Dr. Elliot Johnson

If Gabapentin Is Working, Read This Before It’s Too Late

If your feet have started going numb, the floor muffling, the numbness climbing past the toes, and you're taking Gabapentin or Lyrica for it, you have somewhere between 2 and 4 years before that numbness reaches the point where it does not come back. I am a vascular and limb-salvage surgeon with 21 years of practice. I have spent the last decade watching this exact timeline run in people on long-term nerve-pain medication while telling almost none of them what was actually coming. I am writing this to break that silence. People on long-term Gabapentin, Lyrica, Amitriptyline, and duloxetine experience spreading numbness, loss of protective sensation, and slow-healing skin on the feet at rates almost no appointment tracks — because the pain score on the intake form is the only outcome the visit measures. Almost none of them are told that the same pill "managing" their nerve pain does nothing to restore the blood supply that is starving the nerve in the first place. They're told the drug is "treating the neuropathy." That phrase, in isolation, is one of the most expensive half-truths in the way we treat feet. I'm Dr. Elliot Johnson. I'm a vascular and limb-salvage surgeon who spent years watching people cycle through nerve-pain prescriptions without telling them what was happening to the feet underneath. When the burning and the numbness started in my own feet at 54, I finally understood something I had never explained to a single neuropathy patient. The pain isn't the disease. The tingling isn't the disease. The numbness isn't the disease. They are all symptoms of one thing — the starved circulation and dying fibers the burning was screaming about, that your nerve-pain pill is quieting on paper while doing nothing to feed the nerve. Almost every drug added to a neuropathy protocol mutes the next symptom while the starvation underneath keeps advancing. I have treated thousands of feet. I have seen what happens at year 2 on Gabapentin. Year 4. Year 6. Year 9. And I have seen what almost no one documents, because the appointments are 11 minutes long and nobody asks the question that matters: can you still feel the floor. The 63-year-old. On Gabapentin 5 years, dose taken from 300mg to 2,400mg, pain score "managed." His doctor was pleased. The burning at night had faded — which everyone read as improvement — but it faded because the fibers carrying it were dying, not healing. The numbness that replaced it climbed from his toes to his mid-foot over 3 years, and no one charted it, because he never volunteered it and no one asked. He caught his heel on a space heater one January night and didn't smell the skin until his wife did. That burn became a wound. I met him 14 months later, deciding how much of the foot we could keep. The 59-year-old. Diabetic, diagnosed at 51. On Lyrica, then Lyrica plus a cream. Pain "controlled." His feet had been cold for years — a documented sign of failing circulation — and he'd been told to buy warmer socks. Around year 4 he couldn't feel the clutch in his own truck. His doctor called it expected and raised the dose. A wound opened on the ball of his foot and sat there 3 weeks before he noticed, because he couldn't feel it. His numbness had been the warning at year 3. By the time I saw the wound, the circulation to that foot had been failing for the better part of a decade. The 66-year-old. Not diabetic — "idiopathic," her chart said. On Amitriptyline, then Gabapentin, then both. Every visit measured her pain and adjusted her pills. Not one measured whether she could feel a 10-gram filament on her sole — the 90-second test that predicts exactly who ends up on my table. She failed it badly the first time anyone ran it, in an emergency room, the night an infection from a blister she never felt had already reached the bone. I see these people in follow-up. They don't complain. They're grateful the burning quieted and that someone "managed" the pain. But I know what they lost. They had years to reopen the circulation that was killing the nerve. Years to feed the fibers while they could still recover. Years to stay off my table. Their feet were screaming the warning the whole time — and then, worse, went quiet. The prescriptions just turned the volume down, one symptom at a time, while the starvation compounded. Here is what almost no one explains to a person on a nerve-pain drug whose feet are going numb. The feeling in your feet depends on how well the tiny blood vessels feeding your nerve fibers are delivering oxygen. Healthy microcirculation keeps those fibers alive and sending honest signals — including the one that says "there's a stone