peripheral neuropathy treatment
To Treat the Cause
To Manage the Symptoms
To Optimise daily activity and Quality of Life
- Medicines can be partially effective against pain, though often with side effects.
- Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
- Occupational therapy can help you deal with the dysfunction and pain.
- Surgery may help in cases where there is compression of a nerve, e.g. carpal tunnel syndrome.
- A healthy diet, supporting the nerves and decreasing inflammation [LINK]. This is particularly vital with diabetes to stop progression of nerve damage.
- Orthopaedic aids, e.g. braces and special shoes, can support mobility and maybe ease pain.
- Choosing a healthy lifestyle, such as aerobic and resistance-based exercise to improve circulation and muscle strength, stopping smoking, losing excess weight, and avoiding alcohol and other drugs intake.
B vits [min B12 levels in Japan have been raised to 550nm/l.]
Vitamin E (mixed tocopherols and tocotrienols, from palm oil, hopefully organically and ecofriendly grown )
GLA [borage/starflower, blackcurrant and primrose oils], 350 mg or more per day, upto 5 g.
Chromium and zinc. Enables insulin to get into cells, protecting against and even reversing type 2 diabetes.
Investigating the role of backward walking therapy in alleviating plantar pressure of patients with diabetic peripheral neuropathy.
Arch Phys Med Rehabil.2014 May;95(5):832-9. doi: 10.1016/j.apmr.2014.01.003. Epub 2014 Jan 18
Dioscorea Extract (DA-9801)
There are a variety of complementary therapies that are claimed to help with PN. We have evaluated the best evidence for all the more plausible modalities and found that while most do not show reliable evidence for significant improvement of PN there are some that have excellent records of success.
How is neuropathy from Diabetes, Old Age and Chemotherapy treated?
Curing PN is rare so treatment is aimed at reducing symptoms and managing the condition so it does not worsen.
If you are going to a doctor or complementary therapist for treatment you can expect and hope for a 30-40% improvement in your symptoms. A 50% improvement can happen sometimes, as can more than that. You can also hope the treatment will stop the progression of this condition. You can expect to be needing regular treatment for a long period.
This might seem a bit depressing to only expect 40% improvement and stopping it getting worse however. the seriousness and relentlessness of PN when it progresses means anything you can do to stop the progression is essential, and 40% reduction is the difference between walking and not walking for many people, being able to sleep and not being able to sleep, being able to enjoy life and not.
Prescribed drugs have limited effect and often do not give anywhere near 30% improvement. Their side-effects can also be severe. So while it is essential to work with your doctor to try and find a drug that works for you. Your best port of call may end up being in complementary medicine.
A complementary therapy that has been found to work well and give the improvements we suggested above and stop progression is acupuncture. We thought it would be useful for you to hear the experience of an acupuncturist who specializes in PN in his own words. Jonathon Gilbert has been an invited speaker at John Hopkins, Georgetown University, University of Arizona, University of Maryland, and the American Academy of Pain Management. He has now treated 100s of people with PN from all walks of life, in his clinic in Washington DC:
“Using acupuncture techniques taught to me by my professors in Vietnam I am getting good results with peripheral neuropathy. I am seeing real levels in pain reduction, increased mobility and evidence that we are maintaining levels of improvement. I am seeing this in patients with diabetes, chemotherapy and older people. I find that initially treatment needs to be given 3 times weekly and then after 2 or 3 weeks it can be reduced until the patient is coming fortnightly. We find the patient will need to continue to come fortnightly. My patients are telling me that working with me in this way is giving them a new lease of life that they would not have had otherwise and that they are more than happy with the benefits they are getting from coming to see me just once fortnightly.”
- 2013;309(13):1359-1367. doi:10.1001/jama.2013.2813
Importance There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy.
Among the centrally acting analgesic drugs for many years mainly the tricyclic antidepressants (TCA), carbamazepine, gabapentin, and opioids have been used to treat neuropathic pain. More recently, significant pain relief has been reported in clinical trials of painful diabetic neuropathy using agents such as the dual selective serotonin noradrenaline reuptake inhibitor (SNRI), duloxetine and the anticonvulsant pregabalin,
Approximately 20% to 40% of patients with cancer who receive neurotoxic chemotherapy (e.g. taxanes, platinums, vinca alkaloids, bortezomib) will develop painful chemotherapy-induced peripheral neuropathy.
