Numb Toes and Aching Soles: Coping with Peripheral Neuropathy. By John A. Senneff. San Antonio, MedPress, 1999. Pages: 336. Cost: $29.95.

I read the first several chapters of this book before reading the preface and was surprised to find that the author is not a physician. John Seneff is a person with a long history of painful neuropathy who has had no medical training. His writing style and approach to his topic resembles that of a well-informed clinician writing a review article for professional colleagues.

The book is directed toward a sophisticated, nonmedical audience. I would not recommend the book to a patient who is content to trust a physician to make all his or her healthcare decisions. The book is for the person who would like to actively participate in the medical decision-making process. It is thorough, accurate, and relatively unbiased. Most recognized medical treatments for painful neuropathy are moderately effective at best, and the author presents examples of scientific studies with positive and negative results for each form of therapy.

In a document of this scope, it is impossible to provide a detailed assessment of every form of therapy. On a few occasions, such lack of detail may lead to misleading implications. For example, the author points to promising results with SNX-111 (ziconotide), but fails to inform the reader that the studies involved intrathecal administration of the drug via a surgically implanted device. Similarly, his positive comments regarding cyclooxygenase-2 inhibitors might lead one to believe that they are more effective than older nonsteroidal antiinflammatory drugs (NSAIDs) for neuropathic pain, which is unlikely. With few exceptions, Senneff’s coverage of mainstream medical therapy for neuropathic pain, was thorough (although not exhaustive), accurate, and unbiased. His discussions of medical therapies that are not a part of my practice (e.g. , plasmapheresis, immunosuppressants, and IVIg) are most informative. His coverage of some new variations on the trancutaneous electrical nerve stimulation theme (e.g., “microcurrent therapy”) was a bit optimistic, referring only to “company claims of substantial benefit.” I also thought Seneff’s discussion of “aerobic oxygen” (i.e. , stabilized oxygen in a nontoxic form) should have been more disparaging. Perhaps fear of legal retribution discouraged him from denouncing it as pure flim flam.

I found myself considering whether ginkgo biloba or St. John’s Wort might have a positive effect on my well-being. I agree with Seneff’s opposition to the Food and Drug Administration’s regulation of herbal remedies, which are based upon his belief that such regulation would unnecessarily raise prices. He correctly states that few manufacturers would spend research funds on products that lack patent protection. Nevertheless, we should vigorously support public funding for good scientific studies of safety and effectiveness of herbal derivatives.

A valuable feature of this book is the testimonials, which include comments from internet bulletin boards, forums, and news groups concerning patients’ experiences with the treatments discussed. There are comments about dramatic successes, dismal failures, and terrible side effects. Several entertaining comments about magnetic therapy include “The magnet draws blood to the sore area, and it becomes very warm and then the pain seems to ease”; “If a doctor makes a statement to me that ‘magnets bring warmth to the area,’ that doctor is incompetent a quack, on drugs, all of the above, or worse. Beware of this guy”; and “No, I don’t stick to the refrigerator door.” Following several positive comments about chelation therapy, Seneff comments “If anyone has been injured in a chelation related incident, please contact me regarding suing the doctor that charged you so much for your ineffective therapy.”

In summary, this book is informative and entertaining, and is recommended for patients who are willing to take an active role in their own pain management. The best testimonial I can make is the fact that I have sent the book to a physician friend who recently asked me about treatment options for his peripheral neuropathy. It is certainly worth the modest price of $19.95 (paperback) or $29.95 (hard cover).