Brief Answer:
Neuropathy in the feet

Detailed Answer:
Neuropathy in the feet is a challenging problem to confront. If you were my patient in an office setting I would start our visit by asking to simply describe what you feel in your feet and then, ask you to verify that those symptoms are strictly localized to your feet or could they possibly involve the ankles, the lower legs, up to the calves, or even to some extent up to the knees. I would want to verify that you were not an alcohol user of any frequency since severely burning feet is a common complaint in people who use alcohol to excess. Why that burning pain doesn't really rise beyond the feet in alcohol using patients is a mystery. But if the symptoms in fact, were beyond the neighborhood of your feet then, I would be asking you about other things such as any tests for diabetes, thyroid problems, and even your levels of testosterone which have been shown to play a role in neuropathic sensations in the legs.

Of course, the elephant in the room would probably be the 3 spinal surgeries and the obvious association that most doctors would draw is that the feet and the spinal surgeries are related. And that very well may be true. Therefore, based on that as a possibility I would perform a meticulous neurological motor and sensory exam and see if sensory losses or weakness in the legs or feet correspond at all to any levels that were surgerized in the back. I would also counsel you NOT TO GET ANY MORE back surgeries under threat of your making things worse. There is something that we call ARACHNOIDITIS that we believe happens to people who undergo multiple surgical procedures of the back. And the upshot to that problem is that pain in the back and/or legs can simply increase and be more refractory to standard treatment due to what we believe is a SCARRING PROCESS which occurs as a result of surgery and we believe this scarring entraps and compresses rootlets of nerves which then, leads to pain and loss of sensation and even motor function in some cases. The only real solution to arachnoiditis if you have that as your primary problem is to NOT make it any worse.

Then, there could be side effects from the oxycodone tablets you're taking for pain. You are taking what we considered by many to be a rather large dose of topiate drug which I can tell you will result in tolerance and the need for you to escalate the dose in order to maintain the same degree of pain control. It is unfortunately, a never ending proposition and to boot when the effects of the medication begin wearing off which can be in a matter of several hours SEVERE BURNING sensations and other symptoms of neuropathy can occur. Sometimes it's in the feet, sometimes the entire lower limb, sometimes the neck.....and so I very much would implicate the amount of oxycodone you are taking as a very possible contributor or even causative factor to your symptoms by way of the mechanism of withdrawal symptoms.

The only solution to this mechanism of your foot pain would be to get off the oxycodone but I would recommend you seek out a specialist who knows how to wean patients from opiate drugs. It is not as simple as you may think but it can be done and with much less symptomatology than you might think if done correctly. I know because I am the Assoc. Director at a Detoxification Center and we see this particular patients in our opiate patients who are between doses of their oxy's or whatever they are taking.

I would also recommend that you get an EMG/NCV study done just to rule out the possibility of an upper motor nerve or spinal cord compression/entrapment phenomenon. If it truly is neuropathy of a metabolic or other nature then, the electrical study will not show much but if it's due to compression within the spinal canal then, the study could potentially show that.

I would also do the metabolic studies that I always get in patients with foot symptoms such as B12, FOLATE, and VITAMIN D. Please note that modern lab values for B12 in order to consider it in good order is >400 and preferably closer to 450. Vitamin D levels are best above 40 and preferably 60-80. I would also be sure about thyroid function by running TSH, FT4, TT4, and FT3, TT3

Therefore, in summary- the solution to your problem is to FIRST discover BY PROOF as much as possible the cause of the symptoms generating the pain. Make sure that it's not due to things such as excessive alcohol use, medication effect or withdrawal, or metabolic derangement.

You've been on a number of medications so the way I would handle those is to start from scratch and return to taking medications 1 at a time but titrated up to maximally tolerated doses. I would be extremely careful and even avoid using opiate drugs since there is practically no end game to that class of medication which will continuously have to raised until the physician will simply refuse. At that point, withdrawal side effects will be at least as severe as the originally symptoms you are trying to treat if not worse.

A novel approach to treating neuropathic pain is the use of BOTOX injections but there is also a limit to the daily dose for safety reasons so you need someone experienced in using it for this sort of problem. Other medications that may be of value aside from things I've read you've already had suggested would Topiramate, Mexiletine (careful for cardiac arrhythmic potential), Tegretol, Depakote, and Cymbalta.

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This query has utilized a total of 57 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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