pain with spikes similar to electric shocks – time.news

2023-10-30 09:07:07

by Chiara Daina

It is a peripheral neuropathy which consists of damage to small peripheral nerve fibers and can be linked to various conditions such as diabetes (but not only)

The burning sensation in the feet, accompanied by constant pain with peaks similar to electric shocks or pinpricks, when not brief or occasional, can be the symptom of a

peripheral neuropathy called burning feet syndrome. It consists of damage to the small peripheral nerve fibres, which are distinguished from the large ones by their diameter and their function of transporting sensitivity to temperature and pain to the brain – explains Giuseppe Lauria Pinter, professor of Neurology at the University of Milan and scientific director of the neurological IRCCS Carlo Besta of Milan —. The disorder therefore does not concern the malfunction of the motor nerves, but of the sensory ones, even if people who suffer from it may experience a sense of heaviness and constriction in the legs and discomfort when walking barefoot. The pain, persistent during the day, intensifies at night, disturbing sleep, and generally causes a reduction in quality of life.

Symptoms: tingling and pain on contact with hot water

Other frequent symptoms, usually limited to the feet, are: sensation of internal heat or cold even if the skin is normal to the touch, tingling, pain on contact with predominantly hot water. The small fibers are also responsible for the functioning of the sweat glands and the state of vasoconstriction and vasodilation of the blood vessels – specifies the expert -. Therefore, you may experience reduced sweating, lower blood pressure when standing up from sitting or lying down, intense redness of the skin of the feet, intestinal and erection problems. The causes are multiple. In about half of the cases it is a consequence of other pathologies, first of all diabetes – underlines Lauria Pinter -. In more than 50% of diabetics the function of these small fibers is impaired due to excess glucose in the blood. a very common complication of poorly controlled diabetes.

Triggering factors

Burning feet syndrome can also be triggered by: Hypothyroidism, deficiency of B vitamins, alcoholism, amyloidosis, various autoimmune diseases, such as sarcoidosis, rheumatoid arthritis and connective tissue diseases, including Sjgren’s syndrome, Lupus and scleroderma. – lists the professor -. Many chemotherapy drugs can severely affect sensory nerves, as can the use of some antibiotics and antifungals. More rarely, the HIV or hepatitis C virus. In the other half of cases the cause is idiopathic, i.e. not known. But in approximately 10% of these forms unknown to Irccs Carlo Besta we have contributed to discovering genetic anomalies – continues the expert -. Specifically, these are mutations in sodium channel genes, proteins responsible for conduction of electrical impulses through nerves. This discovery allowed us to identify a new category of pathologies underlying small fiber neuropathy and to experiment with new drugs aimed at modulating sodium channels, with a view to personalized medicine against neuropathic pain.

Who to contact

The person with burning feet should contact their general practitioner to assess the need for a specialist visit with a neurologist. Based on the suspected diagnosis, a visit to the rheumatologist or angiologist may alternatively be indicated. Among the autoimmune diseases of which small fiber neuropathy can be the indicator, there are, in fact, those of rheumatological origin: In addition to rheumatoid arthritis, Lupus and scleroderma, also fibromyalgia and some types of vasculitis, an inflammation of the wall of blood vessels associated with rare diseases, for example eosinophilic granulomatosis with polyangiitis clarifies Andrea Doria, professor of Rheumatology at the University of Padua.

The diagnosis

The diagnosis of neuropathy of the small sensory fibers which causes the sensation of intense burning in the feet (which if not treated adequately can extend to the legs and hands) is made through specific tests. First of all, an electroneurography is performed to exclude that the damage involves large-caliber nerve fibers – explains Giuseppe Lauria Pinter -. This instrument, in fact, is unable to measure the functioning of the small fibres, which could be altered even though they are not abnormal on the test. The decisive test is the skin biopsy, which consists of taking three millimeters of skin just above the ankle to accurately analyze the density of the nerve fibers in the epidermis, a diagnostic technique which, about twenty years ago, was the first introduced once in Europe at the Ircss Carlo Besta and which made it possible to define the diagnosis of small fiber neuropathy in many patients.

The therapies

Once the diagnosis has been confirmed, the cause must be sought and the best treatment must be identified. To relieve burning pain in the feet, a pharmacological therapy based on analgesics is prescribed and at the same time the secondary pathology associated with peripheral neuropathy is treated with targeted treatments, explains Lauria Pinter. Specifying that small fiber neuropathy can be resolved even when the underlying disease is not cured.

October 30, 2023 (modified October 30, 2023 | 08:06)

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