role of ongoing medical testing for idiopathic peripheral neuropathy

Posted by badgerguy @badgerguy, 5 days ago

Hello,

I am in my early 60s and was diagnosed with idiopathic peripheral neuropathy (IPN) in 2020. I am fortunate that I have very little pain associated with it. It exhibits as mostly numbness, weakness, and muscle twitching. It has progressed slowly, but I have noticed its progression more lately.

I have often wondered what role ongoing medical testing and tracking should play with a diagnosis of IPN. I have only seen one neurologist since 2020 (~2023). I got the impression from the neurologist (not Mayo) that I was wasting his time by being there given that I had IPN. He didn't seem to take my questions very seriously.

So I am interested in others views/thoughts. Here are some questions to get the discussion going.

Is there their value in regular appointments with a neurologist if one has IPN? If yes, what purpose do they serve? What is an appropriate frequency? What types of ongoing testing is appropriate (EMGs, other)?

Interested in more discussions like this? Go to the Neuropathy Support Group.

Profile picture for brennankb55 @brennankb55

@njed ~ Around 2010, perhaps earlier, I started noticing the feeling that my sock was wadded up under my left big toe joint. I started getting electrical-type sensations in my toes, and burning in the ball of my foot. My primary and podiatrist both termed it "metatarsalgia" and recommended nothing other than orthotics. It kept getting worse, progressing to my right foot. In 2017, I asked for a referral to a neurologist who had an MRI done which showed a mild disc bulge and possible pinched nerve somewhere around L4. He said it could be the cause of my "neuropathy", but because I had no back pain, he said there was no treatment for it.
We moved out of state in 2020, and my new primary referred me to a neurologist who also acted like I was wasting his time. He said I needed to be on Gabapentin and that he didn't need to see me further. I tried it at a low dose for a month and said "no thanks." My primary asked me to try Lyrica, and I thought I'd hit the jackpot! It worked for about 3 years and then I needed a bigger dose. I'm currently at 75mg 3 times a day - and I'm having incredible burning, stabbing, electric shocks, and numbness. I've read a lot of posts in the neuropathy group of people taking low dose Naltrexone (between 1-5mg once a day) and having incredible results with it reducing all of those symptoms except for numbness. So I found a "compounding pharmacy" here in town and am picking up a 30-day supply later today ($55). My primary says he actually thinks this might work! It's worth a try, especially if it means I can quit taking Lyrica with all of its side effects! In my opinion, it's always good to ask questions and get second and third opinions if you have to. My brother always says, "Remember - doctors are 'practicing' medicine - they don't have all the answers." I guess that's true to a large extent. But with all of us in the "chronic pain" phase of neuropathy, it's good to have hope that there are doctors out there searching for ways to help us. I've also discovered on this 15-year journey that different things work for different people, whether it's medication, PT, exercise, topicals, and even surgeries. I wish all of us on this journey that seems to have no cure the very best. Keep searching and asking questions and sharing information. At least we can maybe help each other stay positive. God bless us all!

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@brennankb55 Thanks so much for letting us know about this. I just emailed my doctor to request a discussion and possible rx for this. On my last visit, she prescribed Lyrica, but after reviewing the side effects, I never filled that rx. It appears that those doctors versed in functional medicine are the ones most tuned in to the “solutions” that aren’t just slapping big pharma meds on symptoms. But in so many areas - mine included - there just aren’t any of those doctors, so this forum is proving to be incredibly helpful. Thank you again!

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Profile picture for megidigo @megidigo

Ive realized there is no point. My last appointment with the neurologist a few days ago was not even 15 mins. Told me not to worry about the large bump on my tendon above the foot I got from exercising which he told me to do. I dont feel pain. In fact told me he didnt need to see me again, not to worry and go live my life. Didnt get a chance to mention that its getting worse. I did get to hear him pat himself on the back like he cured me or actually did something while rushing me out of the office. Im sick of being told to stay positive and that Im on some kind of journey. Im not some kind of “insert illness” warrior. All terms that trivialize how serious this is. All I want is help that isnt there. To hell with this “journey” I see how it ends.

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@megidigo 15 minutes? You are fortunate. My last neurologist appointment lasted all of six minutes. As soon as I mentioned "neuropathy", he couldn't get rid of me fast enough.

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Profile picture for heisenberg34 @heisenberg34

@megidigo 15 minutes? You are fortunate. My last neurologist appointment lasted all of six minutes. As soon as I mentioned "neuropathy", he couldn't get rid of me fast enough.

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@heisenberg34
He did tell me I may improve in 2 to 3 years but I have documentation where he put on paper that I will deterioriate. But to your point Ive noticed that doors close with other doctors Im sent to once I mention neuropathy. So ive decided no more doctors appointments unless Im sent to the hospital or just dealing with my primary as I need medication refills.

