Peripheral neuropathy is a common issue affecting about 20 million people in the United States. This condition often presents itself as burning, tingling, numbness, weakness, and balance problems.
In this article, we will discuss the top seven at-home methods for peripheral neuropathy pain relief in feet. But first, it’s crucial to consult your healthcare professional to determine the underlying cause and potential treatments.
Causes of Peripheral Neuropathy
Peripheral neuropathy has a multifactorial etiology, complicating its management. Common causative factors include diabetes mellitus, aging-related degenerative processes, vitamin deficiencies (notably B vitamins), chemotherapy-induced neurotoxicity, alcohol abuse, smoking, and certain medications, including some that paradoxically treat neuropathy. Discernment is crucial when selecting treatments, as many products claiming to mitigate nerve pain are ineffective for peripheral neuropathy.
Understanding Nerve Pain
Peripheral neuropathy typically manifests in the distal extremities due to their distance from the central nervous system. Nerve pain presents in various forms, including numbness, paresthesia (burning or tingling), and hyperalgesia (intense pain).
Differentiating neuropathic pain from other types of pain, such as musculoskeletal or circulatory pain, is essential for appropriate treatment.
1. Ankle Stretching
Nerves often travel in close proximity to other anatomical structures, such as tendons and muscles. Inflammation or swelling of these structures can compress nerves, exacerbating neuropathic pain. Stretching and muscle mobilization techniques help reduce tension in muscles and tendons, subsequently relieving nerve compression.
Examples of beneficial stretches include the gastrocnemius and soleus stretches, which target the calf muscles, and the towel stretch, focusing on the plantar fascia and intrinsic foot muscles. Regular stretching can improve flexibility and range of motion, further contributing to pain reduction.
Stretching the ankle can help alleviate tightness and improve flexibility in the ankle joint. You can use a stretch-out strap, towel, belt, or even a dog leash to assist with the stretch. To perform this stretch, sit on the floor with your leg extended and loop the strap around the ball of your foot. Gently pull the strap towards you, flexing your ankle and stretching the calf muscle. Hold the stretch for about 30 seconds, then release and repeat 2-3 times per day. This can help reduce tightness in the calf muscle and decrease the chance of tripping due to limited dorsiflexion (toe lifting) while walking.
2. Range of Motion Exercises
Frequent range of motion exercises throughout the day can help maintain ankle flexibility and promote circulation. Perform ankle pumps by moving your toes and calves up and down, followed by heel taps and circular movements in both directions. These exercises can be done both seated and standing but ensure you have proper balance and support if performing them while standing.
Maintaining and improving ankle range of motion can be helpful for those with peripheral neuropathy. Perform ankle pumps by pointing and flexing your toes, heel taps by lifting and lowering your heels, and ankle circles in both clockwise and counterclockwise directions. These exercises can be performed while sitting or standing, and can be done multiple times throughout the day. This will help promote circulation and maintain joint mobility.
3. Far Infrared Heating
Far infrared heating, such as the Thermo-Tex Platinum model, can penetrate up to 60 millimeters (2.36 inches) deep, much deeper than traditional heat sources. This device can provide soothing warmth to help alleviate neuropathy pain. For optimal use, consider investing in a specialized slipper designed to house the heating pad.
4. Walking
Despite the pain, it’s essential to keep walking to improve circulation and release endorphins, which can help relieve pain. Using assistive devices like canes or walkers can alleviate stress on the feet and provide added support.
Walking can help improve circulation and release endorphins, which can help with pain relief. Start with gentle walks and gradually increase the duration and intensity as tolerated. Using a cane or a walker may help provide additional support and stability, reducing the risk of falls.
Foot biomechanics play a crucial role in nerve function and pain perception.
Overpronation, a common foot abnormality, can cause nerve stretching and irritation due to excessive foot flattening during weight-bearing activities. Insoles and custom orthotics can provide essential support and alignment to the foot, alleviating pressure on the nerves and reducing neuropathic pain. Custom orthotics are tailored to an individual’s unique foot structure and biomechanics, ensuring optimal support and pain relief. In addition, over-the-counter insoles can offer a more affordable and accessible option for those with less severe foot abnormalities.
