Neuropathy

[flavopop]

Hey Doc... Ive been suffering with Neurapthy in my feet for about a 2 years now. Ive had the electric stimulus test done and both time they said it was graded mild to moderate. well, the bee sting like pains and the occasional numbness arent so mild. My sugars having been running pretty good lately 130 150 range (sorry Im also type two diabetic) and my foot Dr. has me on 2 50mg Lyrica tablets twice a day. There are times when I have to take a Percocet or two just to relieve the burning and stinging. I dig my foot Dr, she has been awesome but I was wondering if you had any other possible helpful hints on how to combat this pain? Thanks buddy...Ronnie P

[Dr Steve]

Hey Doc... Ive been suffering with Neurapthy in my feet for about a 2 years now. Ive had the electric stimulus test done and both time they said it was graded mild to moderate. well, the bee sting like pains and the occasional numbness arent so mild. My sugars having been running pretty good lately 130 150 range (sorry Im also type two diabetic) and my foot Dr. has me on 2 50mg Lyrica tablets twice a day. There are times when I have to take a Percocet or two just to relieve the burning and stinging. I dig my foot Dr, she has been awesome but I was wondering if you had any other possible helpful hints on how to combat this pain? Thanks buddy...Ronnie P

Ok, the prime directive of this forum is to educate, so let me get everyone on the same page before I answer.

The tree of pain has two branches: nociceptive pain and neuropathic pain. "Nociceptive" pain is regular normal pain...it serves a function. You put your hand on the stove, it hurts like hell and you don't do it again. That's nociceptive pain.

Neuropathic pain is another beast altogether; it's the pain that happens when the nerves themselves are damaged. They just fire at odd times and the pain is usually perceived as odd as well...burning, stinging, weird feelings, etc. "Phantom pain", the pain that is felt in a limb that is no longer there because of amputation, is a kind of neuropathic pain.

Patients with diabetes will often develop neuropathy; the blood vessels serving the nerves (vaso nervorae) are very small and easily clogged, causing misfirings and neuropathic pain.

there are a lot of medications out there that will stabilize nerve membranes (like Lyrica or Neurontin), or will stop pain impulses in the spinal tracts (the so-called tricyclic antidepressants), or will block the receptors (called NMDA receptors) (methadone and its ilk) that are triggered in neuropathic pain. Lyrica is one of them, and is a recent entry into the playing field.

The dose you're on is moderate, for Lyrica in neuropathy. the recommended dose for diabetic neuropathy is 100mg three times a day. So you have a little headroom there that your doctor can work with.

We'll often use a multi-faceted approach, trying to hit the neuropathy symptoms from several angles in hard-to-treat cases. For the really, REALLY refractory cases, we'll even use methadone, which blocks the NMDA receptor very efficiently, causing sometimes complete symptom relief. The problem with methadone of course is...well, that it's methadone. Besides being a powerful opioid (narcotic), it's the stuff that Anna Nicole Smith was playing with before she died. Bad press aside, methadone at very low doses can be effective in cases that won't respond to anything else. It's the only narcotic known that blocks the NMDA receptor (except for dextromethorphan (the active ingredient in "robitussin DM") which is a very weak NMDA receptor blocker).

I'm not recommending any of the above, actually, just giving out a little information on the subject. Neuropathic pain is one of my main interests.


Good luck and I hope this gives you some hope that there is a more effective treatment regimen in your future!


Oh, and keep your diabetes under control, too! Good job so far!



steve

[flavopop]

Thanks Doc, very informative stuff...You rock buddy