Q: I have moderate to severe neuropathy below both knees and some tingling and numbness in both hands. Exercise exacerbates my condition and my legs can be painful. I need to exercise to lose weight and manage my diabetes and blood pressure. I’m concerned about taking gabapentin due to it can cause nerve damage with long term use and I don’t want to be dependent on it. What I can I do to reduce my neuropathy pain and discomfort?
Gary Kaplan, D.O.: The peripheral nervous system includes the nerves that lead from the brain and spinal cord throughout the body. There are a number of different types of peripheral nerves including motor nerves, which carry messages that make our muscles work; sensory nerves, which carry sensations from our skin, muscles and organs including touch, temperature, vibration and pain; and nerves that control autonomic function (involuntary) such as heart rate, breathing, blood pressure and digestion. Peripheral neuropathy is a term used to describe damage to these peripheral nerves.
Symptoms of peripheral neuropathy depend on what types of peripheral nerves have been damaged, but typically can include numbness, tingling, pain and weakness, as well as digestive difficulties and bladder dysfunction. The peripheral nerves most commonly damaged are those that deal with sensation, therefore the most common symptoms of people suffering with peripheral neuropathy are pain, which can unfortunately be quite severe, tingling and numbness.
Damage to the peripheral nerves can be caused by a large number of conditions, including:
- Infections such as shingles, Lyme disease, HIV
- Autoimmune diseases such as Celiac disease, pernicious anemia
- Alcohol abuse
- Side effects from medications (chemotherapy, for example)
- Metabolic disorders such as Diabetes, hypothyroidism and nutritional /vitamin deficiencies
- Hereditary disorders such as Charcot Marie tooth disease
Treatment is first and foremost aimed at addressing the underlying disease and finding the appropriate solution to resolve and/or manage it. Unfortunately in approximately 30% of the cases, an underlying cause cannot be identified and this is called idiopathic peripheral neuropathy.
The next goal of treatment is to alleviate pain and preserve function. In our Center we typically start with acupuncture and herbal supplements that stimulate the body’s natural healing process. Both of these therapies have been very effective for a large number of our patients over the years. Topical medications such as lidocaine patches or creams that we have compounded specially for our patients are our next line of therapy. Next, we consider the use of antidepressant medications such as amitriptyline or nortriptyline, or anticonvulsant medications such as gabapentin or Lyrica, as both of these types of medications can be helpful in moderating pain by altering neurotransmission in the peripheral nervous system. Physical therapy can also be helpful. All of these medications have potential side effects, and unfortunately none of the therapies are 100% effective.
In a case such as this one, management of blood sugar is crucial to control the progression of the neuropathy. There are also a number of supplements such as magnesium and chromium picolinate that might be helpful as people who have diabetes are typically low in both. Also there is a significantly higher risk of celiac disease and thyroid disease in people who have Type-1 diabetes. If you have not already been evaluated for these diseases you need to be tested. A simple blood test can be done for both conditions.
With regards to gabapentin we have used this medication for years and have seen it prove helpful for a number of people. There are a large number of potential side effects but as a rule, with proper supervision this medication has proven to be well tolerated and only rarely have we needed to stop the medication because of side effects. I have never encountered a side effect of nerve damage from gabapentin and spurred by this question I did an extensive review of the medical research on gabapentin and was unable to find any references to peripheral nerve damage as a result of taking this medication. Acupuncture treatment may be a good first approach but with proper medical supervision the medications are well worth a consideration for pain control.
With my best wishes for your optimal health,