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Suggestions to help with Neuropathy pain
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Suggestions to help with Neuropathy pain


   Hi,
     I was wondering what are some of the do's and don't if a patient has peripheral neuropathy in both feet (burning, stabbing pain, pins & needles). The current medicine I am on (Paxil) does not seem to give 24 hour relief.  The doctors are still trying meds to find a good fit for me but I was wondering what are things a patient can do to make the pain less.  I don't find much info on self help/care on this subject.  What would you tell your patient on this subject?  Thank you for any information you might be able to give.
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The first "do" about peripheral neuropathy is to have it evaluated thoroughly.  Many times a cause for neuropathy cannot be found (and sometimes it's familial and so nothing can be done), but there are a few types of neuropathy that need to be evaluated for because they are common or treatable - diabetes, thyroid disease, paraproteinemia (abnormal amounts of certain immune proteins in the body). An EMG is helpful in this evaluation because it helps classify the neuropathy as due to involvement of the nerve fibers or the nerve coating.  If a disease of the myelin coating is noted, this could mean immune disease is causing the neuropathy.
After workup, the question of treatment arises - most neuropathies cannot be treated, but some can (e.g. thyroid disease) and others can be prevented from worsening with treatment (e.g diabetic neuropathy gets worse quicker if sugar control is bad).  
Often a specific treatment does not exist for the neuropathy one has, but there are mnay "symptomatic" treatments for the pain, tingling and burning people experience.  Some of the agents also help people sleep at night (a particularly bothersome time for neuropathy patients).  For neuropathy pain, typical pain medications (Tylenol, Motrin, Percocet, etc) often do not work (and can be addicting), but ther classes of medications do help - some antidepressnats, anti-seizure drugs or even cardiac arrhythmias drugs.  These drugs are taken every day rather than whenever the pain is most.  Some antidepressants such as Elavil or Pamelor do help neuropathy pain - Paxil really does not.  So perhaps a different medication might be more effective.
Lastly, if neuropathy is significant in the feet, one could develop cuts which go unfelt and get infected or bump toes repeatedly leading to joint abnormalities. Reguar foot checks and podiatric follow-up is always useful.




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