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Suggest Treatment For Peripheral Neuropathy And Burning Sensation While Walking
Posted on
Fri, 10 Apr 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 10 Apr 2015
Answered on
Thu, 30 Apr 2015
Last reviewed on
Question : Hi,
About 2 weeks ago I woke up and my feet were burning a little after walking around. This continued on and off for the next few days. I went to my doctor who said that it might be peripheral neuropathy caused by my heart medication, Propafenone so I cut my dose in half.
I went to an acupuncturist and for the rest of that day there was no pain or burning at all but it came back with a vengeance the next day.
Then I went skiing for the weekend and the symptoms disappeared almost completely for 3 days. When I saw my doctor the next day it was so much better that I told him to not worry about running any more tests. Later that evening it came back and has been terrible for the last 3 days.
The pain is mostly burning on my feet but occasionally ankles as well. I've had some shooting pains too and sometimes they feel cold. Symptoms do come and go and are mostly gone at night. I wake up feeling 100% ok and it gets worse as the day goes on but can get better sometimes too.
Any idea what this might be? My doctor tested vit b levels , AMA, and diabetes. I have a history of anxiety and I'm wondering if this could be anxiety linked, especially how it comes and goes. Any ideas?
About 2 weeks ago I woke up and my feet were burning a little after walking around. This continued on and off for the next few days. I went to my doctor who said that it might be peripheral neuropathy caused by my heart medication, Propafenone so I cut my dose in half.
I went to an acupuncturist and for the rest of that day there was no pain or burning at all but it came back with a vengeance the next day.
Then I went skiing for the weekend and the symptoms disappeared almost completely for 3 days. When I saw my doctor the next day it was so much better that I told him to not worry about running any more tests. Later that evening it came back and has been terrible for the last 3 days.
The pain is mostly burning on my feet but occasionally ankles as well. I've had some shooting pains too and sometimes they feel cold. Symptoms do come and go and are mostly gone at night. I wake up feeling 100% ok and it gets worse as the day goes on but can get better sometimes too.
Any idea what this might be? My doctor tested vit b levels , AMA, and diabetes. I have a history of anxiety and I'm wondering if this could be anxiety linked, especially how it comes and goes. Any ideas?
Brief Answer:
Peripheral neuropathy seems likely.
Detailed Answer:
I read your question carefully and I understand your concern.
Anxiety can have many different manifestations, some more common, some rare ones. This type of manifestation is not among the common presentations so before considering anxiety as a cause, all other possibilities should be excluded.
That description of your symptoms does look typical for peripheral neuropathy. That diagnosis often is accompanied by other signs such as loss of reflexes or muscle involvement so a neurological exam is necessary to check for those or other possible signs which might have not been noticed.
Apart from clinical exam testing is necessary as well, called nerve conduction studies/electromyography which should give some evidence of nerve impairment. So I believe such a test is necessary.
If the diagnosis is confirmed the cause must be sought. It can have many causes and at times even after extensive testing it can't be found in 25% of cases. Diabetes and Vit B12 deficit seems to have been excluded. Propafenone is a possible cause but not a common one, so before leaving the whole blame with it some other routine tests are advised such as blood count, erythrocyte sedimentation rate, c-reactive protein, electrolytes (esp Ca and Mg), liver and kidney function studies, thyroid function studies, rheumatoid factor, antinuclear antibodies, HIV.
In the meantime to control the symptoms if really bothersome treatment with drugs for neuropathic pain like antidepressants (amitriptyline) or anticonvulsants (gabapentin, pregabalin) can be used - though if bearable I would wait at least for the nerve conduction studies.
I remain at your disposal for further questions.
Peripheral neuropathy seems likely.
Detailed Answer:
I read your question carefully and I understand your concern.
Anxiety can have many different manifestations, some more common, some rare ones. This type of manifestation is not among the common presentations so before considering anxiety as a cause, all other possibilities should be excluded.
That description of your symptoms does look typical for peripheral neuropathy. That diagnosis often is accompanied by other signs such as loss of reflexes or muscle involvement so a neurological exam is necessary to check for those or other possible signs which might have not been noticed.
Apart from clinical exam testing is necessary as well, called nerve conduction studies/electromyography which should give some evidence of nerve impairment. So I believe such a test is necessary.
