Causes of HIV Related Pain

It may seem that the blog is being flooded with pain articles at the moment but as anybody with both HIV and neuropathy will know, putting your finger on the cause of your pain (or pains) is anything but straightforward. Today's excellent article from thewellproject.org (see link below) addresses the HIV-patient directly and explains that it's not that simple putting the correct neuropathic, or arthritic, or stomach-related or muscular, or whatever label on your pain. With a bit of luck, after reading this, you will be able to locate the source and reason for your pain before you take it to the doctor and have to explain the whole story again. It's also possible that you have more than one source of pain and it's important to know what causes what. Forewarned is forearmed and if you have a good idea of where the problem is and what's causing it, you'll help your doctor considerably to decide the appropriate tests and treatment. However, having read this, or an article like this, never go ahead and self-medicate! Drugs can very easily negatively interact with each other and it is very important that you talk everything over with your doctor before beginning any form of treatment. This may seem like a lecture but you know it makes sense!

HIV Related Pain
Updated November 2010

Pain is common in people living with HIV (HIV+ people). One study of HIV+ people found that more than 50 percent had pain. Pain can occur at all stages of HIV disease and can affect many parts of the body. Usually pain occurs more often and becomes more severe as HIV disease progresses. But each individual is different. Some people may experience a lot of pain, while others have little or none.

What Causes Pain?
HIV related pain can have many causes:

- A symptom of HIV itself
- A symptom of other illnesses or infections
- A side effect of HIV drugs

Regardless of the reason, pain should be evaluated and treated to help HIV+ people have a good quality of life.

Common Types of Pain
The first step in managing HIV related pain is identifying the type, and if possible, the cause of pain. Some common types of pain include the following:

Peripheral Neuropathy – Pain due to nerve damage, mostly in the feet and hands. It may be described as numbness, tingling, or burning. Nerve damage can be caused by HIV drugs or other medical conditions such as diabetes. The older HIV drugs that caused the most peripheral neuropathy are not commonly used today

Abdominal Pain – There are many possible causes of abdominal pain:
A side effect of some HIV drugs (for example cramps)
Infections caused by bacteria or parasites
Problems of the intestinal tract such as irritable bowels
Inflammation of the pancreas (pancreatitis) caused by some HIV drugs or by drinking alcohol.
Bladder or urinary tract infections (especially in women)
Menstrual cramps or conditions of the uterus, cervix, or ovaries

Headache – Head pain can be mild to severe, and may be described as pressure, throbbing, or a dull ache. The most common causes of mild headaches include muscle tension, flu-like illness, and HIV drug side effects. Moderate or severe headaches can be caused by sinus pressure, tooth infections, brain infections, brain tumors, bleeding in the brain, migraines, or strokes. Sometimes the cause cannot be determined.

Joint, Muscle and Bone Pain – This pain can also be mild to severe. It may be related to conditions such as arthritis, bone disease, injury, or just aging. It can also be a side effect of some HIV drugs and medications for other conditions like hepatitis or high cholesterol.

Herpes Pain – Herpes is a family of viruses common in HIV+ people. Herpes viruses stay in the body for life, going into hiding and flaring up later. The varicella-zoster herpes virus first causes chickenpox and later can cause shingles, a painful rash along nerve pathways. Herpes simplex virus types 1 and 2 cause painful blisters around the mouth (“cold sores”) or genital area. Even after a herpes sore heals, a person may still have persistent pain.

Other Types
- Painful skin rashes due to infections or HIV drug side effects
- Chest pain caused by lung infections such as TB, bacterial pneumonia or PCP pneumonia (Pneumocystis pneumonia)
- Mouth pain caused by ulcers (“canker sores”) or fungal infections like thrush
- Fibromyalgia or related chronic pain conditions
- Pain due to cancer anywhere in the body

Assessing Pain
Once the type of pain is identified, the next step is to evaluate its characteristics. The goals of pain assessment are to:

Define the severity of pain (how much it hurts): Your health care provider may ask you to assign a number to your pain, from one (very mild pain) to ten (the worst possible pain). Pictures can also describe pain. A smiling face represents little or no pain, while a crying face represents severe pain.
Describe details of your pain: Your health care provider may ask you to describe how your pain feels, for example sharp, dull, throbbing, or burning. Is it new (acute) or have you had it for a while (chronic)? Where is it located? Is it constant or does it come and go?

