improving circulation to your feet may help relieve pain. Get involved in activities that distract you from the pain.
• Take care of yourself - Reduce your stress level. Stress can aggravate symptoms. Reduce stimulants such as caffeine and nicotine. These may intensify pain. Seek treatment for insomnia or depression, conditions often associated with peripheral neuropathy.