For several years, I’ve endured electric shock sensations in my left big toe. These episodes can disappear for months and then suddenly resurface, causing significant pain. It’s been impacting my sleep. What steps should I take?

Dr Kaye replies: The most common cause of this type of sensation is peripheral neuropathy – or nerve damage.

The nerves function as pathways extending from the brain to the remaining body parts, transmitting sensations—like heat, cold, or pain—back to the brain. However, these nerves can occasionally be damaged, disrupting their message-sending abilities.

Patients often describe experiencing pins and needles, numbness, tingling, burning, or electric shock-like feelings. The most common cause of peripheral neuropathy is diabetes, as the high blood sugar condition can impair the blood vessels nourishing the nerves.

It’s common for individuals with diabetes to lose feeling in their feet, hence the frequent advice to check their feet regularly for any unnoticed injuries or ulcers.

Certain medications may lead to peripheral neuropathy, including some chemotherapy drugs, blood pressure medications, and antiseizure treatments. Excessive alcohol intake can also contribute to the problem, as well as vitamin deficiencies—particularly a lack of vitamin B12 found mainly in animal products like meat, fish, and dairy.

Spinal injuries can cause peripheral neuropathy, along with shingles—the painful rash in adults due to the childhood chickenpox virus—and Lyme disease, a chronic skin condition that can be contracted through a tick bite.

Peripheral neuropathy is difficult to reverse, however there are steps patients can take to relieve some the symptoms and prevent it getting worse.

First, it’s important to treat the underlying cause. So this might mean better blood sugar control for diabetes patients, B12 supplements for those deficient, or cutting down on alcohol if the problem is drinking too much.

There are also nerve painkillers which can relieve some of the symptoms. These include gabapentin and amitriptyline.

A GP can prescribe these and help diagnose the root cause.

I take blood-thinning tablets after suffering a mini-stroke 20 years ago. Last year, a new GP recommended I start taking lansoprazole – a heartburn drug. I don’t have heartburn, but I do have divertuculitis. So do I really need the tablet?

Dr Kaye replies: Any patient with diverticulitis has a heightened risk of painful and potentially dangerous internal bleeding.

The condition occurs when small pouches form in the walls of the intestine. Food can get stuck in these pouches, leading to tummy pain, infections and, sometimes, bleeding.

Blood-thinning drugs, such as clopidogrel, are known to raise the risk of this bleeding. That’s why most patients who have diverticulitis and are on blood-thinning drugs are offered lansoprazole. The tablet – a proton pump inhibitor (PPI) – lowers stomach acid levels and reduces inflammation in the gut.

There are concerns that long-term use of PPIs can marginally increase the risk of health conditions such as osteoporosis, certain cancers and dementia.

But the risk of internal bleeding in diverticulitis patients taking blood-thinning drugs is undeniable. Yes, patients should avoid taking PPIs unnecessarily, but those with this combination of conditions and medicines should almost certainly be taking one.

I’m 83 and suffer with scleroderma. The disease affects my liver, lungs and legs. I now need knee surgery as a result, but I’m worried about the recovery. What should I do?

Dr Kaye replies: Scleroderma is an autoimmune disease where the body overproduces the protein collagen, leading to thickening and tightening of the skin and even scarring of internal organs. It’s caused by an overactive immune system.

The lungs and liver are two of the most commonly affected organs. This can have serious consequences, including breathing problems and fatigue.

When scleroderma affects the joints, physiotherapy and steroid injections are usually the first treatments offered. If these fail, joint replacement surgery may be considered.

Scleroderma patients are more prone to certain surgery complications. Some patients experience slow wound-healing, meaning their recovery can take longer than expected.

And those with affected lungs can develop serious breathing difficulties, as anaesthetic affects lung function. Scleroderma patients due to undergo surgery should ask for a joint consultation with their rheumatology and surgery teams to discuss the possibility of these complications.

This might involve measuring the patient’s lung function to make sure they are fit for surgery, or ensuring that they have tried all other available treatments – such as steroid injections – before agreeing to the operation.

Patients do not have to go through with any surgical procedure that they are not comfortable having.

Paracetamol is still the painkiller to take 

I’m interested in growing scepticism over the use of the world’s most popular painkiller – paracetamol.

There have been studies linking the tablets to serious health problems such as tinnitus, kidney problems and even autism in children (see pages 46-47).

While there is not enough evidence to link these conditions to paracetamol definitively, more and more of my patients are refusing to take it. Often this is because they don’t think it helps with pain.

I don’t agree. Studies show paracetamol is effective for acute pain, but it can be dangerous if taken in excess.

Have you experienced paracetamol side effects? Please write in using the email address below and let me know.

Jabbing away to beat shingles

I was thrilled to see that, from this month, millions more will eligible for the new highly effective shingles vaccine.

Shingles is caused by the chickenpox virus, which remains in the body after infection – which, for most, happens during childhood.

As we age, our immune system grows weaker, allowing the virus to become active again. This usually leads to an agonising rash, typically on the chest, back or face.

For some, shingles can also trigger chronic nerve pain.

That’s why people aged 70 to 79 are offered two doses of shingles vaccine Shingrix. The jabs are also offered to those who have turned 65 since September 1, 2023.

Now anyone over the age of 18 with a severely weakened immune system will be offered Shingrix. This includes those with health conditions such as cancer or those taking drugs to suppress their immune system.

If you have a question for Dr Ellie Cannon, write to DrEllie@mailonsunday.co.uk. Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context