You may be having pain but do not want to complain. Talking about pain to your health care provider is not the same thing as complaining! Telling your health care provider exactly how you feel is the best thing you can do to find out what is wrong and get the right treatment.

Pain Management
Once the type and characteristics of pain are identified, you and your health care provider will decide how to manage or treat it. The following factors will play a role in selecting the right type of treatment for you:

- Cause, type, and severity of pain
- Whether it is short-term or long-term
- History of substance abuse
- If your pain is being caused by a medication you are taking or another illness, your health care provider will want to take care of that first. If you are still experiencing pain, there are many options for pain relief.

Non-medicinal Therapies
Pain relief without medications such as:

- Massage
- Relaxation techniques
- Physical therapy
- Acupuncture
- Heat and cold therapy
- Hypnosis
- Mental imagery or visualization

While these may be enough to relieve pain, they are often used along with pain medications.

Non-opioid Medications
Pain relief medicines that do not contain narcotics (opiates). They are available over-the-counter or by prescription. These medicines relieve mild to moderate pain related to inflammation or swelling. Some people with a history of drug addiction prefer non-opioid pain medicines such as:

- Tylenol (acetaminophen)
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (for example Advil)
- COX-2 inhibitor, a type of NSAID that is less likely to cause stomach problems, for example Celebrex (celecoxib)
- Steroids, natural or manufactured hormones that reduce inflammation. Examples include prednisone and hydrocortisone

Non-opioid pain medicines can cause side effects including liver damage (Tylenol), easy bleeding (aspirin), stomach pain or damage (aspirin and other NSAIDs), and heart problems (COX-2 inhibitors).

Opioids/Narcotics
Narcotics and related drugs known as opioids are the strongest pain relievers, available only by prescription. They are used to treat moderate to severe pain.

Opioids are classified by how fast and how long they work.

Immediate release opioids – act rapidly but pain relief lasts for a shorter period of time
Sustained-released opioids – take longer to start working but pain relief lasts longer

Opioids are also classified by their strength.

Mild to moderate pain relievers (they are often mixed with non-opioid medicines to improve their action):
- Hydrocodone
- Vicodin (hydrocodone plus acetaminophen)
- Codeine
- Tylenol with codeine (acetaminophen plus codeine)
- Ultram (tramadol)
- Severe pain relievers:
- Morphine
- Fentanyl
-OxyContin (oxycodone)
- Methadone or Buprenorphine (not commonly prescribed in first-line pain reliever treatment)
Opioids can cause side effects including drowsiness, nausea, and constipation. Overdoses can slow down breathing and cause death. Opiates can lead to dependence or addiction and may be a problem for people with a history of substance use.

Topical or Local Therapies
These are medications that are injected or applied to the skin around a painful area. Examples include the local anesthetic Xylocaine (lidocaine) and capsaicin, which comes from chili peppers.

Other Therapies
There are medicines prescribed for other purposes that also have pain-relieving properties.

Anti-depressants – relieve neuropathic pain such as peripheral neuropathy. An example is Cymbalta (dulozetine).
Anti-convulsants – usually used to treat seizures, some of these drugs work for peripheral neuropathy. An example is Neurontin (gabapentin).

Determine if the Pain Treatment Works
Once you start medication or other pain treatment, your health care provider should assess your pain regularly to see if treatment is working. Sometimes pain medications can stop working over time.

What to Do if You Have Pain?
When you experience pain, it is important to know how to get fast, safe relief.

Do not ignore your pain – Pain is the body’s way of telling us something is wrong. Ignoring pain often makes matters worse and can cause more damage in the long run.
Assess your pain – When pain occurs ask yourself the following questions:
- How long have I had the pain?
- Did it happen suddenly or over time?
- Is the pain sharp or dull?
- What makes the pain worse?
- Does anything ease the pain?
- Is the pain limited to one place or does it spread out to other areas?
- Are there other symptoms (for example numbness, cough or fever)?
Notify your health care provider – Report pain to your provider without delay. Describing your pain will help find the cause and how best to treat it.
Take your pain medicine as directed – If you need pain medications, make sure you take them exactly as prescribed. Pain medications work best if they are taken at the first sign of pain. Breaking the cycle of pain means taking medications before your pain is at its worst.
Be responsible – Pain medications are very effective when taken as prescribed. Taking them incorrectly can be dangerous. Opioids are addictive, meaning you can develop physical and emotional dependence on a drug. High doses can cause breathing problems. In the worst cases, incorrect use of opioids can be fatal.
Tell your health care provider if treatment does not work – If your pain medicine is not relieving your pain, talk to your providers. You may be taking a medication that will not work for you, or you may have built a tolerance to the drugs over time. You may need to change doses or switch to a new medication.
Pain is common among HIV+ people. But it can be managed using a variety of methods. Talk to your health care provider if you are having pain. He or she can work with you to find the cause, manage the pain, and improve your quality of life.

