Neuropathy: Numbness only, no pain

Posted by John, Volunteer Mentor @johnbishop, Sep 10, 2020

When I was first diagnosed with idiopathic small fiber peripheral neuropathy and numbness was my only symptom, my neurologist told me that I am one of the "lucky" few who didn't also have pain and other associated symptoms of neuropathy. I knew there were others out there but yesterday I met my first member on Connect who has a similar diagnosis. I want to thank that member for joining Mayo Clinic Connect and sending me a private message that I would like to answer here to start this discussion.

Hello @afirefly, Welcome to Connect. You mentioned being diagnosed with large fiber demyelinating predominately sensory peripheral neuropathy at Mayo Clinic. The neurologist's recommendation was exercise and balance exercises. Your symptoms are less than one year and are primarily progressive loss of sensation in your hands and feet. You also said aside from occasional muscle cramps in your calves and dyesthesias in hands and feet, you experience little discomfort. Your greatest concern now is the degree of disability you will have as the numbness progresses.

I can tell you that we think a lot alike. When I walked out of the neurologists office with similar symptoms of just numbness in the feet and lower legs with no pain – and no recommendations for treatment, I was pretty down. I was told to let them know as the condition progressed and my biggest fear at the time was not being able to drive myself. That's when I started doing my own research and found Mayo Clinic Connect after being diagnosed with idiopathic small fiber PN.

You have some really good and thoughtful questions which I will try to answer the best I can.

Question: Although you have improved on the Protocol, did you ever have complete loss of sensation in your feet? I ask because I truly dread the possibility of total sensory loss in my feet.

Answer: I never had a complete loss of sensation in my feet. At the worst, they felt numb and sometimes tingly but not painful, just uncomfortable. They mostly always feel cold and after being diagnosed with lymphedema I have to wear compression socks which doesn't help the numbness feeling. I have noticed that it seems like I've had some feeling returning ever so often when I'm exercising on my crossfit exercise bike. I use it several times a day for 30 to 45 minutes when I can to build up leg and arm strength. I recently purchased a device called a Sand Dune Stepper to work on my balance issues. I do think it helps and I've noticed a little more feeling in the bottom of my feet – if that makes sense for numb feet. Website – https://www.sanddunestepper.com/
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Question: Assuming you have little or no sensation in your toes and the soles of your feet, are you still able to drive a car?
If yes, would you kindly tell me what maneuvers/measures you have used over the years to compensate for the absence of feeling in your feet while driving?

Answer: I am still able to drive a car. The numbness was always a concern in my mind but never kept me from feeling the pressure of placing my feet on the pedals and pushing them down or letting them up.
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Question: Assuming you have little or no sensation in your toes and the soles of your feet, how difficult is it for you to walk? Before my neuropathy, if my foot was in a position too long it would "go to sleep" from lack of circulation to the nerves. The sensation would return seconds later once I changed my foot position. However, I don't believe I would have been able to walk on that sleeping foot until the circulation had been restored. Please tell me if there are/were any maneuvers/measures you have used over the years to compensate for the absence of feeling in your feet while walking.

Answer: When I was in my late 40s, my wife would sometimes tell me that I walk like an old man and now I am one and still walking the same. I've always been slow getting up and slow to take the first steps when walking. I guess I would call it trying to be careful because I wasn't sure of my footing. I think recognizing that your feet may not be as steady is a good thing and keeps you alert when walking. I struggle with walking any distance due to lower back issues. I recently had some physical therapy to learn some back and stomach muscle strengthing exercises which has helped some. Now I just have to execute a plan to do them often.
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Question: You indicated that the cost of the old Protocol was under $10/day (prior to 525 Protocol) several years ago and that the current 525 Protocol is $6.44/day. Does that mean Protocol 525 these days costs somewhat less than the old (original) Protocol?

Answer: Each item in the original protocol lasted a different number of days so the cost was more spread out and roughly calculated at under $10/day. The new 525 Protocol is a 30 day supply for $6.44/day ($193.20). It's also fewer pills to swallow which I really like. The Ramp up version is different due to the R-ALA in the regular 30 day supply. The daily R-ALA dosage is 1200 mg which causes some people to have stomach problems so the ramp up is to gradually increase the dosage to get use to the higher amount. I never had an issue because I was already taking supplements for the PN from my research and was taking that amount of ALA before I found the original protocol. Related discussion — Have you tried the new Protocol 525 product for neuropathy relief?: https://connect.mayoclinic.org/discussion/have-you-tried-the-new-protocol-525-product-for-neuropathy-relief/
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Question: Do you use orthotics or inserts in your shoes? Special shoes?

