10 questions about nerve pain in fingers or toes

What is nerve pain?

Nerve pain (or neuropathic pain, or neuralgia) is tingling, prickling, burning pain. This is usually caused by inflammation, compression or damage to a nerve. The pain often lasts for weeks to months, and can sometimes cause severe shooting pains. The symptoms are very annoying, but not dangerous. The affected area may also feel numb. Nerve pain can have many causes. For example, an underlying metabolic disease, such as diabetes. Or an infection, such as shingles. A nerve can also become pinched, such as in a back or neck hernia or in the wrist in carpal tunnel syndrome. Unfortunately, in many cases no clear cause can be found.

Nerve pain is difficult to treat. Ordinary painkillers such as paracetamol, ibuprofen or diclofenac often do not help. However, there are other medicines that can reduce nerve pain. Unfortunately, it often takes days to weeks for those drugs to start working. It may also happen that a medicine has no effect on you and you have to try another medicine. Medicines for nerve pain often have direct side effects. You therefore start with a low dose and gradually build up, always in consultation with your doctor or doctor. If the medicines do not help enough or cause too many side effects, your doctor or doctor can look with you at other options to combat the pain.

1. I (male, 75) developed neuropathy due to neglected type 2 diabetes. For this I use amitriptyline 10 mg. I suffer from side effects: difficulty urinating and dry eyes and mouth. Are there other options?

“There are different kinds of pain. For example, pain caused by inflammation or damage to skin, muscles or bones. And pain due to nerve damage. We call the latter neuropathic or nerve pain. Because the pain process works differently here, ‘normal’ painkillers, such as paracetamol, ibuprofen and diclofenac, usually do not help with nerve pain. Fortunately, we also have other medicines that specifically work on the overstimulation of the nerves and the brain. They usually do not completely eliminate the pain, but they can reduce it. The most commonly used is amitriptyline, but there are more, such as pregabalin or duloxetine. So if you experience many side effects of amitriptyline, it is definitely worth trying a different drug or combination of drugs. Discuss this with your doctor. Incidentally, we often prefer to prescribe nortriptyline to amitriptyline in older people, because they cause fewer side effects that older people often suffer from. Such as heart problems and a dry mouth.”

2. After a hefty course of chemotherapy I have neuropathy in both my feet. As a result, I am quite unstable. Can I do something about this?

“Neuropathy due to chemotherapy is common. Certain substances in the medication are toxic to nerve cells and can damage them. The long extensions of the nerves in the feet and hands are especially sensitive to this. Fibers that help you feel whether you are standing upright, for example, can be damaged. That ‘position sense’, as we call it, is very important for your balance. If the sense of position is affected, a shaky feeling arises. In general, the more of certain types of chemotherapy (see box on next page) you receive, the higher the risk of neuropathy. When chemotherapy is stopped, the neuropathy symptoms disappear on their own in many patients over time. However, that can take a long time. Unfortunately, in some people, the neuropathy is permanent. Or it may decrease, but not disappear completely. Treatment usually consists of drugs, for example duloxetine, gabapentin, pregabalin or venlafaxine. Your doctor may prescribe one of these or a combination of them. A walker can also offer a solution for more stability. Another tip: make sure that, also in the evening and
at night, there is enough light in the house. This helps your eyes to visually correct a shaky feeling, as it were. Finally, keep moving regularly. Walking, for example, appears to have a beneficial effect on neuropathy. These recommendations also apply to neuropathy due to other causes.

By the way: if the complaints arise during chemotherapy, you should report this to your doctor. In that case, the dose of the drug can be (temporarily) reduced, the treatment (temporarily) stopped or possibly given another drug.”

3. I (female, 85) suffer from neuropathy in my feet. This is very difficult, especially with walking. My neurologist says there is nothing that can be done. Do I have to accept this?

“Nerve pain is often difficult to treat, but improvement to a greater or lesser extent is possible in many cases. See my answers to the previous questions. You may want to discuss it with another neurologist. Preferably one that specializes in pain. Your GP can refer you for such a second opinion.”

4. In connection with neuropathy, I lubricate my feet with amitriptyline cream 5% twice a day. Does a cream help as well as pills?

“When it comes to a local complaint, cream can certainly help. Incidentally, an amitriptyline cream, especially with a high dose, can also have side effects.”

5. For the past four years I have suffered from an annoying feeling in my toes. It feels unpleasant to feel a sheet against it, for example. Can anything be done about this?

“Pain when touching the skin, a certain movement or cold or heat – official name: allodynia – is one of the symptoms of neuropathy. Medications may be able to provide relief. I would definitely go to your doctor with these complaints. If they can’t help you, get a referral to a neurologist.”

6. How can you still play guitar or piano if you have nerve pain in your hands?

“That will probably be difficult. In addition to pain, neuropathy in the hands and feet often also reduces sensation. With nerve pain in the fingers you can therefore feel the strings or keys less well, which makes it more difficult to play an instrument. Whether something can be done about it depends partly on the cause. For example, if it is a pinched nerve in the forearm and wrist – the carpal tunnel syndrome – then the problem can usually be solved surgically.”

7. If you have nerve pain after shingles, do you feel it only where the shingles was, or all over your body?

Shingles is a resurgence of the chickenpox virus, which virtually everyone carries from childhood. The virus infection damages the nerves in the affected skin area, resulting in pain. In some of the patients, the pain symptoms persist for a long time, even after they have recovered. You speak in such a case of postherpetic neuralgia. The pain is limited to the place where the shingles was and does not spread further over the body.”

8. My sister-in-law had shingles and, on the advice of an elderly man, ate a pickled herring twice a day. Her nerve pain has passed. Does this really work?

“This is certainly not a proven effective treatment, so I cannot make any statements about this. Incidentally, there are many alternative treatments for pain. Consider, for example, acupuncture or yoga. I don’t mind that, as long as they’re safe. I recommend a healthy-critical attitude. In any case, always report it to your GP or specialist if you are considering an alternative treatment.”

9. My nerve pain is worst at night. Because of this, I only sleep two to four hours a night. What can I do?

“It depends on. If there is a clear cause, for example a narrowing of the spine that causes nerves to be pinched, you can have something done about it. If there is no identifiable cause, treatment with medication is the most obvious. Consult with a neurologist about the best option.”

10. My wife has had nerve pain in multiple toes for years. If the pain is severe, they will bend. Many neurologists and medicines later, the complaints have not improved. What can we do?

“Your wife may have dystonia. This is a neurological movement disorder, in which muscles in some parts of the body are overactive and contract involuntarily as a result. In that case, botulinum injections may be able to provide relief. This means that the nerve can no longer transmit a signal to the muscle, causing it to weaken. In any case, I would have the problem re-evaluated by a (different) neurologist.”

This article previously appeared in Plus Magazine March 2021. Want to subscribe to the magazine? You can do that in an instant!