http://www.thewellproject.org/en_US/Living_Well/Health/HIV_Pain_Mgmt.jsp

What happens if Neuropathy causes Erectile Disfunction

This subject has been covered once already on the blog but the fact is, that under the physical and mental stresses of having both HIV and neuropathy, the likelihood that men will be affected by ED is so much greater than normal. All the more reason to find out what exactly happens in that process and why it can go wrong. This article from the Official Foundation of the American Urological Association (see link below) gives an extensive description of how and why, although it doesn't talk at length about neuropathy, it is mentioned as a recognised cause. Given that we know that ED can be a problem, especially for sufferers of autonomic neuropathy, this article will provide lots of useful information.

Non-Surgical Management of Erectile Dysfunction (ED)

Erectile dysfunction (ED) is a medical term that describes the inability to achieve and or maintain an erect penis adequate for sexual function. This condition is one of the most common sexual problems for men and increases with age. It is estimated between 15 to 30 million American men suffer from ED, although not all men are equally distressed by the problem.

Most men have difficulty with erections from time to time, yet in some men, it is a regular and more severe problem. It can cause low self-esteem, performance anxiety, depression and stress. ED may affect the quality of a marriage or intimate relationships. However, there are many safe and effective ED treatments available.

What happens under normal conditions?

Achieving a normal erection is a complex process involving psychological impulses from the brain, adequate levels of the male sex hormone testosterone, a functioning nervous system, and adequate and healthy vascular tissue in the penis.

The simplest way to describe the process of erection is to think of a washing machine. The "on-off" switch (the brain) initiates the process; the wires in the washing machine (the nerves) carry the electrical signal to the pipes (the blood vessels); when an appropriate signal arrives a valve opens to allow water to flow in (the arteries carry blood into the penis); and the drain shuts (the penile veins close). Water flows in and fills the tank (the penis fills with blood and becomes erect) and the wash cycle begins (enjoys sexual activity). At the end of the wash cycle this process reverses; the switch goes to the off position (the brain terminates erection); the valve closes (the arteries markedly decrease blood inflow); and the drain opens draining the wash tank of water (the veins open, blood leaves the penis and erection subsides).

How do erections occur?

When a man is not sexually aroused, his penis is soft, limp or flaccid. During sexual arousal, nerve messages release chemicals that increase blood flow into the penis. The blood flows into two erection chambers made of spongy tissue (the corpus cavernosum) in the penis. The “smooth muscle” in the erection chambers relaxes, which allows blood to enter and remain in the chambers. The pressure of the blood in the chambers makes the penis firm, producing an erection. After a man has an orgasm, the blood flows out of the chambers and the erection subsides.

What are the risk factors for ED?

The most common risk factors for ED are:

• Age over 50

• Diabetes

• High blood pressure

• High cholesterol

• Smoking

• Cardiovascular disease


These conditions over a period, can lead to a degeneration of the penile blood vessels, leading to restriction of blood flow through the arteries and to erectile tissue damage, which allows leakage of blood through the veins during erection.

Abnormally low levels of circulating testosterone may cause ED, although low testosterone is found in a minority of men who develop ED. Low levels of sexual desire, lack of energy, mood disturbances, loss of muscle strength and depression can all be symptoms of low testosterone. A simple blood test can determine if the testosterone level is abnormally low. Low levels of testosterone can be replaced by using a number of different delivery systems (e.g., shots, skin patches, gels, sub-dermal implants).

The choices made in life can lead to degeneration of the erectile tissue and the development of ED. Smoking, drug or alcohol abuse, particularly over periods of time, will compromise the blood vessels of the penis. Lack of exercise and a sedentary lifestyle also contribute to the development of ED. Modifying these risk factors may contribute to overall health and in some individuals correct mild ED.

