Typically, a healthy nerve will only send a signal when it is stimulated, e.g., a nerve in the hand that senses temperature will stay quiet until the hand gets near the flame on the stove. However, an injured nerve is like a broken telephone that rings when no one is calling (burning) and is unable to get a dial tone when you need to make a call (numbness). Even when it has nothing of importance to say to the brain, the nerves will send a message and a confused message at that. The "confused" message can be interpreted by the brain as pain or strange sensations like "pins and needles." Over time, the spinal cord can become accustomed to getting bombarded by a nerve that never seems to turn off and makes adjustments to account for it. So, even once the nerve manages to stop firing, the spinal cord has become so used to sending that signal that it will take over and keep doing it on its own. Dr. Corey W. Hunter1, Pain Management Specialist, New York Pain Management Group
Dr. Hunter was referring to Peripheral Neuropathy. Neuropathic pain occurs when nerves or nerve function become too impaired to send the correct message from your brain (think old-time switchboard operator) to your spinal cord (the switchboard) and out to your muscles, skin, and limbs.
Hello Switchboard? I've Been Disconnected
Peripheral Neuropathy first announced its early arrival in Gary with sporadic episodes of slight numbness and tingling in both feet. The tingling eventually became a burning sensation from his arch spreading across the top of his foot. Nighttime was the worst. His pain would make sleeping impossible.
Besides the burning, some members of the Facebook support group have also described this tingling in their feet or hands and a sensation of freezing coldness that never warms. The pain can be constant or occasional, but some pain level is always present in one or both feet. So when you combine neuropathy with balance impairment, walking becomes a minefield.
Symptoms
There are three types of peripheral nerves, so individual symptoms will depend on which of your nerves are affected. A person may experience symptoms in just one area or all three, but the most common are:
Peripheral Neuropathy Sciatica
Peripheral neuropathy sciatica is classified as a pseudo-sciatica that mimics traditional sciatic nerve pain traveling down the lower back into both legs and down to the feet. This pain may be intermittent in the beginning but is known to progress to a chronic state. Pain treatment will be the same course as peripheral neuropathy. While true sciatica occurs from problems arising from the compression of the nerve root source of the sciatic nerve, peripheral neuropathy pseudo-sciatica stems from the smaller nerves which branch out throughout the body into the lower extremities. These nerves control the motor and sensory needs. Early published superficial siderosis case reports often referenced Bilateral sciatica as a symptom but Peripheral neuropathy sciatica is a more accurate description.
Managing The Pain
Over-the-counter pain meds such as Naproxen (Aleve), Acetaminophen (Tylenol), or Ibuprofen (Advil) were useful over the years, but our neurologist was worried by the amount Gary was taking. Using massive amounts of NSAIDs is not good for your liver health. Everyone is different regarding pain thresholds, so it often takes a trial and error period before finding the right treatment combination. Your physician will need to fully assess your pain to arrive at a good care plan.
Early Care Plan
In 2015, Gary was managing his muscle and joint pain by walking in water for resistance and daily massage with arnica, a natural anti-inflammatory oil. He found it helped with everything but the foot pain. Pregabalin (Lyrica) was the first prescription medication his neurologist tried for the constant burning in his feet, but it did not help his pain. He also experienced an adverse side effect that was so strange pregabalin is now listed as Not to be administered in his medical record.
Next, his neurologist agreed to try Traditional Chinese Medicine (TCM) for his foot pain. We chose a herbal neuropathy formulation made with Corydalis yanhusuo root, which contains dehydrocorybulbine (DHCB). Dehydrocorybulbine is an alkaloid found in the rhizome of Corydalis yanhusuo. A 2014 study reported DHCB is an effective analgesic in inflammatory and neuropathic pain models without tolerance build-up.
" In a plant used for centuries for its analgesic properties, we identify a compound, dehydrocorybulbine (DHCB), that is effective at alleviating thermally induced acute pain. We synthesize DHCB and show that it displays moderate dopamine receptor antagonist activities. By using selective pharmacological compounds and dopamine receptor knockout (KO) mice, we show that DHCB antinociceptive effect is primarily due to its interaction with D2 receptors, at least at low doses. We further show that DHCB is effective against inflammatory pain and injury-induced neuropathic pain and furthermore causes no antinociceptive tolerance " (Zhang et al. 2014)
Six Years Into The Care Plan
I wrote the original version of this article in 2015. After six years of use, the TCM herbal blend ultimately offered the best relief, but If Gary doesn't use his herbal supplement, his feet are now completely numb on the bottoms with a sensation of needles stabbing him. He has cycled off using it twice now. Once when his pacemaker was implanted and again before his neurosurgery to repair his active bleed in March 2021, both times, the pain in his feet returned within weeks as the effect of the herbal blend wore off. His last neurosurgery follow-up is scheduled for the week after next (late September 2021), so he will begin his neuropathy herbal supplement again if there are no problems. This time will be a challenge. Gary's neuropathy in his feet has reached a new level of pain and discomfort.
His Arnica Oil helps manage his body and muscle pain but has never helped with the foot pain. Unfortunately, it needs to be applied often, so we have been applying it at night to help him sleep. I am wondering if adding a morning arnica massage would also help his pain level during the day. His current neurologist has updated his pain management plan by adding Gabapentin three times daily and a Diclofenac topical gel for pain and inflammation caused by his Trigger Finger condition in his hands (thank genetics and not superficial siderosis for this condition). In addition, he is restricted to 3000 mg of acetaminophen daily and is not allowed to take naproxen or ibuprofen.
Managing chronic pain requires a customized care plan designed to meet your individual needs. If your doctor is unsure how to help, you might consider asking for a referral to a pain management clinic.
You may download a copy of the full study here 2
1 Dr. Corey W. Hunter is a pain management specialist at the New York Pain Management Group. A member of the Neuropathy Association's Neuropathic Pain Management Medical Advisory Council.
2 Zhang Y, Wang C, Wang L, Parks GS, Zhang X, Guo Z, Ke Y, Li KW, Kim MK, Vo B, Borrelli E, Ge G, Yang L, Wang Z, Garcia-Fuster MJ, Luo ZD, Liang X, Civelli O. A novel analgesic isolated from a traditional Chinese medicine. Curr Biol. 2014 Jan 20;24(2):117-123. doi: 10.1016/j.cub.2013.11.039. Epub 2014 Jan 2. PMID: 24388848; PMCID: PMC3912990.