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Suggest Treatment For Severe Foot Neuropathy Along With Burning Feeling And Sharp Pain
Question: I have severe foot neuropathy, burning, "walking on marbles, and especially sharp pain. I have had little relief from gabapentin or electrical stimulation. Can dietary changes be beneficial and/or are there other treatments you can suggest?
Brief Answer:
Pregabalin, antidepressives
Detailed Answer:
I read your query carefully and I understand your concern. Neuropathic pain can really affect quality of life.
Gabapentin, an anticonvulsant, is a good option to have been tried first. However since you report it to be ineffective other management means should be tried.
One option would be to try another anticonvulsivant like Pregabalin although it generally has similar efficacy to Gabapentin.
The other main alternative would be an antidepressant either of the tricyclic class (TCA) like Amitriptyline or Nortriptyline or of SNRI class like Duloxetine or Venlafaxine ER. Considering your age the last two would be perhaps more appropriate because TCA class is not often used in the elderly due to side effects.
Combination therapy Gabapentin+Venlafaxin or Gabapentin+Nortriptylin can also be attempted as it has shown superior efficacy to Gabapentin alone in studies.
These are the recommended first line options. If still ineffective opioids are a second line therapy.
Regarding your question on dietary changes it is a little hard to answer without knowing more about the cause of your neuropathy (of course addressing the cause is most important, the above-mentioned medications only ease the symptoms). There can be many causes, dietary changes may be needed in some like diabetes or vitamin B12 deficiency, but and not in others.
So if you can provide some more details on your history, other medical conditions, other medications, exposure to toxins or alcohol abuse, diagnostic tests you have done perhaps I might be able to say more.
I remain at your disposal for further questions.
Pregabalin, antidepressives
Detailed Answer:
I read your query carefully and I understand your concern. Neuropathic pain can really affect quality of life.
Gabapentin, an anticonvulsant, is a good option to have been tried first. However since you report it to be ineffective other management means should be tried.
One option would be to try another anticonvulsivant like Pregabalin although it generally has similar efficacy to Gabapentin.
The other main alternative would be an antidepressant either of the tricyclic class (TCA) like Amitriptyline or Nortriptyline or of SNRI class like Duloxetine or Venlafaxine ER. Considering your age the last two would be perhaps more appropriate because TCA class is not often used in the elderly due to side effects.
Combination therapy Gabapentin+Venlafaxin or Gabapentin+Nortriptylin can also be attempted as it has shown superior efficacy to Gabapentin alone in studies.
These are the recommended first line options. If still ineffective opioids are a second line therapy.
Regarding your question on dietary changes it is a little hard to answer without knowing more about the cause of your neuropathy (of course addressing the cause is most important, the above-mentioned medications only ease the symptoms). There can be many causes, dietary changes may be needed in some like diabetes or vitamin B12 deficiency, but and not in others.
So if you can provide some more details on your history, other medical conditions, other medications, exposure to toxins or alcohol abuse, diagnostic tests you have done perhaps I might be able to say more.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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