New guidelines help doctors diagnose elusive nerve problem called neuropathy

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New guidelines help doctors diagnose elusive nerve problem called neuropathy

Feb. 18, 2009
Chris Swingle
Democrat and Chronicle

A painful form of the nerve problem known as neuropathy left Millie Murphy unable to walk on her own and unable to tolerate shoes, socks or even a bed sheet on her right foot.

''It felt like someone was stabbing needles in my foot,'' says Murphy, 77, of Webster.

The problem worsened over the course of a year, spreading up her leg and to the other leg. She gained weight from not being able to move comfortably.

She saw her doctor, her surgeon from a just-completed right knee replacement and a neurologist. They prescribed pain pills and sleeping pills, but the sharp pains persisted.

''I could do nothing,'' she recalls. ``The more this went on, the more depressed I got.''

Finally, last fall, she searched online for information about neuropathy and found neurologist David Herrmann , director of the Peripheral Neuropathy Clinic at Strong Memorial Hospital.

He ran additional tests, prescribed Cymbalta (duloxetine) in addition to the high-dose Neurontin (gabapentin) for her neuropathy pain, and finally her pain dramatically improved.

Herrmann was part of a new national effort to help doctors diagnose neuropathy more efficiently and affordably. He and 18 other physicians developed the first evidence-based guidelines to diagnose distal symmetric polyneuropathy -- the most common type of peripheral neuropathy -- and they were published in December in the journal
Neurology.

More than 20 million Americans have this disorder, which affects the nerves that go to the limbs.

Some neuropathy cases are obvious. But other times symptoms are initially misdiagnosed, said Herrmann, an associate professor of neurology at the University of Rochester Medical Center.

A patient may report burning or painful feet, but the physician may find few abnormalities during a physical exam.

That may lead to a diagnosis of arthritis of the ankle, plantar fasciitis, nerve entrapment or a bone spur. Those conditions may also exist but may not be causing the pain, said Herrmann.

Some patients undergo surgery for a bone spur only to find that the foot pain persists.

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