His toes were on fire.
Trying to ignore the searing pain in his right foot propped against the accelerator, Pete gritted his teeth and focused on the heavy rush hour traffic.
The tingling in his toes had begun about a year ago, and he had had no idea what was causing it and it kept worsening. Finally, he mentioned it to his coworkers, some of whom thought it might be gangrene.
Panicked, he went to the doctor who diagnosed it as "Peripheral Neuropathy", and checked his blood sugar levels.
Dr. Hammond explained that Peripheral Neuropathy was usually caused by nerve deterioration in the extremities, and began with a tingling sensation in the toes or fingers. The "wiring" in his body had become damaged, and was now transmitting sensations that weren't there.
He prescribed Neurontin?, a drug originally developed to control seizures, but had been discovered to work as a "pain manager" in the condition of Peripheral Neuropathy.
"It's not a cure," he said. "We have no idea how it works. But it'll reduce the pain and keep you functional"
Pete didn't like the words "it'll keep you functional." The phrase definitely had an ominous ring to it.
He took Neurontin? faithfully according to prescription, and for awhile it worked, but it wasn't too long before he began to see what Dr. Hammond was alluding too. The painful sensations increased, and it seemed like it was getting more difficult for the drug to handle them.
Then, one day, he forgot to take his medicine, and he vowed he would never do it again. Without the pain manager, the pain level ramped up several orders of magnitude, and Pete discovered that the full extent of his condition had been masked by the drug.
Neuropathy had taken over half of his foot.
Sledgehammers slammed against his feet. Hot blowtorches seared his toes. Hot rocks were jammed inside the soles of his feet. Once ... worst of all ... a white hot band saw tried to cut his foot half off.
Now he knew he was now entirely dependent on the Neurontin?. Without it, he couldn't endure the pain...
And he almost couldn't walk at all.
THERE'S DAMAGE OUT THERE SOMEWHERE
So what do we mean by the term "Peripheral Neuropathy"?
The nervous system of the human body is broadly divided into the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The former consists of the brain and spinal chord, whereas the latter is divided into the Somatic and Autonomic Nervous Systems.
Peripheral Neuropathy affects the PNS, and can result in nerve damage to the Somatic or Autonomic Systems. Translated, Neuropathy can develop not only in the feet or hands, but in the nerves regulating the lungs, heart, digestive and sexual organs.
In other words, it can develop anywhere and have very serious and far reaching consequences to the body. It can take the form of:
-- Polyneuropathy (Peripheral nerves throughout the body)
-- Autonomic Neuropathy (the cardiovascular system, digestive tract, bladder, or genitals)
The painful sensations of Polyneuropathy, burning, itching, "electric shock", or hammering, may develop in the feet and legs either gradually or suddenly. You may or may not get a warning before they appear.
THREE STRIKES AND YOU'RE OUT
Today, there are three classes of medication on the market that can treat the pain resulting from neuropathic nerve damage:
-- tricyclic antidepressants such as Amiriptyline (Elavil?)
-- anticonvulsants such as Gabapentine(Neurontin?) and Pregabilin (Lyrica?)
-- Serotonin and Norepenephrin reuptake inhibitors such as Duloxeten (Cymbalta?)
Blocking uptake of neurotransmitters or blocking pathways in the spinal chord prevent pain signals from reaching the brain. Sodium and Calcium channels may also be blocked to keep the brain from registering pain from "cross talking" neurons.
None of the medicines can be thought of as a "cure", and if the causes of Neuropathy are not addressed, it will continue to progress.
So, if Medical Science has thrown three balls at us and none of them are a "cure", is that it? Are we stuck with merely "managing the pain" and hoping we don't end up down the line with a foot amputation?
In Part II of this series, Pete will learn more?
Copyright 2006 John Young
