Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forum. This week’s question is inspired by the forum topic “MS Burning Feet and Hands Could Be Erythromelalgia,” from Aug. 14, 2018.
Burning sensations in the hands and feet
You might be sitting on the couch watching TV. Or you could be sleeping. Maybe you’re working at your desk (like I am right now). Suddenly, it feels as if your feet have caught fire and your toes are alight.
Perhaps it’s your fingers that feel like they are shooting flames from their tips. No, this isn’t a sign that you have a hidden superpower — rather it suggests that as a person with multiple sclerosis (MS), you are experiencing something that is known clinically as erythromelalgia.
Erythromelalgia: The basics
Burning sensations generally belong to the broad spectrum of symptom clusters referred to as “pain syndromes.” Pain takes on a variety of sensations, especially in those with a neurological condition such as MS. It can be felt as throbbing, stabbing, cramping, itching, aching, tingling, or burning.
Erythromelalgia falls into the last category affecting the feet or hands, which is clinically described as peripheral pain. In rare cases, it may spread to upper or lower limbs, or even to the face.
The skin may look reddish and feel hot to the touch. However, the condition doesn’t occur as a result of direct exposure to heat, but rather is due to the dysfunction of the peripheral nervous system.
The peripheral connection
The peripheral nervous system comprises the nerves that serve the extremities and include motor nerves (muscle control), sensory nerves (sensations), and autonomic system nerves (involuntary processes like core body temperature and blood pressure).
Erythromelalgia is an example of peripheral neuropathy, where mixed signals from the brain — due to demyelination activity and MS lesions — can result in chronic unpleasant sensations akin to someone holding a match to your hands or feet.
This intense burning nerve pain can happen in brief episodes or linger continuously; it may be mild and gradual or acute and severe.
The vascular connection
The condition shares a critical connection with vascular health. According to the National Organization for Rare Disorders (NORD), “Erythromelalgia is thought to result from vasomotor abnormalities or dysfunction in the normal narrowing (constriction) and widening (dilation) of the diameter (caliber) of certain blood vessels, leading to abnormalities of blood flow to the extremities.”
For people with MS, a common trigger is heat intolerance, either because of the environment or due to exercise. However, about 5 percent of primary erythromelalgia cases are familial, regardless of neurological health status.
What you can do if you feel like you’re on fire
In her column “Faith of the Mustard Seed,” Debi Wilson outlines ways to address your “burning issues.” Following are Debi’s suggestions and some of my tips for relief of your erythromelalgia:
- Apply a cooling lotion. I’ve found products containing peppermint essential oil do the trick, as do those with capsaicin.
- Try topical products such as magnesium spray or cream that includes CBD — if available and legal in your area.
- Consider oral supplements of magnesium or CBD edibles.
- Place your feet or hands in a bath of cool water.
- Drink a tall glass of cold water to prevent overheating and dehydration.
- Remove socks or avoid tight-fitting shoes. Or conversely, wear compression stockings.
- Avoid drinking alcohol or eating spicy food.
Medications that might help include nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen. Some patients may find relief with prescription gabapentin or lidocaine patches to cool the affected areas. Others may respond to pregabalin.
However, no single solution is consistently effective in treating erythromelalgia. NORD suggests that this indicates the presence of subtypes of the condition. You may need to try various medications and therapies to find the treatment that works best for you.
As always, consult your doctor before deciding to take any medications or treatments.
Do burning feet or hands wake you at night? Have you conquered erythromelalgia? What has helped you to manage this unusual MS symptom? Post your replies in the comments below or at the original “MS Burning Feet and Hands Could Be Erythromelalgia” forum entry.
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