Patients undergoing surgery or radiation therapy for cancer of the prostate, bladder, colon or rectum are at high risk for the development of ED. Drugs used to treat these risk factors listed above may also lead to or worsen ED.

Another cause of ED is peripheral neuropathy in which the nerves leading to the penis fail to send coordinated signals to the penis. Peripheral neuropathy can be caused by diabetes, HIV infection, certain medications and other less common conditions.

What causes ED?

ED can result from medical, physical or psychological factors. ED may be caused by a combination of factors that could also include medicine, alcohol or drugs. The physical and medical causes of ED include three basic problems:

• Not enough blood flows into the penis. Many conditions can reduce blood flow into the penis, examples include heart disease, diabetes and smoking.

• The penis cannot store blood during an erection. A man with this problem, called venous leak or cavernosal dysfunction, cannot maintain an erection because blood does not remain trapped in the penis. This condition can occur to any man regardless of age.

• Nerve signals from the brain or spinal cord do not reach the penis. Certain diseases, injury or surgery in the pelvic area can damage nerves in the penis.

Sexual activity requires the mind and body to work together. Psychological, emotional or relationship problems can cause or worsen ED; and include but are not limited to:

• Depression

• Relationship conflicts

• Stress at home or work

• Anxiety about sexual performance

Many prescription and over-the-counter medications may have side effect often causing erection difficulties. Drugs such as marijuana, heroin, cocaine and alcohol can lead to sexual problems.

If your ED is due to a hormonal problem, such as low testosterone or diabetes, you may be referred to an endocrinologist. Your healthcare provider may also refer you to a mental health professional. These specialists treat psychological or emotional causes of ED. Even if your ED is not caused by these factors, it may contribute to them. It may be helpful to get counseling, alone or with your partner, in addition to getting medical therapy for ED.

Who gets ED?

Studies show about one-half of American men over age 40 have some degree of ED. At one time, health care providers thought that psychological problems, such as stress and anxiety, were the main causes of ED. Recent studies show most ED cases have a physical cause. While ED becomes more common as men age, growing old is not the cause of the problem. Though sexual function may decrease with age, many men enjoy sexual activity well into their senior years.

ED can be an early warning sign of a more serious illness, such as heart disease, high blood pressure or diabetes mellitus. Diagnosing and treating the condition that causes ED can improve your overall well being, as well as help restore your sexual health.

How is ED diagnosed?

ED is diagnosed by an urologist or another medical professional and for most patients the diagnosis will require a simple medical history, physical examination and a few routine blood tests.

Medical History exam requires health care providers to ask about you, and your ED experience. The doctor will also want to know if you have any other conditions that might affect your ED, such an any endocrine problems or depression. They may ask questions about your sexual history and performance, which may be very personal but necessary to understand the root cause of the problem. The important thing to remember is not to be embarrassed while speaking with your physician and to be very open to allow for the best treatment options for you. Other questions the physician is likely to ask are the following:

• Your current sexual function

• When you started noticing changes

• Any past medical or sexual problems

• Surgery or injury to the pelvic area

• Current and past medication usage

• Lifestyle and personal habits (i.e. smoking, drinking, use of illicit drugs, etc.)

• Relationship with current and past partners

Physical Examinations means the doctor will check your overall health and physical condition. They will look for signs of problems with your circulatory, nervous and endocrine systems. This includes checking your blood pressure, penis and testicles, and you may need to have a rectal exam to check the prostate. These tests are not painful and may provide valuable information about the cause of ED. Most patients do not require extensive testing before beginning treatment.

The choice of testing and treatment depends on the goals of the individual. If erection returns with simple treatment like oral medication and the patient is satisfied, no further diagnosis and treatment are necessary. If the initial treatment response is inadequate or the patient is not satisfied, then further steps may be taken. In general, as more invasive treatment options are chosen, testing may become more complex.

What are some non-surgical treatments?

The first line of therapy for uncomplicated ED is use of oral medications known as phosphodiesterase-5 inhibitors (PDE-5):

• sildenafil citrate (Viagra®),

• vardenafil HCl (Levitra®),

• tadalafil (Cialis®)

Men with ED take these pills before beginning sexual activity and the drugs boost the natural signals that are generated during sex, thereby improving and prolonging the erection itself. The medication works by relaxing the muscle cells in the penis, allowing for better blood flow and production of a rigid erection. These medications are often effective, and nearly 80% of men show improvement once they begin use. The drugs are effective regardless of race and age. Although studies have shown these medications can be used by heart patients, men taking nitrates should speak with their physician before use to understand the possible drug interactions or effects on their other health conditions.

