Q: My mother-in-law’s hands and feet have been red, burning and itching for quite some time. She has recently seen a neurologist who prescribed Lyrica. She has none of the conditions listed in the description for the use of this drug and it has not helped. She says she is losing tissue on the pads of her palms. This didn’t start until about the last year or so. Any suggestions?
A: Lyrica is an anti-convulsant medication that works by slowing impulses in the brain that cause seizures. It is also used to treat fibromyalgia and pain caused by nerve damage in individuals who suffer from diabetic neuropathy, post herpetic neuralgia, neuropathic pain associated with a spinal cord injury, and for other purposes a physician deems appropriate.
By way of explanation, fibromyalgia presents with widespread pain, fatigue, sleep problems, memory and mood issues. There may be a constant, dull pain arising from the muscles. Tender points on the body include the knees, hips, elbows, shoulders, neck, chest, shoulder blades and the back of the head. This pattern isn’t similar to your mother-in-law’s pain.
Post herpetic neuralgia is a complication of shingles that affects the nerve fibers and skin, with a burning pain. Other symptoms include numbness and itching, muscle weakness, and a sensitivity to touch. Were this her diagnosis, you would be aware of her having shingles that would not present on both palms.
Neuropathic pain a/k/a nerve pain, is typically indicative of nerve damage of the peripheral nervous system. While the feet are commonly affected, the upper extremities can also be involved. Pain, burning, and tingling may be present. This could be her problem.
Diabetic neuropathy is a form of nerve damage that occurs in diabetics since high blood sugar levels can injure nerve fibers in the extremities, cause problems with the digestive and urinary tracts, blood vessels and heart. Peripheral neuropathy, the most common form of diabetic neuropathy presents with numbness, tingling or burning of the extremities – commonly the feet and toes, pain with ambulation, pain that may increase in intensity at night, and more. This strongly resembles her pain pattern but you don’t mention diabetes.
It would be my guess that your mother-in-law’s physician likely prescribed Lyrica because of damage to her peripheral nervous system. Peripheral neuropathy can result from infection, metabolic issues, exposure to toxins, and more. The nerves of the peripheral nervous system send signals from the brain and spinal cord throughout the body. Generally speaking, signs and symptoms include burning pain, numbness of the feet or hands, sensitivity to touch, light headedness, digestive issues, and more. The symptoms that present will depend on which nerve or nerves are affected.
Causes for the condition include such autoimmune disorders as lupus, rheumatoid arthritis, and Sjogrens; alcoholism because of the vitamin deficiencies that can result; chemotherapy medications; bacterial infections such as varicella zoster (shingles), Lyme disease, hepatitis C, Epstein-Barr virus, and others; diabetes; vitamin deficiencies – primarily B and E; kidney or liver disease; hypothyroidism; and others. Because there are so many conditions that must be ruled out, it may not be easy for a physician to quickly pinpoint the underlying cause.
Diagnosis may entail providing a full medical history, undergoing a full medical examination, and a neurological check. Blood testing can confirm or rule out vitamin deficiencies, sugar levels, thyroid abnormalities, and kidney function. CT or MRI imaging will help determine if a tumor or other abnormality is present. If any question remains, nerve function, biopsy or lumbar puncture may be ordered.
Treatment may begin with over-the-counter pain relievers, followed by opiods only if absolutely necessary due to their addictive potential, prednisone, anti-seizure drugs, antidepressants, and several other choices. TENS (transcutaneous electrical nerve stimulation, plasma exchange or even surgery might follow. On the home front, she should exercise as much as possible, discontinue smoking if appropriate, avoid alcohol, and massage her hands and feet to improve circulation. She might consider acupuncture, tai chi, water aerobics, or biofeedback. Lastly, if the Lyrica isn’t helping, she should advise her physician who may choose to make a medication change or refer her to a pain medicine specialist.