Answer: I've tried some orthotics and different inserts but don't always use them. I found some felt/wool inserts that I like during the winter time as an extra cushion. I do like Sketchers because of the memory foam cushion and comfort. I used to wear the canvas shell ones but my neurologist told me it would be best to wear shoes with good side support for walking. So, I try to choose slip-ons with good side support made out of leather. There is another discussion on Connect you might find helpful for shoes – If the shoe fits…right?: https://connect.mayoclinic.org/discussion/if-the-shoe-fits-right/
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Question: Besides daily foot exams, lotion to your feet, and avoiding barefoot walking, are there any other measures you use to protect your numb feet?

Answer: For me, this all started with a trip to the ER after waking up one night to go to the bathroom and when reaching the bathroom seeing blood all over the floor and trying to figure out where it's coming from. Surprised was I to see it pumping in a small stream from my ankle. Long story short, I unconciously rubbed my feet during the night and I had a hang nail on my big toe which tore the skin and part of a vein close to the surface. After that episode, I always wear white short loose socks to bed and I apply lotion to my feet and legs to keep them moisturized. I think that also helps with the healing process when you think that there are tiny sensory nerves just under the skin and it helps to keep the skin moist to protect them.

Hope this helps…let me know if I missed anything or if you have any other questions. We have a great group of members with a lot of experience here on Connect.

John

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

@lecowing

I too have numbness with no pain. I see lots of discussion about feet and balance problems but little or none about problems with numbness in hands.. I can no longer touch type, or button my shirt without a button hook, and my handwriting is getting worse. My father and one sister eventually couldn't write, then later feed themselves. Anyone else having similar problems.

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I don't have much numbness in my hands but do have a little. I have a little bit of the shakes when using a mouse and my touch typing leaves a lot to be desired but I just keep doing what I can. Writing is another problem. I've pretty much given up cursive and handprint notes, letters and checks. I can still sign my name but it can look pretty rough sometimes 🙂 Just taking it one day at a time and practicing the senior shuffle when walking outside in the winter. I mostly wear pull over shirts with 1/4 zippers or just pull overs so that helps with buttons.

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lecowing - Yes, similar issues - I have given up wearing button down collars on shirts and although majority of numbness is south of knees to toes, I now dump pills on a towel otherwise I'm chasing capsules across the table. My handwriting is terrible, so I now print everything and even that, at times, is questionable. I also have loss of strength in hands.... bottle caps are a problem. All hand issues in past 2 - 3 years and very gradual, unfortunately, like the feet. On the numbness, I've also tried CBD cream on ankles, feet, hands with no help. I did find it helps on lower back pain. Any recommendations for numbness reduction would be great! Ed

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@lecowing

I too have numbness with no pain. I see lots of discussion about feet and balance problems but little or none about problems with numbness in hands.. I can no longer touch type, or button my shirt without a button hook, and my handwriting is getting worse. My father and one sister eventually couldn't write, then later feed themselves. Anyone else having similar problems.

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I haven’t been tested for SFN but have been told I do not have it based on my EMG saying it was a different idiopathic PN. I have numbness in hands/lower arm and feet/lower legs, but with pain and tingling if I don’t keep it in check with Gabapentin.
I went from “healthy” to crippled by PN in about 10 days. No walking, feeding, dressing, typing, writing, wiping myself etc. Almost a vegetable, and institutionalized for 7 weeks with extensive PT and OT.
The therapies were tough, but with special designed eating utensils, I was able to feed myself. With continued concentrated home then outpatient PT and OT and a lot of practice, I can now get by with my hands and feet; far from perfect, but so great compared to that dark period. I have to improvise on how to get things done, and assess the importance of what I’ll risk injuring myself for or spending excessive time on.
I avoid buttons and shoestrings. Velcro, zippers, pullovers, and slip-on shoes help. Typing (with big computer buttons vs cell phone) over writing. I avoid childproof stuff as much as I can choose and use grippers when opening jars. Ziplock over the storage bags you have to line up and press until you get it right. I haven’t found a way to use Tide Pod packages; I buy one large container and have someone open it for me then I transfer them to a ziploc I am able to use. Even their pods sold in the sealed bags are made so kids can’t open them & eat them, so it means I can’t either. Newspapers are a thing of the past for these hands, but I still prefer paper books over reading on a tablet, so I still manage that.
I drop a lot, have to make sure my utensils are positioned correctly, and watch what I’m doing. I do try to avoid having to cut with very sharp knives. I make a lot of mistakes. I no longer take a terrible amount of time to keep backspacing to correct errors, I just let a lot of them go; I have to decide best use of time sometimes. I can drive right now and am beyond-belief grateful!
So, I think physically my disease started out at that rock bottom you talk about getting to, but with hard work and great therapy, I climbed so far up from there. Nobody knows for sure what’s ahead, but I’ll continue keeping my exercises going and living life smartly to avoid injuring myself and hopefully have an edge if things start declining.

