DEAR DR. GOTT: Four years ago, I was told that I have both neuropathy and myopathy. I’m finding it more difficult to walk and even to lie down comfortably. Is there anything new I can take to eliminate the nerve- and muscle-damage discomfort I’m experiencing?
I take one 300 mg gabapentin at night. I’ll be 74 this year and take no other drugs.
DEAR READER: Neuropathy, as you know, is caused by damage to nerves. It can occur anywhere in the body, but it is most common in the extremities, especially the feet and legs. Unfortunately, you don’t specify what type of neuropathy you have, and there are many from which to choose.
Peripheral neuropathy is the most common form so this is the type I will assume you have. To begin with, it isn’t a single disease but a symptom with numerous possible causes. It results in communication problems between the central nervous system and the remainder of the body. It may be caused by an injury, infection, diabetes, vitamin B deficiency, hypothyroidism, liver or kidney disease, or other conditions. The feet and hands may be numb, may tingle, and there may be pain involved. A person may lack coordination, experience muscle weakness or paralysis if motor nerves are affected. Bladder or bowel difficulties might occur.
Initial treatment may be with over-the-counter pain medication, anti-seizure medications such as the gabapentin you are taking, antidepressants or a lidocaine patch.
There are a number of steps a person can take on the home front. At the top of the list — discontinue smoking if you currently do so, followed by foot and hand care. Massage the extremities gently or have someone else do it regularly in an attempt to improve circulation. Avoid the pressure of poorly fitting shoes, crossing your knees, or resting on your elbows for extended periods of time. Speak with your physician regarding the use of over-the-counter topical creams containing capsaicin rubbed onto painful areas; discuss acupuncture and biofeedback.
Myopathy is a neuromuscular disease that results in muscle weakness. It may involve muscles on both sides of the body. The three main types are polymyositis, dermatomyositis and inclusion body myositis. Polymyositis affects the skeletal muscles on both sides of the body. Dermatomyositis is characterized by a skin rash resembling red or purple patches that develop on various parts of the body. The rash may be accompanied by progressive muscle weakness. Inclusion body myositis affects proximal and distal muscles, often resulting in weakness on one side of the body only.
Symptoms of myopathy include fatigue following minimal exercise such as walking or standing, difficulty swallowing or breathing, and muscles that may be tender to simple palpation.
Diagnosis is made through an individual’s medical history, testing of muscle strength, lab testing that reveals elevated levels of muscle enzymes and auto-antibodies, MRI, and through other means.
Chronic inflammatory myopathy cannot be cured in most adults, but the symptoms can be reduced and treated through medication, exercise, acupuncture, massage, braces for support, physical therapy and a number of other methods. Most individuals with the diagnosis respond well to prescribed therapies. I recommend you speak with your physician to determine which therapy is best for you.
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