What is the best treatment option for neuropathy in the feet?

Treatment falls into two categories: symptomatic treatment for any uncomfortable tingling or burning and treatment of the underlying cause.

For symptomatic treatment there are many medications that are used. One of the most common and most effective was originally an anti-seizure medication and pain medication for the pain one has after getting the shingles. This is gabapentin and there is a close cousin to this medication called pregabalin that is also used a great deal. Other anti-seizure, anti-depressant and, on occasion, narcotic pain medications are used as well. If a patient has intolerable side effects or the oral medications are not working, neuropathy creams can also be tried. Pain patches can also be tried in those hard to treat patients.

Treating the underlying disorder is also very important. For the most common cause of neuropathy, diabetes, good glucose control is paramount. This will help the neuropathy stabilize. Other potentially reversible causes can include folate, B12 deficiencies, thyroid disorders, medication side effects (especially chemotherapeutic agents), paraneoplastic disorders and blood diseases like monoclonal gammopathies (multiple myeloma being the most worrisome). A thorough workup by a neurologist is advised if you develop numbness, tingling or burning in the feet.
First and foremost it is important to determine the cause of your neuropathy as treatment of the underlying cause often reduces the pain associated with it. If the cause of your neuropathy is unknown (despite having undergone a work up by a neurologist) or the pain persists despite treating the underlying cause, there are several options. Certain vitamins such as alpha-lipoic acid and acetyl-carnitine and medications such as gabapentin, pregabalin, amitriptyline, and duloxetine can help reduce the pain of neuropathy. It is also important to wear comfortable shoes which support your feet and posture. 

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