Gabapentin not working for neuropathy? My friend Bonnie was on her highest dose ever, and her feet still burned at 2 a.m.

My friend Bonnie carried mail in Toledo for twenty-nine years. Rain, snow, the August heat on the east side, a route she could walk with her eyes closed. So it says something that when her feet started burning at night three years ago, she didn't complain to anybody until she couldn't sleep through to the alarm.

Her doctor started her on gabapentin. A small dose at bedtime, then a bigger one, then a dose in the morning too. And for a while it took the edge off. She slept. Then the burning came back through it, the way water comes back through a patched roof, and every time she said so, the dose went up again.

This October, sitting at her kitchen desk with the open-enrollment booklet and every bottle she takes lined up in a row, she typed gabapentin not working for neuropathy into her phone and called me. "Denise," she said, "I'm on the highest dose I've ever been on, my feet are on fire, and I can't remember where I parked at the Kroger. Something is wrong with this picture."

Gabapentin not working for neuropathy: you're not imagining it

Gabapentin is one of the most common prescriptions for nerve pain in the feet, and for many people it does help. But it doesn't help everyone, and the people it does help often find it fades or needs more and more to do the same job. If that's you, you are not being difficult, and you are not doing it wrong.

It helps to understand what it actually does. Gabapentin calms the nerve signal. It turns down the volume on the alarm. It doesn't do anything to the reason the alarm is going off. That's why, for a lot of people, it feels like it's working on everything except the feet: the dizziness, the fog, the heavy legs, the swollen ankles, the "where did I put my keys" moments Bonnie kept laughing off.

Things worth asking your doctor about if it's stopped working for you:

• The dose and the timing. Sometimes it's the schedule, not the medicine.
• What's causing the neuropathy in the first place. Blood sugar, B12, thyroid, alcohol, some medications. Treating the cause is the only thing that changes the course.
• Side effects you've been blaming on age. Unsteady walking and fogginess matter more when your feet are already numb.
• Never stop it on your own. Gabapentin has to be tapered. Stopping suddenly can cause real problems.

See a doctor quickly if the burning or numbness is getting worse fast, is on one side only, or comes with weakness, a wound that isn't healing, or trouble with balance or your bladder.

What Bonnie tried alongside it. It can help, but…

Bonnie didn't just sit on the pill. She soaked her feet in Epsom salt. She rubbed in a capsaicin cream that made her eyes water when she forgot to wash her hands. She bought a TENS unit off a late-night commercial. She took a B12 because her sister did.

Every one of those can help somebody. The soak felt lovely for twenty minutes. The cream worked some nights. But a month later she was still standing at the bedroom door at 2 a.m. with the comforter kicked off the end of the bed.

"Every single thing I'm doing," she said, "is about the pain. Nothing is about the nerve."

The question the pill bottle can't answer

Here's what nobody had explained to Bonnie in three years. The nerves in your feet are wrapped in a thin protective coating, like the plastic around the copper in a lamp cord. When that coating wears thin, the signal shorts out. That short circuit is the burning, the buzzing, the pins and needles. Calm the signal all you like; the wire underneath is still bare.

And what wears it thin, the way it was explained to Bonnie, is two things working together: a slow, quiet inflammation around nerves that are already stressed, and poor blood flow to the far end of the longest nerves in the body. The feet get the least of everything. Leave either one alone and the coating never gets what it needs to repair itself.

There's an old kitchen spice that keeps turning up in the research on that first part. Which spice, what it has to be paired with before the body can use it, and why the time of day it's taken seems to matter, is the piece Bonnie had never heard in a single appointment. I hadn't either.

The woman at the bake sale

Bonnie volunteers at her senior center's fall bake sale. This year she worked the table with a woman named Pearl, seventy-one, a retired cafeteria manager, who spent the whole morning on her feet without once sitting down. Bonnie, who had to sit every twenty minutes, finally asked her how.