If the diagnosis is confirmed the cause must be sought. It can have many causes and at times even after extensive testing it can't be found in 25% of cases. Diabetes and Vit B12 deficit seems to have been excluded. Propafenone is a possible cause but not a common one, so before leaving the whole blame with it some other routine tests are advised such as blood count, erythrocyte sedimentation rate, c-reactive protein, electrolytes (esp Ca and Mg), liver and kidney function studies, thyroid function studies, rheumatoid factor, antinuclear antibodies, HIV.
In the meantime to control the symptoms if really bothersome treatment with drugs for neuropathic pain like antidepressants (amitriptyline) or anticonvulsants (gabapentin, pregabalin) can be used - though if bearable I would wait at least for the nerve conduction studies.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your advice i an following up with my doctor tomorrow
cbc, liver, kidney, thyroid, ana tests were done and came back normal
Quick follow up questions
1) is it normal for the symptoms to disappear at night and be present during the day? Also to disappear sometimes during the day or for entire days at a time? This is why i wonder about anxiety. I have a history of somatasizing my pain. If nothibg else, in sure its making things wors
2) is a sudden onset normal or common?
3) if no cause can be found, does it ever just go away? It did last weekend for 3.5 dayse
cbc, liver, kidney, thyroid, ana tests were done and came back normal
Quick follow up questions
1) is it normal for the symptoms to disappear at night and be present during the day? Also to disappear sometimes during the day or for entire days at a time? This is why i wonder about anxiety. I have a history of somatasizing my pain. If nothibg else, in sure its making things wors
2) is a sudden onset normal or common?
3) if no cause can be found, does it ever just go away? It did last weekend for 3.5 dayse
Brief Answer:
Read below.
Detailed Answer:
Your wondering about the fluctuations is correct, they are not that typical as symptoms are usually more pronounced at night and do not fluctuate as much as you describe, that is why I suggested to wait for nerve conduction studies confirmation before starting therapy because it being normal and lack of neurological signs might orientate towards other diagnoses like fibromyalgia.
That also applies to the onset which typically is more gradual.
In the cases where no cause is found usually it is permanent but mild, however you shouldn't run too far ahead as you have to confirm you have neuropathy first, I mentioned it only to illustrate that at times it can be difficult to identify right away the cause.
I hope to have been of help.
Read below.
Detailed Answer:
Your wondering about the fluctuations is correct, they are not that typical as symptoms are usually more pronounced at night and do not fluctuate as much as you describe, that is why I suggested to wait for nerve conduction studies confirmation before starting therapy because it being normal and lack of neurological signs might orientate towards other diagnoses like fibromyalgia.
That also applies to the onset which typically is more gradual.
In the cases where no cause is found usually it is permanent but mild, however you shouldn't run too far ahead as you have to confirm you have neuropathy first, I mentioned it only to illustrate that at times it can be difficult to identify right away the cause.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry, one further question. So, if it is neuropathy, are the nerve tests definitive? I.e. If it comes back negative, does that mean its something else or can it still be PN?
Brief Answer:
Read below
Detailed Answer:
Most tests in medicine don't have a 100% sensitivity, meaning there are cases where they fail to detect the disease even in its presence. Nerve conduction studies are no different unfortunately, there are cases where a neuropathy might be missed particularly in the case of neuropathy involving small nerve fibers.
However judging by the intensity of your symptoms, with the shooting pains you describe it shouldn't be a case of small fiber involvement, so the sensitivity would be higher. Of course us doctors when we evaluate a patient as a whole not only tests. So in your case with the unusual fluctuations you describe, if in the physical exam there are no objective signs of neuropathy like loss of normal reflexes, sensory changes or muscle wasting, then combined with a normal nerve conduction study would exclude polyneuropathy and would prompt other considerations.
Feel free to ask other questions if you need to.
Read below
Detailed Answer:
Most tests in medicine don't have a 100% sensitivity, meaning there are cases where they fail to detect the disease even in its presence. Nerve conduction studies are no different unfortunately, there are cases where a neuropathy might be missed particularly in the case of neuropathy involving small nerve fibers.
However judging by the intensity of your symptoms, with the shooting pains you describe it shouldn't be a case of small fiber involvement, so the sensitivity would be higher. Of course us doctors when we evaluate a patient as a whole not only tests. So in your case with the unusual fluctuations you describe, if in the physical exam there are no objective signs of neuropathy like loss of normal reflexes, sensory changes or muscle wasting, then combined with a normal nerve conduction study would exclude polyneuropathy and would prompt other considerations.
Feel free to ask other questions if you need to.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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