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The toes burn and tingle and sharp
pains shoot into your legs. The bed sheets feel uncomfortable
on the feet as you toss and turn, trying to get some rest. Your
feet felt numb throughout the day, but now feel like they are
on fire. Nothing seems to help as you watch the hours on the
clock pass by, hoping to fall asleep.
Burning, numbness, tingling, hot
and cold sensations, shooting and electrical pain are common
sensations felt at rest in painful peripheral neuropathy. Neuropathy
is an abnormality of the nervous system. There are many different
types of neuropathy, but the most common neuropathy effecting
diabetics is peripheral neuropathy. Diabetic neuropathy is described
as a loss of sensation that starts in the tips of the toes and
gradually works its way up the legs, and in severe case into
the hands. It is sometimes referred to as a stocking glove neuropathy
because it progresses as if one was pulling on a stocking.
Sixty percent of diabetics have
some type of neuropathy in their feet. Five percent of diabetics
will experience painful diabetic neuropathy and the incidence
increases with age. Over 45% of individuals who have had diabetes
for over 25 years will experience some symptoms of painful diabetic
neuropathy.
The cause of diabetic neuropathy
is not clearly understood. Many believe that the damage to the
small vessels surrounding the nerves, from the diabetes, causes
damage to the nerves. Others believe the increase in blood sugar
causes damage to the nerves. Despite the different theories,
studies have shown better blood
sugar control helps prevent progression of the neuropathy.
There are currently no treatments
to help reverse diabetic neuropathy. There are no treatments
which help reduce the numbness. But, there are many treatments
to help decrease the pain associated with the neuropathy.
Your doctor may prescribe medications
to help with the pain. There are many options, but until recently
none were FDA approved for the treatment of painful neuropathy.
Cymbalta ®, duloxetine HCl, was recently approved by the
FDA in September of 2004 for use in diabetic peripheral neuropathy
at doses of 60 and 120 mg per day. This is the first drug approved
for this use. Similar medications, like amitriptyline, desipramine
and nortriptyline, have been used to help decrease pain and help
with sleep. Gabapentin, also known as Neurontin®, has been
a successful treatment for painful diabetic neuropathy. Neurontin®
was originally approved by the FDA for adjunctive use in seizures,
but the benefits of this drug for other conditions, like neuropathy,
soon became known. The manufacturers of Neurontin® were caught
up in a controversy regarding their marketing tactics for this
off label use. Many physicians still use this drug despite the
controversy. Tegretol and Dilantin, common seizure medications,
can be used in more severe cases. New treatments include lidocaine
5% cream, acetyl-L-canitine, nerve growth factor and Annodyne
®, infrared therapy.
To help treat painful
peripheral neuropathy without prescription medications, consider
the following tips:
1. Keep
your blood
sugar in control: Studies have shown that when blood sugars
remain high, or roller coaster from high to low, peripheral neuropathy
will worsen.
2.
Exercise. This is probably the last thing you wanted to hear.
Exercise helps increase circulation and stimulates the growth
of new vessels which help slow the progression of the neuropathy.
Exercising also helps to increase your pain threshold and to
provide a distraction from the nerve pain in your feet.
3. Eat
healthy. Besides helping to control your blood sugar, eating
a wide variety of fruits and vegetables will add anti-oxidants
to your diet. Anti-oxidants will combat the damaging oxidative
effects glucose has on your nerves. In particular, try dark-green,
leafy vegetables, yellow, orange, and red fruits and vegetables,
citrus fruits and tomatoes.
4.
Try red pepper powder. Capsaicin is the active ingredient in
chile peppers. When applied to the feet it acts as a counter-irritant
and can help decrease neuropathic pain. Capsaicin can be purchased
at your local drug store. If you cannot afford capsaicin, try
mixing 1 tablespoon of dry chile powder with 2 tablespoons of
baby powder. Place the mixture in a sock and use the socks at
night.
5. Try
alpha lipoic acid. ALA is an effective anti-oxidant that has
been shown to relieve pain associated with neuropathy in multiple
studies. To help relieve pain, the dose must be at least 600mg
a day. It is advisable to start with a lower dose, as higher
doses can cause nausea, stomach upset, fatigue, insomnia and
can lower blood
sugar. In general, ALA is a safe supplement.
6.
Try gamma linolenic acid. GLA is an essential fatty acid found
in evening primrose oil. Most of the studies have shown modest
results, but the possibilities are still encouraging. Take 360mg/day.
Many indications require higher dosages, but side effects with
long term use at higher doses may include inflammation, thrombosis
(blood clots), or decreased immune system functioning.
Treating painful diabetic peripheral
neuropathy is very difficult and many of the above mentioned
therapies should be tried and combined. Don't expect any "cures"
and make sure you give each therapy a chance to work.
Christine Dobrowolski is a podiatrist
and the author of Those Aching Feet: Your Guide to Diagnosis
and Treatment of Common Foot Problems. To learn more about Dr.
Dobrowolski and her book visit
http://www.skipublishing.com
or http://www.northcoastfootcare.com.
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