Painful or numb feet and hands?

April 6, 2018 Johnson Moon, MD



Pain from peripheral neuropathy can be treated with vitamins, medications, diet and exercise

Numb feet can be dangerous, so check them for cuts and sores

Regular pain medications usually don’t work for neuropathy pain

Numbness and pain are two sides of the same coin known as peripheral neuropathy (PN). It may feel like arthritis pain, but the throbbing, burning or tingling sensations in your hands or feet—whether they recur every now and then or have crept up on you over the years—are unlikely to be helped by an over-the-counter pain reliever or arthritis medication. Dr. Johnson Moon, a neurology specialist at St. Joseph Health’s St. Jude Medical Center says, “Pain medications like those used for joint pain generally do not work for the pain from peripheral neuropathy.” That’s because neuropathy is a form of nerve damage, while arthritis is a condition that affects the joints. And that’s a difficult situation for the 20 million people in the U.S. who have some type of PN.

The human nervous system

The human body has two main parts to its nervous system: 1) The central nervous system (CNS), meaning your brain and spinal cord, and 2) The peripheral nervous system (PNS), which links the brain and spinal cord to the other parts of your body, like the organs, skin, and muscles. Peripheral neuropathy means there is damage in the peripheral system, and the messages going to and from the CNS to points in the PNS are not working correctly. Either too much ‘information’ (sensations of pain, heat, cold) or too little information (numbness) can result.

Peripheral neuropathy is painful and dangerous

Damaged and ‘confused’ nerves do not operate correctly. For instance, while you’re trying to sleep, a single bed sheet can feel scratchy or even heavy. Many people with PN say they have worse neuropathic pain at night than during the day, and they become unable to get a good night’s sleep. The chronic pain often causes emotional difficulties for the patient and their loved ones.

Damage to nerve endings in the autonomic nervous system (which controls breathing, for instance) can lead to other problems like difficulty in eating and swallowing, incontinence, constipation or diarrhea. When extremities are numb, not being able to feel heat, cold or pain can invite burns, frostbite, or undetected wounds which become infected.

Risk factors

Peripheral neuropathy often accompanies diabetes: 60% of people with PN have diabetes. Some 23% of people with PN have no known cause, and the other 17% are either chemo-induced (10%), HIV/AIDs (2%) related, or due to miscellaneous causes (5%). Diabetes and PN go hand in hand because the high glucose associated with diabetes attacks nerves and stops blood from flowing through them.

Alcohol may also be a risk factor. Dr. Moon says, “Excessive alcohol use, even at a young age, can cause nerve damage that comes back later in life.” Carpal tunnel syndrome from overuse of your wrists is a form of PN. Advanced age and cancer are risk factors, too.

Pain and numbness are treated differently

Neuropathy pain may be reduced with medication or vitamins, but numbness cannot be removed except by treating the underlying cause. Dr. Moon says that no matter what the cause of the nerve damage, “pain treatment for neuropathy patients varies. It could range from antidepressants to seizure medicines, and from B-12 vitamins to folic acid and alpha lipoic acid, depending on what works best for each individual.” Caution must be exercised with prescription opioid pain medications, which can easily become addictive.

Treating numbness requires a different approach. Dr. Moon says, “Numbness is a negative symptom: the nerves are simply not working. To reverse the numbness, the underlying cause of the PN must be treated. For example, if you’ve got diabetes, you need to treat the diabetes; or, if you’ve got low levels of vitamin B-12 or thyroid issues, those need to be addressed.” Moon continues, “There are two dangers in numbness of the feet: 1) People can lose their balance and fall because they cannot feel their feet, and 2) They may have open cuts or sores that don’t hurt because they cannot feel the pain. Injuries can become bigger and even get infected without the patient knowing it.” Muscle weakness from damaged nerves connections between the brain and the muscles can also increase the risk of falls and accidents.

It’s important for people with numbness in their feet to regularly check for wounds or infection. This is a well-established part of self-care for diabetic neuropathy.

What’s the best way to find out if you have PN?

If your hands or feet are sensitive, painful, weak or numb, see your doctor. Your primary care physician will talk with you about your symptoms, perform a physical examination and may determine that you need to see a neurologist. You may need some diagnostic tests (blood tests, neurological analyses, etc.).The questions below are a partial listing from the Foundation for PN that may be helpful as you prepare for your appointment.

  • What is causing my symptoms?
  • Are there certain types of tests that can determine what I have and the cause?
  • Are the tests done in the hospital or doctor’s office and how long will they take?
  • Do the tests require any special preparation? What will the tests show?
  • Will my insurance cover these tests?
  • Is the condition temporary or permanent?
  • What treatments are available and which are best for my condition? Are there side effects? What if the medication/treatment does not work?
  • How long will it take before the medication becomes effective?
  • Are there any alternative medicines or procedures that I can do or take along with the other prescribed medications?
  • Would physical or occupational therapy help?
  • What type of exercise do you recommend?
  • Do I need to restrict any activities?

Relief is possible

Medications and lifestyle changes can be effective in treating neuropathy. Dr. Moon says, “Some courses of treatment might be best for one individual and not another. Make sure you get the proper diagnosis to make sure you are treating the problem and underlying causes and managing symptoms correctly and safely.” For many people, symptoms are eased with exercise which can increase pain tolerance, take one’s mind off the pain, and help the body’s blood vessels stay open, which is essential for nerve health. Others find relief with vitamins or prescription medications such anti-depressants or anti-seizure medicines. Dr. Moon adds, “Along with any neuropathy treatment plan goes maintaining a healthy diet, as nutrient-rich foods will help to both prevent the problem and ease the symptoms, while also helping prevent or manage type 2 diabetes.

Finally, says Dr. Moon, “Peripheral neuropathy can be difficult to diagnose because its symptoms can overlap or mimic those of other conditions. See a doctor and/or neurologist to confirm the PN diagnosis and help you manage any pain and numbness.”

Find a skilled physician near you.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.



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