Electric ‘zaps’ in the toe likely nerve damage, experts say; advice on PPIs, surgery with scleroderma and vaccines

Readers reporting sudden, painful "electric" shocks in a toe are most likely experiencing peripheral neuropathy, a condition doctors say is usually caused by nerve damage and commonly linked to diabetes, certain medications, alcohol misuse and nutritional deficiencies.

In answers to readers' questions published in a health column, Dr. Kaye described the sensations — pins and needles, numbness, burning or sudden electric-shock episodes — as classic features of peripheral neuropathy. He said the condition is difficult to reverse in many cases but that identifying and treating the underlying cause can reduce symptoms and prevent progression.

Diabetes emerged in Dr. Kaye's explanation as the leading trigger because prolonged high blood sugar can damage the small blood vessels that supply nerves, particularly in the feet. That loss of sensation is why people with diabetes are routinely advised to inspect their feet for ulcers or injuries they may not feel. Other potential causes he cited include certain chemotherapy agents, some antihypertensive and antiseizure drugs, excessive alcohol intake, vitamin B12 deficiency — more common in people with restricted intakes of animal products — spinal injuries, shingles and Lyme disease.

Dr. Kaye advised patients who have intermittent or recurring electric shock sensations to see a general practitioner for assessment. Diagnostic steps can include blood tests for sugar control and B12 levels, medication reviews to identify potential culprits, and neurological or imaging studies when spine injury or other structural causes are suspected. For symptomatic relief, GPs can prescribe established medications for nerve pain, such as gabapentin or amitriptyline. Addressing modifiable risks — improved blood sugar control in diabetes, B12 supplementation when deficient, or reduction in alcohol intake — is central to preventing further nerve damage, he said.

A second reader asked whether a proton pump inhibitor, lansoprazole, was necessary after a GP recommended it when the patient, who takes a blood thinner following a previous mini-stroke, also has diverticulitis. Dr. Kaye replied that diverticulitis — inflammation and infection of small pouches in the colon — raises the risk of internal intestinal bleeding and that blood-thinning drugs such as clopidogrel increase that hazard. He said proton pump inhibitors lower stomach acid and reduce gut inflammation and that patients with diverticulitis who are taking blood-thinning medication are generally offered a PPI to lower bleeding risk.

Dr. Kaye acknowledged growing concerns about long-term PPI use, including suggested associations with osteoporosis, some cancers and cognitive decline in observational studies, but said the increased risk of a potentially life-threatening gastrointestinal bleed in this patient group makes the protective role of PPIs compelling. He advised patients not to stop prescribed medications without consulting their clinician and to weigh the known short-term benefit against possible long-term risks in individual circumstances.

In response to an 83-year-old reader with scleroderma who faces knee replacement surgery, Dr. Kaye outlined specific perioperative considerations. Scleroderma is an autoimmune condition characterised by excess collagen production, which can thicken and tighten the skin and scar internal organs. The lungs and liver are frequently affected, and compromised lung function raises the risk of breathing complications under anaesthesia.

Patients with scleroderma may also experience slow wound healing. Dr. Kaye recommended that those considering surgery request a joint consultation involving both the surgical team and their rheumatologist to assess lung function and other organ involvement, to confirm that conservative measures such as physiotherapy or steroid injections have been exhausted, and to plan perioperative care. He emphasised that patients retain the right to decline surgery if they are uncomfortable with the assessed risks.

The column also addressed growing public scepticism over paracetamol, the world’s most widely used analgesic. Dr. Kaye said that while some studies have reported associations between paracetamol and conditions including tinnitus, kidney problems and, in observational work, neurodevelopmental outcomes, the evidence is not sufficient to establish cause. He reiterated that clinical trials support paracetamol’s effectiveness for acute pain, while warning that the drug can be dangerous in overdose and should be used at recommended doses.

On vaccination, the column noted recent eligibility expansions for the recombinant shingles vaccine Shingrix. Shingrix is offered as two doses to people aged 70 to 79 and to those who reached 65 since Sept. 1, 2023, and from this month eligibility now includes adults aged 18 and over with severely weakened immune systems, including people with cancers or those taking immunosuppressive therapies. Dr. Kaye and colleagues emphasised that shingles, caused by reactivation of the chickenpox virus, can lead to a painful rash and, in some people, chronic nerve pain, making vaccination a key preventive tool for eligible groups.

Across the topics, the column stressed common themes: seek medical assessment for new or worsening symptoms, treat underlying causes where possible, and discuss risks and benefits of medications and procedures with clinicians. Patients were advised not to stop prescribed treatments without consultation and to pursue specialist review when chronic conditions — such as diabetes or autoimmune disease — complicate diagnosis or management.