Numb Toes and Aching Soles: Coping with Peripheral Neuropathy, by John A. Senneff, discusses dozens of different treatments which people are using for peripheral neuropathy, a poorly-understood condition causing loss of sensation, weakness, or pain, most often in the feet or hands. Millions of Americans have peripheral neuropathy; about half the cases are caused by diabetes. Many people with HIV also have peripheral neuropathy, either caused by the illness itself, or by some of the drugs used in its treatment. While Mr. Senneff's book is not specific to HIV, what has been learned about how to relieve neuropathy due to diabetes or other causes may be helpful for persons with HIV as well.
Some of the treatments discussed are:
- Non-opioid pain medications: Elavil (amitriptyline), Norpramin (desipramine), Pamelor (nortriptyline), Tofranil (imipramine), Mexitil (mexiletine hydrochloride), Neurontin (gabapentin), Ultram (tramadol), Dilantin (phenytoin), Klonopin (clonazepan), Tegretol (carbamazepine), Catapres (clonidine), and Lioresal (baclofen).
- Non-steroidal anti-inflammatory drugs including aspirin, acetaminophen, ibuprophen, and naproxen.
- Topical medications: capsaicin (Zostrix, Zostrix H.P., Axsain, or Capsin); EMLA (lidocaine and prilocaine), and cream preparations containing non-steroidal anti-inflammatory drugs.
- Opioid drugs: morphine, codeine, Dilaudid (hydromorphone), Demerol (meperidine), Dolophine (methadone), (Sublimaze (fentanyl), OxyContin (oxycodone), and MS Contin (morphine sulfate). The book includes a discussion of the problem of under-prescribing of narcotic pain medications because of fear of addiction, which research has found to be very unlikely when these drugs are used for relief of pain.
- Miscellaneous drugs: Ketamine (including a topical form which can be prepared by a compounding pharmacy); immune-suppressive drugs; IVIG (intravenous immune globulin).
- Other medical treatments: TENS (transcutaneous electrical nerve stimulation) gets several pages of discussion. (We believe that TENS deserves more attention because of its potentially low cost and simplicity.)
- Other treatments including acupuncture, physical therapy, relaxation and meditation training, massage and similar therapies, and magnets.
- Nutrients: including vitamins A, vitamins B1, B2, B3, B5, B6, and B12, biotin, folic acid, inositol, choline, vitamins C and E, and minerals (selenium, magnesium, chromium, zinc).
- Herbs: ginkgo biloba, St. John's wort, bioflavonoids, and other herbal products.
- Other supplements: alpha-lipoic acid, gamma linolenic acid, acetylcarnitine, n-acetylcysteine (NAC), glutamine, coenzyme Q10, SAMe (S-Adenosylmethionine), and DMSO.
There are also discussions of over a dozen experimental drugs, not listed in this review.
A chapter on Coping includes exercise, arranging for comfort during sleep, finding comfortable shoes, and miscellaneous hints on clothing and other items.
For More Information on Neuropathy
- Numb Toes and Aching Soles can be purchased in paperback for $19.95 + $4 shipping and handling ($6 outside of the U.S.), from Medpress, 1-888-633-9898 or http://www.medpress.com (Priority shipping is available for $3 extra in the U.S., Canada, and Mexico, $7 extra in most other countries.)
- The book includes several recommendations for more information, including two organizations, the Neuropathy Association (1-800-247-6968 or http://www.neuropathy.org), and the Neuropathy Trust, in the United Kingdom, http://www.neuropathy-trust.org).
- We contacted John Senneff in January 2000 to ask about new developments. He suggested an article by Rick Mendosa, who interviewed neuropathy experts and published a summary, "Drugs for Diabetic Neuropathy," at http://www.mendosa.com/neurdrug.htm.