The side effects of PDE-5 inhibitors are mild and usually transient, decreasing in intensity with continued use. The most common side effects are headache, stuffy nose, flushing and muscle aches. In rare cases, sildenafil can cause temporary blue-green shading of vision. There is no long-term risk and decreases as the amount of the drug in the body decreases. It is important to follow the medication instructions in order to get the best results. Tests have shown 40 percent of men who do not respond to sildenafil will respond when they receive proper instruction on the medications' use.

For men who do not respond to oral medications another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms: injections that the patient places directly into the side of the penis and an intraurethral suppository. Success rates in achieving a firm erection useful for sexual intercourse with self-injection can reach 85 percent. Modifying alprostadil to allow intraurethral delivery avoids the need for a shot, but reduces the likelihood of successful treatment. The most common adverse effects of alprostadil use are a burning sensation in the penis and a prolonged erection lasting over four hours, requiring medical intervention to reverse the erection.

For men who cannot or do not wish to use drug therapy, an external vacuum device may be acceptable.

This device combines a plastic cylinder or tube that slips over the penis, making a seal with the skin of the body. A pump on the opposite end of the cylinder creates a low-pressure vacuum around the erectile tissue, which results in an erection. To keep the erection once the plastic cylinder is removed, a rubber constriction band goes around the base of the penis, which maintains the erection. With proper instruction, 75 percent of men can achieve a functional erection using a vacuum erection device.

Some men who have severe penis tissue degeneration do not respond to any of the treatments listed above. While this is a small number of men, they usually have the most severe forms of ED. Patients most likely to fall into this group are men with advanced diabetes, men who suffered from ED before undergoing surgical or radiation treatment for prostate or bladder cancer and men with deformities of the penis called Peyronie’s disease. For these patients reconstructive prosthetic surgery (placement of a penile prosthesis or "implant") will create an erection, with patient satisfaction rates approaching 90 percent. Surgical prosthetic placement normally can be performed in an outpatient setting or with one night of hospital observation. Possible adverse effects include infection of the prosthesis or mechanical failure of the device.

What can be expected after treatment?

All of the treatments, with the exception of prosthetic reconstructive surgery, are temporary and meant for use on demand. The treatments compensate for but do not correct the underlying problem in the penis. It is important to follow-up with your doctor and report on the success of the therapy. If your goals are not reached, if your erection is not of sufficient quality or duration and you are still distressed, you should explore the alternatives with your doctor. Because the medications used are not correcting the problems leading to ED, your response over time may not be what it once was. If such should occur again, have a repeat discussion with your physician about the remaining treatment options.

http://www.urologyhealth.org/urology/index.cfm?article=60

What Causes Your Feet To Hurt At Night

Today's post from huffingtonpost.com (see link below) is a useful examination of what causes foot pain at night, (a very common problem among neuropathy patients) although it does tend to lean a little too much on 'nerve entrapment' as a principle cause, when very often it's not as simple as that. It also suggests that operations to release nerves in the foot and ankle can often be successful. That may be so in a few cases but if the nerve is damaged, either due to neuropathy or nerve entrapment, an operation won't help much because we can't knit nerves together as easily as that. That all said, it's a helpful article because it may be able to help you differentiate between possible causes of your foot problems and it does explain the various causes pretty well. Worth a 'Sunday morning over a cup of coffee' read!

Common Causes of Foot Pain While Sleeping
By Derek Roach

Has this happened to you? You have gone through your normal bedtime routine and have drifted off to sleep comfortably. Then, seemingly all of a sudden, pain in your foot jars you awake.

While most foot pain occurs during the day while we are up and moving around on our feet, some conditions can cause us discomfort at night while we are trying to sleep. Let’s look at some of the common problems that can cause nighttime foot pain and what you can do about it.

Peripheral Neuropathy

Peripheral neuropathy is a disorder of the nerves that can cause pain and numbness in the hands and feet. With peripheral neuropathy, you may begin by feeling some numbness in your middle toes and in the balls of your feet after a day spent on your feet.

After awakening you, the pain usually lessens if you get up and walk around a bit, but it usually returns after you lie down again.