Ive been told it isnt a death sentence but due to circumstances for me it actually is. I just wander if someone out there will listen (not online but in real life) but not looking that way. Sorry I do realize my posts turn into vents but its all I got.

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Profile picture for brennankb55 @brennankb55

@njed ~ Around 2010, perhaps earlier, I started noticing the feeling that my sock was wadded up under my left big toe joint. I started getting electrical-type sensations in my toes, and burning in the ball of my foot. My primary and podiatrist both termed it "metatarsalgia" and recommended nothing other than orthotics. It kept getting worse, progressing to my right foot. In 2017, I asked for a referral to a neurologist who had an MRI done which showed a mild disc bulge and possible pinched nerve somewhere around L4. He said it could be the cause of my "neuropathy", but because I had no back pain, he said there was no treatment for it.
We moved out of state in 2020, and my new primary referred me to a neurologist who also acted like I was wasting his time. He said I needed to be on Gabapentin and that he didn't need to see me further. I tried it at a low dose for a month and said "no thanks." My primary asked me to try Lyrica, and I thought I'd hit the jackpot! It worked for about 3 years and then I needed a bigger dose. I'm currently at 75mg 3 times a day - and I'm having incredible burning, stabbing, electric shocks, and numbness. I've read a lot of posts in the neuropathy group of people taking low dose Naltrexone (between 1-5mg once a day) and having incredible results with it reducing all of those symptoms except for numbness. So I found a "compounding pharmacy" here in town and am picking up a 30-day supply later today ($55). My primary says he actually thinks this might work! It's worth a try, especially if it means I can quit taking Lyrica with all of its side effects! In my opinion, it's always good to ask questions and get second and third opinions if you have to. My brother always says, "Remember - doctors are 'practicing' medicine - they don't have all the answers." I guess that's true to a large extent. But with all of us in the "chronic pain" phase of neuropathy, it's good to have hope that there are doctors out there searching for ways to help us. I've also discovered on this 15-year journey that different things work for different people, whether it's medication, PT, exercise, topicals, and even surgeries. I wish all of us on this journey that seems to have no cure the very best. Keep searching and asking questions and sharing information. At least we can maybe help each other stay positive. God bless us all!

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I can relate. My feet burn, and socks feel like I am being suffocated. For years Iattributed it to stuffing my big wide feet into affordable shoes (Size 13 4E). In 2015 an MRI revealed severe spinal stenosis in my Lumbar. dealt with the pain, but eventually had a laminectomy (L2-4) which helped a bit, but my foot pain was getting worse. Then had a stroke, and saw a neurologist. He was concerned that my pain and footdrop was not confined to just my left foot, but was polyneuropathy. So he ordered many tests, which revealed I have MGUS, which is an abnormal monoclonal antibody that is assocated with many conditions that exhibit polyneuropathy as a symptom. Thanks to this doctor's diligence and knowlege, I am being monitored for this slowly growing condition. My footdrop has severely limited my activity, and I have undergone another back surgery. I am a formerly very active 70 year old man, who is still finding pleasure each day, (sometimes with effort). Modesty helps- A cane, and recently a walker to get more than a block from home, as well as raised beds in my garden and being careful not to overdo it help, along with loving family and friends. I am grateful for the excellent medical care I recieve ( I am living in British Columbia, Canada) and open minded, well educated doctors like my neurologist. We all will face more and more pain or frustration as we age, so make sure we have something to rejoice in each day. Gratitude- to good doctors, especially to nurses, and others who share their journeys in dealing with deteriorating health. Peace and joy to you all.

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Profile picture for megidigo @megidigo

@heisenberg34
He did tell me I may improve in 2 to 3 years but I have documentation where he put on paper that I will deterioriate. But to your point Ive noticed that doors close with other doctors Im sent to once I mention neuropathy. So ive decided no more doctors appointments unless Im sent to the hospital or just dealing with my primary as I need medication refills.

Ive been told it isnt a death sentence but due to circumstances for me it actually is. I just wander if someone out there will listen (not online but in real life) but not looking that way. Sorry I do realize my posts turn into vents but its all I got.

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@megidigo I hear you loud and clear. Sometimes I think that the only way to get real care is to go to the ER and tell them that I am in severe pain and nothing helps. That way I should be able to get a team looking into my situation not just one, uninterested doc.

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Profile picture for megidigo @megidigo

Ive realized there is no point. My last appointment with the neurologist a few days ago was not even 15 mins. Told me not to worry about the large bump on my tendon above the foot I got from exercising which he told me to do. I dont feel pain. In fact told me he didnt need to see me again, not to worry and go live my life. Didnt get a chance to mention that its getting worse. I did get to hear him pat himself on the back like he cured me or actually did something while rushing me out of the office. Im sick of being told to stay positive and that Im on some kind of journey. Im not some kind of “insert illness” warrior. All terms that trivialize how serious this is. All I want is help that isnt there. To hell with this “journey” I see how it ends.

