Hands and Feet Burning

Hands and Feet Burning
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  • Geoff arrives to Mindara Hospital quite distressed and upset!
  • HELP ME I AM IN SO MUCH PAIN!!
  • My hands and feet are tingling, burning and going NUMB!
  • Hello Geoff, I am Ralph your nurse today, What pain relief have you taken?
  • Panadol, Neurofen NOTHING WORKS! I have never felt this type of pain before!
  • MY LEGS ARE ON FIRE !
  • Geoff remains very upset, Dr Gibbens assesses Geoff's pain and explains what Neuropathic pain is.
  • Hi Geoff, my name is Dr Gibbens I just want to ask you a few questions about both your current pain and your medical history
  • Neuropathic pain is caused by injury to the peripheral or central nervous system. Neuropathic pain can have multiple mechanisms and clinically present as both other neurological conditions and nociceptive pain. It often is therefore, difficult to diagnose and is commonly refractory to treatment.
  • Nociceptive Pain V Neuropathic Pain
  • Geoff these are the differences between the pain you are used to experiencing normally to the pain you are feeling now.
  • THANKYOU I hope this works!
  • Geoff now understands what is happening but his pain has not settled and he is becoming increasingly frustrated and agitated.
  • Geoff here is some Endone to help relieve your pain
  • Pharmacological Treatment Pharmacological treatment of Neuropathic pain is based on the patients presenting symptoms. Geoff's primary symptoms include bilateral burning, numbness, and tingling in his hands and feet. These symptoms are commonly treated with: GABA antagonists such as Gabapentin Tricyclic Antidepressants including Amitriptyline Serotonin Reuptake inhibitors like Fluoxetine  Opioids such as Endone are commonly used however only during the acute stages of neuropathic pain and are not suitable long-term.
  • Day 7 of Admission Geoff has been commenced on Gabapentin and Amitriptyline
  • Thanks, Doctor Gibbens my pain is so much better! Will I be able to go back to my normal life?
  • Yes, Geoff. Just make sure you look after yourself and manage your pain well.
  •   Neuropathic pain is complicated in its mechanisms and consequently treatment. Therefore, it is not uncommon for treatment methods to have a gradual and minimal effect depending on the patient. Therefore, Geoff upon discharge from the hospital needs to be proactive in his management and self-assessment. His life will be impacted socially, mentally and socioeconomically. The prevalence of depression is high amongst neuropathic pain sufferers. Providing Geoff with appropriate education regarding neuropathic pain is important. He also needs to know the resources he can access if he feels like he is not coping at home.  
  • Reference Cohen, SP & Mao J, 2014, ‘Neuropathic pain:mechanisms and their clinical implications’, British Medical Journal, vol. 348, pp. 1-12, doi:https://doi.org/10.1136/bmj.f7656.  
  • Bye, THANKYOU so MUCH!
  • Ward P1
  • No Problem Geoff, Look after yourself!
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