Your doctor troubles me somewhat.  Numbness in legs/feet and arms/hands
is not something that should simply be given symptomatic treatment. If
there's no other explanation, yes, an anticonvulsant would be a
reasonable empirical treatment.

If a primary practitioner -- and I don't know your doctor's background
-- can't come up with a good explanation, I would want a referral to a
neurologist, as the most likely practitioner to figure it out. I
wouldn't accept "non-diabetic neuropathy" without a full workup; I don't
think that's even an accepteble diagnostic code in the International
Classification of Diseases (ICD).

An adequate workup would include the type of specialized physical
examination that neurologists tend to do, quite likely nerve conduction
studies and electromyography, general blood testing plus B vitamin
levels and assorted indicators of inflammation, and possibly imaging
such as ultrasound.  The latter would be especially important if there
were any question about the blood circulation in your legs.  I'd want to
know how diabetes was ruled out, minimally with a hemoglobin A1C test
and possible a glucose tolerance test.

Deficiency, or abnormal absorption, of B vitamins can cause symptoms
like this. Unfortunately, while it's generally impossible to overdose on
B vitamins, this isn't true of vitamin B6 (pyridoxine).  Both B6
deficiency and overdose can cause peripheral neuropathy.

<snipped lots of good pharmacological information>

Well...

I can't disagree with anything you wrote (mostly because so much of it went
right over my head so far it didn't even muss my hair ;>), but I think you
can admit that the pharmaceutical companies are not in the business for
philanthropic reasons.  Just like the rest of us capitalists, they're out to
make a buck.  I'm not even saying that they are knowingly pushing harmful
drugs on an unsuspecting public only to line their own pockets - I'm sure
most of them believe in their products.

But...

My best friend is a nurse and I know several other people in the medical
profession, and I have heard some personal accounts of drug company
representatives doing the following:

- Giving "luncheons" for a "Continuing Education Programs" on certain drugs
to doctors (even the nurses and techs are invited) at the most expensive
restaurants.

- Giving out other gifts to doctors just for allowing them to leave samples
of their drugs.

- Giving physicians free trips and monetary "incentives" for giving out a
certain "quota" of prescriptions to their drugs.

- Asking doctors to prescribe a drug and then fill out a nominal
questionnaire once a week for a few weeks and then giving them as much as
$10,000 for doing so.

- Lobbying congress and spending huge amounts of their billion dollar
profits on passing legislation that promotes their "cause".

- Writing PDRs (physician's desk reference) (these are put out by the
pharmaceutical companies, not by the AMA) to "slant" information about what
drugs should be prescribed for which symptoms.

- Working hand-in-glove with the FDA and basically policing themselves when
in comes to warning labels and such.

This last one is harder to prove, but the proof can be self evident when we
look at the recent problems that have surfaced with Vioxx and other pain
medications.

My friend, a nurse, works in a psychiatric hospital.  The doctor she works
with noticed that the children he was treating with Risidol (or maybe it was
Celexor (SP?) - I can't remember which one she told me about) were showing
prolonged QT waves on their EKGs and repeatedly reported this to the drug
company.  The drug company kept denying it for over a year until the
preponderance of this evidence became overwhelming and doctors petitioned
the FDA to require "black box" warnings on this drug.

Taking all of the above into account, it will be a cold day in h*ll before I
blithely allow a doctor to prescribe *any* medications to me that I don't
*thoroughly* investigate beforehand taking.

My experiences with Neurontin and Effexor were so harrowing that I would
have to be facing *death* before I agreed to take any long-term medications.
I was *NOT TOLD BEFOREHAND* that there were any side effects or withdrawal
problems associated with these drugs.  My doctor is very diligent and I
don't think he was being ingenuous in prescribing these drugs - I just don't
think the drug companies are being very "up front" in their warnings.  They
want to sell their products, of course they're not going to warn people not
to take them.

Yes, I should have "weaned" myself off the meds I was taking (it was
extremely stupid not to do so) and I probably should have been hospitalized
while doing so.  However, I lost my job and along with it my insurance.  The
medications I was taking cost several *thousands* of dollars a month and
without a job there was no way I could afford that.  I seriously doubt that
it cost the drug companies thousands of dollars to produce these drugs even
if you factor in the costs of research and development, but nobody was
willing to give me a discount on the medications I needed to continue with
in order to prevent a possible catastrophic withdrawal.

Oh my, here I am on this darned soapbox again.  Sorry Howard.  I know you
know much more about this subject than I do, I didn't mean to preach!

Hugs,

CatNipped

This entire discussion of Neurontin is disturbing to me as my dad's
been taking it for a while now (diabetic neuropathy in his legs). As
far as I can tell, he's not had any trouble with pain, loss of muscle
control, lost balance or falling due to his medication. To the
contrary, he's gotten better since he's been on it.

YMMV

Jeanne Hedge, as directed by Natasha

============
http://www.jhedge.com

While there's a good deal of positive experience with Neurontin
(gabapentin) in diabetic neuropathic pain, its use is an off-label
indication.  Two drugs were approved in 2004 with specific indications
for diabetic neuropathy, Cymbalta(duloxetine) and Lyrica (Pregabalin).  
You might want to discuss these with your doctor.  

Duloxetine is not an anticonvulsant, but an antidepressant. Certain
"first-generation" tricyclic antidepressants such as amitriptyline
(Elavil) are useful in a variety of chronic pain conditions. These drugs
affect two kinds of neurotransmitters, serotonin and norepinephrine. The
"second generation", typified by fluoxetine (Prozac), selectively affect
only serotonin.  A new group, perhaps not a new generation, affects both
neurotransmitters, but by a different mechanism than the tricyclics.
Duloxetine is in this group.  It is also a clinically effective
antidepressant, if that's a consideration.

Pregabalin is closely related to gabapentin, but, in oversimplified
terms, is "purer" -- both drugs affect the same neurotransmitter pathway
(GABA [1]), but both need to undergo conversion in the body to affect
the pathway.  Pregabalin is "further along" that pathway, and has a much
lower dose than gabapentin. It's hypothesized that the lower active
dose, and the improved molecule, may have a decreased incidence of side
effects over gabapentin.  Yes, it's also a Pfizer drug, and gabapentin
is close to going generic where this new one is not.

[1] gamma aminobutyric acid. Did you really want to know? Now do you
   understand why scientists call it GABA?