Many medical disorders have been linked with peripheral neuropathy, including diabetes, shingles, certain cancers, immune disorders, kidney failure and vitamin deficiency as well as the use of some prescription drugs.

While the specific cause is difficult to determine, doctors do know that the disorder causes partial to complete interruption of the inner core of the nerve fiber (axon) in the foot or ankle.

In many cases of people with foot or ankle neuropathy, doctors have discovered a constriction of this canal and a thickening of a ligament that compresses the nerves. In severe cases, surgeons have been successfully able to decompress the trapped nerves of the foot.

Home remedies for peripheral neuropathy include:

• Regular gentle exercise, including walking, yoga and tai chi.
• Healthy eating with essential vitamins and minerals that contribute to overall wellness. A deficiency in Vitamin B-12 has been linked with neuropathy.
• Limit your alcohol consumption. Research shows that excessive alcohol may worsen peripheral neuropathy.
• If you have diabetes, carefully monitoring your blood glucose levels may improve your neuropathy.

Morton’s Neuroma

Morton’s neuroma is a thickening of the tissue around the nerves leading to the toes. Sometimes called interdigital neuroma, the condition often develops when the bones in the third and fourth toes become pinched and then compress a nerve.

The nerve becomes inflamed and enlarged, causing a burning or tingling sensation, cramping and numbness. The pain, which can worsen at night, can be aggravated by improperly fitting shoes as well as by foot problems such as hammertoes, mallet toes and bunions.

Changes in footwear alone often can provide immediate relief from Morton’s neuroma. Look for shoes that provide more room in the toe area, such as box-toed shoes. Avoid high heels and tight shoes in favor of low-heeled or flat shoes with soft soles.

Additionally, custom shoe inserts and orthotic pads also can relieve pain and irritation by lifting and separating the bones, thereby reducing pressure on the nerve. Massage in the painful area also can be effective in reducing pain.

Pinched Nerve

If you experience a throbbing pain in your foot that builds throughout the day and worsens at night, you may be suffering from a pinched nerve inside your ankle or heel.

Research indicates that a common cause of chronic heel pain is nerve entrapment. Frequently a nerve problem is misdiagnosed because the entrapment or “pinching” is taking place in another part of the body, such as the lower back.

If a nerve root in the lower back is compressed, it can cause pain to travel along the sciatic nerve into the leg and foot. The sciatic nerve extends down the back of each leg all the way to the toes and connects the spinal cord with the many of the muscles in the leg and foot.

A pinched nerve can be the result of repetitive motions or from holding your body in one position for a long period. If nerve compression lasts for a long time, the protective barrier around that nerve may break down, causing swelling and numbness in that area. The resulting pain may worsen at night.

Treatment for a pinched nerve varies depending on the severity of your pain. Sometimes rest is all you need to do. Exercises to stretch and strengthen muscles can help as can avoiding the repetitive or restricting activities that caused the compression in the first place.

Restless Legs Syndrome

Are you bothered by an overwhelming urge to move your legs when you lie down at night or do aching, tingling sensations or involuntary jerking motion in your legs and feet wake you up at night?

If so, you may have restless legs syndrome (RLS), an annoying but treatable condition. Studies estimate that as many as one in 10 people have RLS, but unfortunately, many of us live with it rather than seek treatment.

In addition, RLS is often misdiagnosed. Left untreated however, RLS can negatively impact the quality of your life and the life of your partner.

Scientists believe that RLS is caused by an imbalance of dopamine, a chemical in the body that transmits signals between the brain and nerve cells. Thought to be genetic, RLS is more common in older adults and women. Conditions such as diabetes, rheumatoid arthritis, iron deficiency and kidney failure can trigger RLS. About 20 percent of women experience temporary RLS during pregnancy.

Ideas for limiting RLS include wearing compression socks or stockings, sleeping with a pillow between your legs and doing simple leg stretching exercises throughout the day.