5. Sleep Management
Ensuring adequate sleep is crucial for managing peripheral neuropathy symptoms. Limit caffeine intake, keep the bedroom cool, and avoid electronic devices before bedtime to promote better sleep[1]Herrero Babiloni A, De Koninck BP, Beetz G, De Beaumont L, Martel MO, Lavigne GJ. Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. Journal … Continue reading.
Using the far infrared heat therapy device before bed can also help relax and warm up the feet, potentially making it easier to fall asleep.
| Importance of Sleep for Neuropathic Pain | |
|---|---|
| Sleep Quality | Sleep quality is an important factor in reducing neuropathic pain. Poor sleep quality can lead to increased pain intensity, reduced pain tolerance, and increased pain-related disability. Poor sleep quality is also associated with higher levels of fatigue, depression, and anxiety. |
| Cognitive Function | Adequate sleep is associated with improved cognitive function in people with neuropathic pain. Cognitive function refers to the ability to think, remember, and make decisions. Poor sleep is associated with deficits in cognitive function, including impaired attention and memory. |
| Pain Tolerance | Adequate sleep is associated with increased pain tolerance in people with neuropathic pain. Pain tolerance is the ability to withstand pain without experiencing discomfort. Poor sleep is associated with decreased pain tolerance, which can lead to increased pain intensity and increased pain-related disability. |
| Neuroplasticity | Adequate sleep is thought to promote neuroplasticity in people with neuropathic pain. Neuroplasticity is the brain’s ability to change in response to experience or injury. Poor sleep can limit neuroplasticity and impede the brain’s ability to adapt to pain. |
| Mood | Adequate sleep is associated with improved mood in people with neuropathic pain. Poor sleep is associated with increased levels of fatigue, depression, and anxiety. Improved sleep quality can lead to improved mood and overall quality of life. |
6. Topical Pain Relievers
Topical analgesics containing menthol or capsaicin can help alleviate neuropathic pain by providing an alternative stimulus, modulating the pain signals transmitted to the brain.
Menthol activates the TRPM8 receptor, producing a cooling sensation, while capsaicin stimulates the TRPV1 receptor, generating a warming effect. Both compounds disrupt the pain signal transmission, resulting in temporary relief[2]O’Neill J, Brock C, Olesen AE, Andresen T, Nilsson M, Dickenson AH. Unravelling the mystery of capsaicin: a tool to understand and treat pain. Pharmacological reviews. 2012 Oct 1;64(4):939-71..
Furthermore, topical cannabidiol (CBD) preparations have demonstrated potential in calming the nerves and mitigating neuropathic pain, possibly due to their anti-inflammatory and analgesic properties.
| Mechanism of Action | Technical Details |
|---|---|
| Capsaicin binds to a receptor called TRPV1 in the peripheral nervous system, activating it. | Capsaicin is a vanilloid compound, and TRPV1 is a member of the transient receptor potential (TRP) family of ion channels. It is activated by heat, protons, and a variety of other chemical compounds, including capsaicin. |
| TRPV1 activation leads to neurogenic inflammation. | Neurogenic inflammation is an immune response initiated by the release of neuropeptides (such as substance P) from peripheral sensory nerve fibers. This causes the release of inflammatory mediators such as histamine, serotonin, and bradykinin, which can lead to pain and inflammation. |
| The inflammation leads to an influx of calcium ions into the nerve cells, which causes them to depolarize. | Calcium influx into the nerve cells is mediated by TRPV1 activation, which leads to an influx of calcium ions into the nerve cells. This depolarizes the cells, leading to the release of neurotransmitters such as glutamate and GABA, which can reduce pain signals. |
| Capsaicin also reduces the release of substance P from nerve cells. | Capsaicin binds to and activates TRPV1 receptors in nerve cells, which leads to the release of anandamide, an endocannabinoid. Anandamide binds to cannabinoid receptors in the nerve cells, which inhibits the release of substance P, reducing pain signals. |
7. TENS Units
Transcutaneous electrical nerve stimulation (TENS) is a non-invasive method that uses electrical stimulation to provide pain relief by blocking pain pathways[3]Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Review of Neurotherapeutics. 2011 May 1;11(5):735-53..