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@dbeshears1

I haven’t been tested for SFN but have been told I do not have it based on my EMG saying it was a different idiopathic PN. I have numbness in hands/lower arm and feet/lower legs, but with pain and tingling if I don’t keep it in check with Gabapentin.
I went from “healthy” to crippled by PN in about 10 days. No walking, feeding, dressing, typing, writing, wiping myself etc. Almost a vegetable, and institutionalized for 7 weeks with extensive PT and OT.
The therapies were tough, but with special designed eating utensils, I was able to feed myself. With continued concentrated home then outpatient PT and OT and a lot of practice, I can now get by with my hands and feet; far from perfect, but so great compared to that dark period. I have to improvise on how to get things done, and assess the importance of what I’ll risk injuring myself for or spending excessive time on.
I avoid buttons and shoestrings. Velcro, zippers, pullovers, and slip-on shoes help. Typing (with big computer buttons vs cell phone) over writing. I avoid childproof stuff as much as I can choose and use grippers when opening jars. Ziplock over the storage bags you have to line up and press until you get it right. I haven’t found a way to use Tide Pod packages; I buy one large container and have someone open it for me then I transfer them to a ziploc I am able to use. Even their pods sold in the sealed bags are made so kids can’t open them & eat them, so it means I can’t either. Newspapers are a thing of the past for these hands, but I still prefer paper books over reading on a tablet, so I still manage that.
I drop a lot, have to make sure my utensils are positioned correctly, and watch what I’m doing. I do try to avoid having to cut with very sharp knives. I make a lot of mistakes. I no longer take a terrible amount of time to keep backspacing to correct errors, I just let a lot of them go; I have to decide best use of time sometimes. I can drive right now and am beyond-belief grateful!
So, I think physically my disease started out at that rock bottom you talk about getting to, but with hard work and great therapy, I climbed so far up from there. Nobody knows for sure what’s ahead, but I’ll continue keeping my exercises going and living life smartly to avoid injuring myself and hopefully have an edge if things start declining.

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Sounds like your journey to where we both are now was far worse than mine. My journey has been a slow but progressive worsening over the last 15 or so years, I am now 85. I haven't driven in 5 years, afraid of hitting the gas instead of brake. So my wife does all the driving.

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@johnbishop

I don't have much numbness in my hands but do have a little. I have a little bit of the shakes when using a mouse and my touch typing leaves a lot to be desired but I just keep doing what I can. Writing is another problem. I've pretty much given up cursive and handprint notes, letters and checks. I can still sign my name but it can look pretty rough sometimes 🙂 Just taking it one day at a time and practicing the senior shuffle when walking outside in the winter. I mostly wear pull over shirts with 1/4 zippers or just pull overs so that helps with buttons.

Jump to this post

Sounds like your hand problems are a little different. My hands don't shake, my hand writing differs from day to day but I still maintain our checkbooks and writ some but if the bank checked my signatures they would think different people are writing my checks. I also wear only pullover sport shirts and tees. I just purchased a rollator so I can walk further outside. When we go to the grocery store I use their grocery carts to get around.

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@dbeshears1

I haven’t been tested for SFN but have been told I do not have it based on my EMG saying it was a different idiopathic PN. I have numbness in hands/lower arm and feet/lower legs, but with pain and tingling if I don’t keep it in check with Gabapentin.
I went from “healthy” to crippled by PN in about 10 days. No walking, feeding, dressing, typing, writing, wiping myself etc. Almost a vegetable, and institutionalized for 7 weeks with extensive PT and OT.
The therapies were tough, but with special designed eating utensils, I was able to feed myself. With continued concentrated home then outpatient PT and OT and a lot of practice, I can now get by with my hands and feet; far from perfect, but so great compared to that dark period. I have to improvise on how to get things done, and assess the importance of what I’ll risk injuring myself for or spending excessive time on.
I avoid buttons and shoestrings. Velcro, zippers, pullovers, and slip-on shoes help. Typing (with big computer buttons vs cell phone) over writing. I avoid childproof stuff as much as I can choose and use grippers when opening jars. Ziplock over the storage bags you have to line up and press until you get it right. I haven’t found a way to use Tide Pod packages; I buy one large container and have someone open it for me then I transfer them to a ziploc I am able to use. Even their pods sold in the sealed bags are made so kids can’t open them & eat them, so it means I can’t either. Newspapers are a thing of the past for these hands, but I still prefer paper books over reading on a tablet, so I still manage that.
I drop a lot, have to make sure my utensils are positioned correctly, and watch what I’m doing. I do try to avoid having to cut with very sharp knives. I make a lot of mistakes. I no longer take a terrible amount of time to keep backspacing to correct errors, I just let a lot of them go; I have to decide best use of time sometimes. I can drive right now and am beyond-belief grateful!
So, I think physically my disease started out at that rock bottom you talk about getting to, but with hard work and great therapy, I climbed so far up from there. Nobody knows for sure what’s ahead, but I’ll continue keeping my exercises going and living life smartly to avoid injuring myself and hopefully have an edge if things start declining.

