Neuropathic Pain

Abstract

Mrs. Showalter is a 60-year-old woman with well-controlled diabetes, which was diagnosed at age 45. She complains of cold, numb feet, noting pain primarily when water hits her feet after stepping into the shower or when the bedclothes brush against the feet after going to bed. She says that her feet often feel “dead” or “wooden” during the day. A physical examination reveals that she is wearing thick woolen socks, which she reports is necessary to keep her feet warm. Both feet appear normal, with good coloring, temperature, and pulses. Despite her complaints of “ numbness,” she is able to identify light touch throughout both feet. When approached with an open safety pin for pinprick testing, Mrs. Showalter reacts with dramatic withdrawal, complaining that the pin produces an intolerable, searing “fire” whenever it touches her feet. Her doctor orders Doppler studies and nerve conduction tests, both of which show relatively normal results. Because of the normal testing and lack of confirmatory examination evidence to support the claims of either coldness or numbness, Mrs. Showalter is advised to limit activities that may stress the foot and aggravate her pain. No other therapy is prescribed.