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Cold feet

  : : : : I've had idiopathic peripheral neuropathy for over 5 years and have had cold feet for as long as I can remember. For the past 2 winters when I get into a pre-warmed bed my feet get so cold they hurt. Over time they warm up and when I get up several hours later they are nice and warm. The strangest thing is that my husband tells me my feet don't feel cold to him. What's happening?
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  : : : Thanks for your questions.  Although not quite as common as complaints of
  : : : pain in the extremities of limbs, the transmission of temperature sensation
  : : : for both heat and cold are also done via small caliber unmyelinated nerve
  : : : fibers (just like the "pain" nerve fibers).  Your complaint is one of
  : : : altered perception of temperature, similar to the altered sensation of pain
  : : : threshold reported by patients who feel pain/discomfort with mere skin touch.
  : : : One would consider the possibility that you might have a vascular problem -
  : : : i.e. inappropriate blood perfusion in the extremities, but the fact that
  : : : your husband do not notice/observe a cold foot seems to indicate that the
  : : : actual temperature and perfusion is normal.  Although there is not clear
  : : : evidence that anti-epileptics are helpful in altered perception of temperature
  : : : in the same way that they are in neurogenic pain, your physician might
  : : : attempt a trial period of either carbamazepine (Tegretol) or gabapentin
  : : : (Neurontin).  Please discuss these possibilities with your physician.
  : : : I hope this information is helpful.  Best of luck.
  : : : This information is provided for general medical education purposes only.
  : : : Please consult your doctor regarding diagnostic and treatment options.
  : : Sorry, I should have mentioned that I am taking Neurontin, Mexiletine, and Desipramine for neuropathic pain. Does this change anything?
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  : Thanks for your reply.  Can you tell us the current dosages fo each of those
  : medications; for how long have you been taking each drug; and whether you
  : noticed any improvement of symptoms with any of those medications?
  : Thanks.
  All 3 drugs take the edge off the pain. I've been taking Desipramine (100 mg.) for 2.5 years, Mexiletine (150 mg/2 a day))for about 1.5 years, and Neurontin (300, 3 x day) for about 1 year. As I noted, each contributes to comfort and puts the pain on 'back burner' as long as I don't walk too much.
Thanks for your reply.  Our apologies for the long delay in the answer.  If you are not having any significant side-effect from your current medications, your physician might consider further increases in the dosages of Desipramine (up to 150mg/day, can be divided in twice a day), and Neurontin (there isn't a clear upper limit, some epileptic patients receive up to 3600mg/day).  The increases should be titrated to effect, that is, if you do not observe clear benefits from the higher dosages after 2-3 weeks, then you should return to the previous dosages.
I hope this information is helpful.  Best of luck.

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