A TENS unit has electrodes that are placed on the skin around the painful area, and it sends electrical impulses to the nerves. Although it may not cover the entire affected area, it can be worth trying for some individuals, as TENS units are now more affordable and accessible than they used to be.
| Mechanism | Technical Details |
|---|---|
| Neuromodulation | Neuromodulation is a method of modulating nerve activity through the use of electrical stimulation, chemical agents, or other interventions. TENS is a type of neuromodulation that uses low-voltage electrical current to stimulate nerve fibers in the skin, interrupting pain signals sent to the brain[4]Cruccu G, Aziz TZ, Garcia‐Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. EFNS guidelines on neurostimulation therapy for neuropathic pain. European journal of neurology. 2007 … Continue reading. |
| Endorphin Release | Endorphins are hormones that are naturally released in the body in response to pain and other stressful stimuli. TENS has been shown to increase the release of endorphins, which can reduce pain perception and improve overall wellbeing. |
| Gate Control Theory | The Gate Control Theory suggests that nerve fibers in the spinal cord act as a “gate” that can be opened or closed to regulate the flow of pain signals from the peripheral nerves to the brain. TENS is thought to stimulate certain nerve fibers that can close this gate, reducing the perception of pain. |
Importance of Blood Sugar Control
For individuals with diabetes, maintaining optimal glycemic control is crucial in managing neuropathic pain. Chronically elevated blood glucose levels can result in microvascular complications, including diabetic neuropathy.
Achieving glycemic control requires a multifaceted approach, including the use of medication or insulin, adherence to a balanced diet, regular physical activity, and frequent blood glucose monitoring. Proper diabetes management can slow the progression of neuropathy and minimize its associated symptoms.
Possible Medications
In severe cases where neuropathic pain is debilitating, a topical lidocaine cream or patch can help provide temporary relief by deadening the nerves through sodium channel blockade, reducing the transmission of pain signals to the brain.
Systemic medications, such as pregabalin (Lyrica) and gabapentin, can also alleviate nerve pain by modulating calcium channel activity and inhibiting the release of excitatory neurotransmitters.
However, these medications may produce significant side effects, including dizziness, somnolence, and peripheral edema. Patients should carefully weigh the potential benefits and risks before initiating such treatments.
Consultation with a specialist
In some cases, peripheral neuropathy may result from a physical impingement of the nerve, necessitating specialist intervention. A neurologist can evaluate nerve conduction velocities and assess the integrity of the nerves in the lower extremities.
Depending on the underlying cause, physical therapy may be recommended to address the impingement, employing techniques such as nerve gliding exercises, joint mobilization, and soft tissue manipulation. In refractory cases or when conservative management fails, surgical intervention may be necessary to decompress the affected nerves and restore function.
Conclusion
Keeping your feet healthy is vital in managing peripheral neuropathy. Moisturize the skin with a good cream, use soothing oils, support your feet with proper footwear, stretch regularly, and engage in exercise.
By following these at-home treatments, you can significantly reduce the pain associated with peripheral neuropathy. If you suspect that peripheral neuropathy is contributing to your pain, consult a specialist to explore further treatment options.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Herrero Babiloni A, De Koninck BP, Beetz G, De Beaumont L, Martel MO, Lavigne GJ. Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. Journal of neural transmission. 2020 Apr;127:647-60. |
|---|---|
| ↑2 | O’Neill J, Brock C, Olesen AE, Andresen T, Nilsson M, Dickenson AH. Unravelling the mystery of capsaicin: a tool to understand and treat pain. Pharmacological reviews. 2012 Oct 1;64(4):939-71. |
| ↑3 | Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Review of Neurotherapeutics. 2011 May 1;11(5):735-53. |
| ↑4 | Cruccu G, Aziz TZ, Garcia‐Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. EFNS guidelines on neurostimulation therapy for neuropathic pain. European journal of neurology. 2007 Sep;14(9):952-70. |