In conclusion, if nighttime foot pain is a recurring problem that is interfering with your sleep to the point that it is affecting your daily activities, it is time to seek medical attention. Be sure to keep track of any details in your condition that will help your doctor diagnose the problem. With proper care and treatment, a good night’s sleep can be in your future.

http://www.huffingtonpost.com/derek-roach/common-causes-of-foot-pai_b_9745394.html

More Possible Causes Of Tingling In Hands And Feet

The last 3 posts and the next 2 posts all relate to Vitamin B12 and neuropathy. If you weren't a hypochondriac before reading these, you may well be afterwards, so taking a sensible view of the many symptoms shown here is advisable. Strangely, most HIV and/or neuropathy patients aren't standard tested for B12 deficiency but it may well be worth asking your doctor to do exactly that - it may explain several things. All 5 posts come from the same site B12patch.com (see links below the articles), which is pretty much an 'all you would ever want to know' type of information site but the descriptions of what neuropathy is are accurate and honest and explained in language that we all can understand. Very interesting and worth discussing with your doctor if there's time, especially if you're considering taking B12 supplement pills (usually need Folic acid to help absorption) - injections may be better in your case.

What causes annoying tingling in the hands and feet?

 

 

 

 Pernicious anemia

One of the earliest symptoms of vitamin B12 deficiency anemia is neuropathic pain- sufferers of vitamin B12 deficiency feel sharp, achy tingling in the hands and feet, numbness, “pins and needles,” or a painfully swollen tongue.
Even if you eat sufficient food sources of vitamin B12 from meat, fish, and dairy sources, you might have dangerously low B12 levels.
Causes include autoimmune disorders, gastrointestinal diseases or surgeries, drug interactions, or the inability to produce intrinsic factor in the stomach. To find out if you have vitamin B12 deficiency, ask your physician for a vitamin B12 blood test- you might require vitamin B12 supplements.

Underactive thyroid

Hypothyroidism causes symptoms similar to vitamin B12 deficiency, like “brain fog,” fatigue, depression, muscular pain, and numbness or tingling in your hands and feet.

Sitting and standing

Sitting or standing for long periods without moving or taking a break- washing the dishes, standing by a register, or sitting at a computer for hours- can cause prickly tingling in your feet and legs.

 

Striking a nerve

If you have suffered a head or neck injury, then you may experience numbness in your arms. Similarly, a lower-back injury could cause painful numbness in your legs.

Shingles

If you’ve ever had the Chicken Pox, then you’re a candidate for shingles. The herpes zoster virus appears around middle age, and causes neuropathic pain such as painful skin rash, itchiness, red blisters, and painful tingling and numbness.

Frostbite

Both frostbite and atherosclerosis (arterial plaque build-up) restrict blood supply to your extremities, causing severely painful numbness in toes, hands, feet, or fingers.

Nerve pressure

If you have suffered a herniated disk, then painful nerve pressure on your spine may cause tingling and numbness in legs. Dilated blood vessels, scar tissue, infections, or tumors may also cause severe peripheral neuropathy.

Carpal tunnel syndrome

Carpal tunnel syndrome caused by constant repetitive motions, such as typing or knitting, causes aching in your hands, fingers, and wrists.

Multiple Sclerosis

Multiple Sclerosis (MS) is a disease that affects the brain and spinal cord, causing feebleness, reduced motor control, trouble maintaining physical balance, and foot numbness.

Diabetes

One of the many symptoms of diabetes, a blood sugar disorder, included painful tingling sensations and numbness in the hands and feet.

Seizures

People who experience frequent seizures, such as epileptic seizures, may experience dizziness, prickly “pins and needles” sensations in their hands, feet, arms, legs, or numbness in the face.

Stroke

Stroke victims suffer loss of consciousness, speech slurs, disorientation, partial paralysis, numbness, and tingling on one side of the body.

Migraines

Migraines with aura produce stroke-like symptoms such as sudden “gibberish” talk, visual distortions, facial numbness, feebleness, and mental confusion.

Transient ischemic attack (TIA),

A transient ischemic attack, or “mini-stroke,” may signal an oncoming stroke; symptoms include dizziness, mental confusion, balance problems, and numbness or tingling on one side of the body.

Lupus

One of the symptoms of lupus autoimmune disorder is Raynaud’s phenomenon, which causes poor blood flow to your fingers and toes by constricting blood vessels.

Toxic poisoning

Exposure to toxic amounts of alcohol, lead, radiation therapy, seafood toxins, or tobacco may cause neuropathic damage, including painful numbness in arms or legs.

Animal or insect bite

If you’re bitten by an animal or insect (spider, tick), then you might experience symptoms such as prickly tingling and numbness in your fingers, toes, arms, or legs


http://www.b12patch.com/blog/symptoms-of-vitamin-b12-deficiency-2/painful-tingling-in-hands-and-feet-what%e2%80%99s-up-with-that/