in your shoe, move." When that supply is choked off — by years of high blood sugar, by aging, by poor circulation — the fibers begin to suffocate. Some misfire on the way out: the burning, the shocks, the shattered glass. Others fall silent: the numbness, the muffled floor, the wound you never feel. Your doctor's answer to the pain is a nerve-pain drug. Here is what each one actually does — and the tell each one leaves behind. Gabapentin and Lyrica quiet an overexcited pain signal by binding a calcium channel in the nervous system. The burning drops. But they do nothing to the blood supply feeding the fiber. The signal is muted while the fiber keeps starving. The tell is the fog — the dizziness, the half-asleep-by-noon, the word you can't find. That fog is the drug reaching your brain. It is not reaching the choked-off vessel in your foot. Nothing in that pill ever does. Amitriptyline and the other nerve-pain antidepressants dampen how pain is processed centrally. The pain chart improves again. The tell is the dry mouth, the morning grogginess, the constipation — the drug acting body-wide on everything except the one thing that's killing the nerve: the circulation. The vessel and the fiber are never touched. Duloxetine works on the same central pain-signaling and leaves its own tell — the nausea, the sweating, the blunted feeling. Again the number moves. Again the starved fiber in your foot is exactly as starved as it was the day before you started. The numbing creams work at the surface for an hour. The bloodstream is never involved. The nerve underneath is never reached. Every one of them moves the pain score. Not one restores the circulation. All of them leave the fiber to keep dying while the appointment records a win. And when the dose stops holding, the answer is always the same — more of it, or another one stacked on top. The burning you've been medicating is not the warning. The numbness that replaced it is the louder warning. The loss of the ability to feel a coin under your foot is the warning before the catastrophe. And the wound that opens on a foot that can no longer feel it — the wound that won't close because the same starved circulation can't deliver what healing requires — is the disease finally arriving where I can see it. The research isn't obscure. Loss of protective sensation is the single strongest predictor of the foot ulcer and the amputation that follow — it precedes the wound, and the wound precedes the operation, by years. The pain score is what the medication moves. The sensation and the circulation are what decide whether you keep your foot. Your numbness isn't embarrassing, and it isn't "just getting older." It's your early-warning system, and the warning is louder than the pain score your doctor is tracking. I wasn't going to walk the road I'd watched thousands of my own patients walk. I needed a path that reached the mechanism instead of muting one more symptom. I tried what patients try. Lifestyle. Tighter blood sugar, walking, weight off. Helped at the edges. The numbness held. Supplements. Alpha lipoic acid, benfotiamine, high-dose B12 — the whole forum list. Didn't move the floor back under my feet. My pain was manageable. But my feet stayed cold. The numbness held its ground, and on the bad months gained a little. The pills had moved the pain while the circulation kept failing. But I kept circling something that made no sense in standard practice. Starved fibers, in the early-to-moderate stage, can recover — if you restore the blood supply and switch the repair signal back on. The circulation research had shown it for years. Almost no one in neurology was applying it to feet. So why wasn't I applying it to my own? March 3rd. 11:40 PM. After a long clinic day and one amputation I've never stopped seeing. Couldn't sleep. The numbness in my own soles was worse that week. I was reading through research on peripheral circulation and nerve repair. Not looking for anything specific. Just tired. I found the work on photobiomodulation — red and near-infrared light — and nitric oxide. Two precise wavelengths, 660nm red and 850nm near-infrared, drive the body's own nitric oxide — the molecule that tells a vessel to open. Open the vessel, the blood follows, the starved fiber gets fed. And at the same wavelengths, stimulate Nerve Growth Factor — the body's own signal to rebuild a damaged nerve ending. The pathway didn't depend on the pain-signaling the drugs were blunting. It reached the thing underneath the drugs entirely: the blood supply, and the nerve it was supposed to feed. It didn't just quiet the symptom. It addressed the starvation. Open the circulation. Repair the nerve. And in the early-to-moderate