Pearl laughed. "Honey, two years ago I couldn't stand to have the sheet touch my feet. I was on the same pill you're on." She'd stayed on it, she said, under her doctor's eye, but she'd stopped waiting for it to fix the nerve. "I started on something that went after the coating and the blood flow together." She dug in her tote bag, between the price stickers and the napkins, and put a bottle on the table next to the pumpkin bread.

It was NervoLyn. Bonnie sorted mail for a living; she reads every label twice. She stood there with her reading glasses on her nose and went down the back of it:

• Turmeric extract, standardized to 95% curcuminoids. For the body's normal inflammation response around stressed nerves. "So that's the spice," she said. Pearl just nodded.
• Butcher's broom. A traditional herb for circulation, to help blood make the long trip out to the toes.
• Alpha lipoic acid. An antioxidant the company describes as one of the most studied for the nerves of the hands and feet.
• L-carnitine and Coenzyme Q10. Fuel for the cells, so a tired nerve has the energy for its own slow repair.
• Magnesium glycinate. A gentle form of magnesium the company connects with calmer nerve signals and better sleep.

"It's the first thing anybody's shown me that's about the wire and not the alarm," Bonnie told me. She did it the right way: she took the label to her doctor, who checked it against her gabapentin and her blood pressure pill, told her to stay on her prescription, take this with breakfast, check her feet every night, and come back before the end of the year. They'd talk about the dose then, together.

What Bonnie noticed, and when

• Week 1. Nothing she'd swear to. Same burning at bedtime, same comforter on the floor.
• Weeks 2 and 3. A warm, prickly feeling in two toes that had felt dead since spring. Pearl told her she'd had that too. Some people notice a quiet nerve stirring before it settles, though nobody can promise what it means.
• Month 1. She slept from eleven to five without getting up. First time since the summer.
• Months 2 and 3. Where Pearl is now: a whole bake sale on her feet. Bonnie's next appointment is in December, and for the first time she's going in to talk about lowering a dose instead of raising one.

Why does it take that long? Because nothing in that bottle numbs anything. A coating that has been wearing thin for years is rebuilt on the body's own schedule, and the longest nerves get their turn last. The company says many people notice early changes in three to four weeks and fuller results over eight to twelve. Bonnie ordered the three-month supply. "I carried the same route for twenty-nine years," she said. "I can give my feet ninety days."

Who it's for, and who it isn't

It may be worth a look if you're over 50, the burning, tingling or numbness is in both feet, your doctor has checked the basics (blood sugar, B12, thyroid), and the prescription or the creams calm it down without ever making it better.

It is not for you if the symptoms came on suddenly or on one side only, if a foot or leg feels weak, or if you have a wound that isn't healing. Those need a doctor first. If you take gabapentin, pregabalin, or medicine for blood sugar, blood pressure or blood thinning, or are pregnant or nursing, show your doctor the label before you start, the way Bonnie did. And please, never stop or cut your prescription without your doctor.

The company gives you 60 days, with your money back if your feet don't notice. It's a one-time order, nothing that renews on its own, made in the United States in a GMP-certified facility. "Sixty days," Bonnie said. "That's less time than I spent waiting for the last dose increase to kick in."

So, what if gabapentin is not working for your neuropathy?

You're not alone, and it doesn't mean nothing will. Gabapentin calms the nerve signal; it doesn't repair the nerve. Talk to your doctor about the dose, the side effects and, most of all, the cause. Never stop it suddenly. Protect your feet, check them every night, and keep moving. Results with any supplement vary from person to person, and Bonnie's are her own. She still sees her doctor, and she's still on her prescription until the two of them decide otherwise.

P.S. Bonnie picked her Medicare plan last week. She told me the best part of open enrollment this year wasn't the plan; it was going down that row of bottles and finally understanding which ones were about the nerve. If you're at your own kitchen table tonight with a dose that keeps climbing, here's what Pearl pulled out of her tote bag. And if it's mostly the cold making it worse lately, read what happened to my friend Gloria when the cold came in.

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