Jump to this post

Deb - I am amazed on how much this peripheral neuropathy has impacted us so differently. Sounds like you were slammed up against a wall and on the other side of the coin, mine took years to develop. I'm also amazed at the stories I see on Mayo Connect on how we are all coping with this in our own way. Seems we each have to figure out what we need to do to get by and hope that tomorrow, we will be able to continue doing what we did today. Most of us over time realize there is no fix. This numbness can drive me crazy at times and with many others it is pain. You have figured things out as you go so keep climbing upward and don't give in or give up. Many of us need to do the same.

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@njed

Deb - I am amazed on how much this peripheral neuropathy has impacted us so differently. Sounds like you were slammed up against a wall and on the other side of the coin, mine took years to develop. I'm also amazed at the stories I see on Mayo Connect on how we are all coping with this in our own way. Seems we each have to figure out what we need to do to get by and hope that tomorrow, we will be able to continue doing what we did today. Most of us over time realize there is no fix. This numbness can drive me crazy at times and with many others it is pain. You have figured things out as you go so keep climbing upward and don't give in or give up. Many of us need to do the same.

Jump to this post

Actually, I climbed out of the "traumatic" onset from 6 years ago, but the progress did plateau at some point, about 50% of where I started. I know it will not improve from here (unless there's a miracle discovery) so I'm just in a fight to maintain this level. But it's a cycle of ups and downs, and I've accepted that I won't get better, but what I've learned from folks on here as given me a quality of life I otherwise wouldn't have!

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@dbeshears1

Actually, I climbed out of the "traumatic" onset from 6 years ago, but the progress did plateau at some point, about 50% of where I started. I know it will not improve from here (unless there's a miracle discovery) so I'm just in a fight to maintain this level. But it's a cycle of ups and downs, and I've accepted that I won't get better, but what I've learned from folks on here as given me a quality of life I otherwise wouldn't have!

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Could not agree more. This format has reminded me that we are not alone despite the fact that I personally know only one person who has PN. If we can understand more from each other and share experiences, what helps and what doesn't, it sure helps.

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@njed

lecowing - Yes, similar issues - I have given up wearing button down collars on shirts and although majority of numbness is south of knees to toes, I now dump pills on a towel otherwise I'm chasing capsules across the table. My handwriting is terrible, so I now print everything and even that, at times, is questionable. I also have loss of strength in hands.... bottle caps are a problem. All hand issues in past 2 - 3 years and very gradual, unfortunately, like the feet. On the numbness, I've also tried CBD cream on ankles, feet, hands with no help. I did find it helps on lower back pain. Any recommendations for numbness reduction would be great! Ed

Jump to this post

For me, I am on several medications and serious numbness—can literally squeeze my toes or poke them with a pin with no feeling. Toes to thighs and forearm to fingers are at varying degrees of numbness. I am on several meds including Lyrica and Tramadol, That still leaves me with burning legs and feet—the only relief for that is a CBD balm with some essential oils. Relief is very quick and usually works for 6-8 hours. Some companies, like Lazarus, give large discounts for ability to pay and military service.

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@dckuke

For me, I am on several medications and serious numbness—can literally squeeze my toes or poke them with a pin with no feeling. Toes to thighs and forearm to fingers are at varying degrees of numbness. I am on several meds including Lyrica and Tramadol, That still leaves me with burning legs and feet—the only relief for that is a CBD balm with some essential oils. Relief is very quick and usually works for 6-8 hours. Some companies, like Lazarus, give large discounts for ability to pay and military service.

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dckuke - OK, I have total numbness. Are you prescribed Lyrica for pain or for numbness? Just curious because if prescribed for numbness, does it help at all?

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