window, the fiber can come back. The whole chain runs on nitric oxide — the discovery that won Ignarro, Furchgott, and Murad the Nobel Prize in 1998. I sat there past midnight staring at the diagram. Gabapentin was quieting my pain signal and doing nothing for the blood supply. A higher dose would quiet it more and starve the fiber just the same. The pill addressed the alarm. It never once addressed the fire. The light went straight at the fire. Open the circulation. Repair the nerve. The two things a starved fiber actually needs, at the two wavelengths the research actually used. 21 years a surgeon, and I'd never connected clinical red-light therapy to the feet I was amputating. It was never in a curriculum I sat through. That week I went looking for a device that delivered those exact wavelengths correctly — because most "red light" foot gadgets are the wrong wavelengths, too weak to reach the nerve, or aimed at the surface where the pain is instead of the depth where the nerve lives. I found one built right. 660 and 850 at clinical intensity, wrapped around the foot. I started that week. 30 minutes every evening, both feet. Day 6. My feet, always cold, warmed from the inside — the first shift in circulation I'd felt in years. Day 15. I slept through the night without the 2 a.m. burning. Week 4. Standing in the shower, I felt the water on my soles the way I had a decade earlier. Not pressure. Water. I hadn't known that was gone until it came back. Week 8. I re-ran the filament test — the same one I run on my patients. The points I'd failed at the start, I now felt. Every one. My circulation markers had improved. The floor was under my feet again. I took it to a colleague, a podiatrist I refer my worst cases to. He ran the filament himself, checked his notes, looked at me. "Elliot. What did you do? Your sensation moved and your flow improved. That doesn't happen once this is established." I explained the photobiomodulation. The nitric oxide pathway. The way it sat entirely outside the pain-drugs, reaching the circulation and the nerve instead. He was quiet a moment. "I've got a waiting room full of people I'm sending to wound care and vascular. If this is reproducible…" "The mechanism is real." He started recommending it to his neuropathy patients before their feet reached my table. I'm not writing this because I'm against nerve-pain medication. If the burning is unbearable, these drugs have a place, and you shouldn't stop anything without your doctor. Quieting pain you can't sleep through is not nothing. But they don't fix what's starving your nerve. They move the pain score while the circulation keeps failing and the numbness keeps climbing — first the toes, then the mid-foot, then the day you can't feel a wound open on your own skin. They don't lower your risk of that wound to zero. They hide the alarm while the fire spreads. Your numbness isn't failing you. Your fading sensation isn't failing you. They're warning you. I think about what I almost did. I almost accepted the numbness as the price of "managing" the pain, almost let my own feet climb the same ladder I'd watched take so many others — one dose increase at a time, until the day the ladder ends on a table like mine. 8 weeks. That's how long it took for the warmth to come back, the burning to quiet, the sensation to return to my soles, and my own filament test to come back clean — 30 minutes a night, wrapped around my feet, while I read. Nouvera Neurosoothe costs a fraction of one clinic course of the same red-light therapy, and it comes with a 90-day money-back guarantee. Use it daily. If the warmth, the sleep, the sensation, and the feeling of the floor under your feet don't measurably improve, send it back in any condition for a full refund. — Dr. Elliot Johnson, MD Vascular & Limb-Salvage Surgeon, 21 years Practicing physician P.S. — Give it 60 to 90 days. Track the warmth in your feet. Track how you sleep. Track whether you can feel the floor when you stand up in the morning, and whether you notice the small things — the seam of a sock, the pebble in a shoe — the moment they're there. If the trend lines don't move, send it back. The upside is the version of you that never learns what the inside of a wound-care center smells like. P.P.S. — You are not too late yet. Your nerve-pain drug is doing what it was designed to do for your pain score. Your circulation is not. The window where a starved fiber can still recover is the early-to-moderate one — the one you're most likely in right now, and the one that closes quietly. Open the circulation now, while the fiber can still come back, before the numbness becomes the permanent kind and the first wound arrives that you never feel.