Jump to this post

@megidigo I know exactly how you feel, I basically had the same experience with my last neurologist. After all of the testing came back as "normal", I was down to only seeing him once a year. This lasted a couple of years before he admitted that there wasn't anything more that he could do for me. Believe it or not my regular doctor did more to help me than he ever did. He's the one who prescribed gabapentin for the pain, along with recommending that I take ALA, alpha lipoic acid.
And as far as I'm concerned this is a death sentence, it's never going to improve, let alone just go away. I've been living with chronic pain from osteoarthritis and neuropathy in my feet for over a decade, and I'm going to spend the rest of my life like this.

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Profile picture for megidigo @megidigo

@heisenberg34
He did tell me I may improve in 2 to 3 years but I have documentation where he put on paper that I will deterioriate. But to your point Ive noticed that doors close with other doctors Im sent to once I mention neuropathy. So ive decided no more doctors appointments unless Im sent to the hospital or just dealing with my primary as I need medication refills.

Ive been told it isnt a death sentence but due to circumstances for me it actually is. I just wander if someone out there will listen (not online but in real life) but not looking that way. Sorry I do realize my posts turn into vents but its all I got.

Jump to this post

@megidigo ~ No apology needed. We all need to vent rather than keep our frustration bottled up. I've had my idiopathic neuropathy going on 15 years. It's been a "trial and error" process to find what helps and mostly what doesn't. Different things help different people, so one really has to do their own sleuthing, but so many share what they have discovered. Gabapentin didn't help me at all, but it helps a great majority. Lyrica has helped for the past 3-4 years and others can't tolerate it. There are various topical creams and gels and even essential oils that are helpful. Some swear by CBD. I've spent so much on useless gimmicks and "cure" promises. So for myself, I trust in the God who sent His Son Jesus to die in my place, and that believing in Him, I can have eternal life - regardless of what this life becomes. But I find great hope, peace and encouragement in that, and I pray it for all who are likewise afflicted here. It's definitely a journey. I'm praying God will direct you to someone who will actually listen to you.

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Profile picture for brennankb55 @brennankb55

@njed ~ Around 2010, perhaps earlier, I started noticing the feeling that my sock was wadded up under my left big toe joint. I started getting electrical-type sensations in my toes, and burning in the ball of my foot. My primary and podiatrist both termed it "metatarsalgia" and recommended nothing other than orthotics. It kept getting worse, progressing to my right foot. In 2017, I asked for a referral to a neurologist who had an MRI done which showed a mild disc bulge and possible pinched nerve somewhere around L4. He said it could be the cause of my "neuropathy", but because I had no back pain, he said there was no treatment for it.
We moved out of state in 2020, and my new primary referred me to a neurologist who also acted like I was wasting his time. He said I needed to be on Gabapentin and that he didn't need to see me further. I tried it at a low dose for a month and said "no thanks." My primary asked me to try Lyrica, and I thought I'd hit the jackpot! It worked for about 3 years and then I needed a bigger dose. I'm currently at 75mg 3 times a day - and I'm having incredible burning, stabbing, electric shocks, and numbness. I've read a lot of posts in the neuropathy group of people taking low dose Naltrexone (between 1-5mg once a day) and having incredible results with it reducing all of those symptoms except for numbness. So I found a "compounding pharmacy" here in town and am picking up a 30-day supply later today ($55). My primary says he actually thinks this might work! It's worth a try, especially if it means I can quit taking Lyrica with all of its side effects! In my opinion, it's always good to ask questions and get second and third opinions if you have to. My brother always says, "Remember - doctors are 'practicing' medicine - they don't have all the answers." I guess that's true to a large extent. But with all of us in the "chronic pain" phase of neuropathy, it's good to have hope that there are doctors out there searching for ways to help us. I've also discovered on this 15-year journey that different things work for different people, whether it's medication, PT, exercise, topicals, and even surgeries. I wish all of us on this journey that seems to have no cure the very best. Keep searching and asking questions and sharing information. At least we can maybe help each other stay positive. God bless us all!

Jump to this post

@brennankb55

Please let us know how the LDN works for you. Who prescribed it for you? I was on gabapentin (1800) and it was causing tremors so I weaned off. Recently, I asked about LDN when I had my neuromuscular neurology appointment; he would not prescribe because he only prescribes what is currently recommended and evidence based?! He prescribed Lyrica instead. I have been diagnosed with Small fiber neuropathy that came on very rapidly in 2024.

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