Nerve Pain and Numbness
Part of A Practical Guide to HIV Drug Side Effects
Figuring Out the Cause
Peripheral neuropathy can cause numbness, tingling, burning and sometimes severe pain. It most often occurs in the toes, feet and lower legs, but can also arise in the hands and arms. Normally, both sides of the body are affected. It is important to identify the cause so it can be addressed, and your doctor may want to order some tests.
If your nerve symptoms appear to be caused by a medication, it should be stopped as soon as possible. Delay could result in permanent problems. When medications causing the problem are stopped shortly after symptoms begin, pain and numbness usually subside over time. Too many people have ended up with permanent pain, numbness and burning because the symptoms of peripheral neuropathy weren't identified soon enough or they continued too long on the medication after the pain started.
The antiretroviral drugs that were once the most frequent cause of neuropathy in people with HIV -- d4T (Zerit), ddC (Hivid), and ddI (Videx EC) -- are no longer in common use in Canada. Much less commonly, neuropathy can be caused by 3TC (lamivudine, and in Combivir, Kivexa and Trizivir) and T-20 (enfuvirtide, Fuzeon). Many other drugs can also cause this condition, so if you begin to develop symptoms of peripheral neuropathy, it is important to discuss with your doctor and pharmacist the possibility that a medication is contributing to the problem.
There are other factors that can cause or contribute to peripheral neuropathy as well. These include diabetes, hypothyroidism, alcohol, cocaine or amphetamine use, vitamin B12 deficiency and HIV itself.
Anecdotal reports and clinical trials in people with diabetes and people with HIV have shown the following nutrient supplements to be useful in preventing or reversing peripheral neuropathy:
Antiretroviral drugs, particularly the older nucleoside analogues (nukes) listed above, can damage mitochondria, the power plants of cells. This is thought to contribute to neuropathy and other health problems. Fortunately, the newer nukes appear not to cause the extent of mitochondrial damage seen with the older drugs.
Because of the link between mitochondrial damage and neuropathy, some people seek to prevent or reverse mitochondrial damage by taking a combination of antioxidants, B vitamins and the amino acid acetyl-L-carnitine. One way to get this combination of nutrients is to take:
When B complex vitamins have been determined to be too low, some people have reported it helpful to supplement, especially with vitamin B6 (25 to 50 mg daily taken as part of a B complex supplement) and vitamin B12 (see the appendix for more info about this vitamin). Taking very large amounts of vitamin B6 has been linked to nerve problems. The recommended maximum daily dose is 100 mg. Vitamin B12 is generally safe, even at high doses.
Some people also take magnesium, a mineral essential for nerve function. The recommended maximum daily dose for magnesium is 350 mg daily, though doses of 500 to 600 mg per day may be needed by some people to see benefit. Doses above 350 mg of magnesium daily can cause diarrhea. Magnesium glycinate may be better tolerated than other forms.
Vitamin D may also be helpful. Multiple studies have shown that vitamin D deficiency is common in people with HIV. A study in people with diabetes showed that the pain of peripheral neuropathy was cut almost in half after three months of supplementation with vitamin D. See the appendix on vitamin D for more information.
Anything that soothes and reduces pressure on hypersensitive feet or hands can help to reduce pain caused by peripheral neuropathy. This includes:
If you are experiencing numbness or lack of sensation in your feet, it's a good idea to get in the habit of checking your feet every day when you remove your shoes and socks. Sometimes neuropathy prevents you from feeling cracks and sores on your feet. A visual inspection can help you identify any problems early to prevent them from getting worse.
Although they have mostly been studied for diabetic neuropathy, the following medications and treatments can help some people with HIV reduce the pain of peripheral neuropathy, although they won't eliminate numbness:
This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
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