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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 4931
Experience:  American Board Certified Neurologist, Internal Medicine
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Severe raw to the bone on backs of legs and arms. Cold feet.

Customer Question

Severe raw to the bone on backs of legs and arms. Cold feet. Tingling and sharp stabbing pain. Last few days then goes away but returns. Very tender to the touch no physical marks etc. Lmbeen going on for months
Submitted: 10 months ago.
Category: Neurology
Customer: replied 10 months ago.
I am taking neurontin but it doesn't help at all. I have trouble sleeping and the raw feeling is very painful. Hurts to wear clothes or take a hot bath
Expert:  Neuro Doctor replied 10 months ago.

Hi, I am an American Board Certified Neurologist and I am very glad to help you with your health concerns.

Based on your symptoms (severe raw feeling, pain, stabbing like feeling, tingling etc) it seems that you might have developed what is called as SFN (small fiber neuropathy). The pain & temperature sensations are carried from the limbs & body to the brain through small diameter nerve fibers and any damage to these small diameter nerve fibers (called as SFN or small fiber neuropathy) can produce these symptoms you are having.

I am not sure what investigations have already been done to find out the cause for your symptoms. if not already done then you need an EMG/Nerve conduction study – a nerve muscle test and this test will check for any nerve damages. If this test has already been done that does not rule out SFN because this type of neuropathy is not picked by the EMG test, the EMG test is done to look for the possibility of any large diameter fiber neuropathy. So if EMG test comes normal then further investigations are necessary. If not already done then you need a “punch skin biopsy” that can help in ruling in or out the diagnosis of SFN.

If the skin biopsy shows evidence for SFN then the following tests are needed to find out the causes for SFN; These tests include - Blood sugar, B12, TSH (thyroid test), ESR, CRP, ANA, RA factor, SS-A SS-B (sjogren’s antibodies), Serum complements, SPEP, IPEP, Urine Bence Jones protein, Lyme antibodies, RPR, HIV, Hep B, Hep C etc (the last 5 tests only if risks are present, not otherwise). If these tests do not ascertain the cause then additional specialized tests like test for Fabry disease etc are needed.

If any of the above tests are already then there is no need to repeat them. Once the diagnosis is confirmed then it will be treated appropriately and in the meantime you certainly need some symptomatic treatment to treat your severe symptoms and I see that the Neurontin is not helping you, so you may consider trying one or more of the following treatments to get relief from these torturous symptoms.

The following is the list of several treatment options to help with your symptoms;

1) Nerve-pain pills like Amitriptyline or Nortriptyline

2) Nervex neuropathy pain relief cream

3) Neuroveen (a homeopathic treatment)

4) TENS (Transcutaneous Electrical Nerve Stimulation)

5) Calmare Scrambler Pain therapy

6) Evening Primrose oil

7) Capsaicin skin cream

8) Laser therapy (Cold laser type)

9) Lidocaine anesthetic pain relieving skin patches

10) Complementary and Alternative medicine treatments like Acupuncture

11) Opioid pain killers (narcotic pain killers) like Lortab or Oxycontin etc

I am not telling all these above treatments are required in your case; I am just providing you with a list of different treatment options that are available for the control of severe neuropathic symptoms you are having. And if you see any of the treatments mentioned in the above list you have already tried please disregard them, and consider trying the other options which you have not already tried.

Along with one or more of the above treatments you may also try nutritional supplements like Metanx (a special combination of active vitamin b12, folate & vitamin b6), ALA (Alpha Lipoic Acid) & Acetyl Carnitine etc and these supplements may help in nerve repair & nerve regeneration and this can additionally help in the relief from the pain & the numbness.

Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.

Best regards,

Neuro Doctor