DEAR DR. ROACH: My husband has neuropathy in his feet. He is otherwise healthy, exercises daily, maintains his weigh, and eats healthy. My concern is that he uses chewing tobacco. He insists that it doesn’t have a negative influence on his condition, but I disagree. What’s your medical opinion? He is fully aware of other health complications that chewing tobacco can cause, but he doesn’t make an effort to quit. I’m frustrated and worried about his future. He is 63.

• A.C.W.

ANSWER: There are many causes of neuropathy. Diabetes is a major one, but I get many letters from readers (and also have several patients) with unexplained neuropathy, which often causes pain or numbness in their feet or hands. Without a precise diagnosis, doctors often try medications to reduce nerve pain, such as gabapentin or antidepressants like amitriptyline or duloxetine, which work at the level of the nerve cell.

You’re right that chewing tobacco can make many kinds of neuropathy worse. It seems that nicotine can damage the nerves themselves. Smoking increases the risk of neuropathy in people with diabetes by about 40%. A different study in people without diabetes found an 18% increased risk for neuropathy in smokers compared to nonsmokers.

Chewing tobacco provides about the same level of nicotine as smoking. So does taking snuff, but I hardly ever see anyone who uses snuff. (Some people don’t know that snuff is powdered tobacco.) In addition to the neuropathy that is the issue here, chewing tobacco dramatically increases the risk of head and neck cancer, particularly oral cancer. If your husband saw the effects of oral cancer and its treatment, he might be more motivated to quit.

But a person’s own motivation isn’t enough sometimes. Many people who habitually use nicotine need external help. Nicotine replacement and medications like a nicotine receptor blocker (varenicline) or an antidepressant (bupropion), along with behavioral counseling, can dramatically improve a person’s ability to quit tobacco in any form.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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