Painful chemotherapy-induced neuropathy can persist from months to years beyond chemotherapy completion, causing significant challenges for cancer survivors due to its negative influence on function and quality of life (QOL) Chemotherapy – induced peripheral neuropathy is difficult to manage, and most randomized controlled trials testing a variety of drugs with diverse mechanisms of action revealed no effective treatment.
There is mounting evidence that serotonin and norepinephrine dual reuptake inhibitors (SNRIs) are only very slightly effective in treating neuropathy-related pain. Both serotonin and norepinephrine are key neurotransmitters that suppress transmission of painful peripheral stimuli by inhibiting input to the spinal dorsal horn neurons.Several phase 3 studies show that duloxetine is an effective treatment for painful diabetic neuropathy.Based on these trials, our hypothesis was that duloxetine would ameliorate chemotherapy-induced peripheral neuropathic pain as well. A randomized phase 3 trial was conducted to test this hypothesis.
Treatments and drugs
One goal of treatment is to manage the condition causing your neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. Another goal of treatment is to relieve the painful symptoms.
Many types of medications can be used to relieve the pain of peripheral neuropathy, including:
Pain relievers. Mild symptoms may be relieved by over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs. For more-severe symptoms, your doctor may recommend prescription painkillers.
Medications containing opioids, such as tramadol (Ultram ER) or oxycodone (Roxicodone), can lead to dependence and addiction, so these drugs are generally prescribed only when other treatments fail.
- Anti-seizure medications.Medications such as gabapentin (Gralise, Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Carbatrol, Tegretol) and phenytoin (Dilantin, Phenytek) were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects may include drowsiness and dizziness.
- Immunosuppressive medications.Medications to reduce your immune system’s reaction, such as prednisone, cyclosporine (Sandimmune) and azathioprine (Imuran, Azasan), may help people with autoimmune conditions.
- A cream containing this naturally occurring substance found in hot peppers can cause modest improvements in peripheral neuropathy symptoms.
As with spicy foods, it may take some time and gradual exposure to get used to the hot sensation this cream creates. Generally, you have to get used to the heat before you can experience pain relief. Doctors may suggest you use this cream with other treatments.
- Lidocaine patch.This patch contains the topical anesthetic lignocaine/lidocaine (Xylocaine). You apply it to the area where your pain is most severe, and you can use up to four patches a day to relieve pain. Lidocaine may help reduce pain from peripheral neuropathy.
- Certain tricyclic antidepressant medications, such as amitriptyline, doxepin and nortriptyline (Aventyl, Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also may effectively treat the pain of peripheral neuropathy caused by diabetes.
Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation.
Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. In this therapy, adhesive electrodes are placed on the skin and a gentle electric current is delivered through the electrodes at varying frequencies. TENS should be applied for 30 minutes daily for about a month.
The longterm effects of TENS is unknown and since it should not be used longterm nor should it be used at night TENS is of limited use for PN.
People with certain inflammatory conditions may benefit from procedures such as plasma exchange and intravenous immune globulin, which help suppress immune system activity.
In plasma exchange, your blood is removed, a machine removes immune cells from your blood, and your blood is returned to your body.
In immune globulin therapy, you’re given high levels of proteins that work as antibodies (immunoglobulins), which can help reduce your immune system’s activity.
Try using hand or foot braces to help support your movement if you have muscle weakness. You may also need physical therapy to improve your movements.
If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you may need surgery to reduce pressure on your nerves.
A procedure using infrared therapy may help improve sensation in the feet of people with diabetes. Researchers are studying the effects of infrared therapy and a therapy that uses magnetic foot soles to improve neuropathy in people with diabetes. The longterm effects of these treatments is not yet known.
A number of pharmacological treatments can be used to manage neuropathic pain outside of specialist pain management services. However, there is considerable variation in how treatment is initiated, the dosages used and the order in which drugs are introduced, whether therapeutic doses are achieved and whether there is correct sequencing of therapeutic classes. A further issue is that a number of commonly used treatments are unlicensed for treating neuropathic pain, which may limit their use. These factors may lead to inadequate pain control, with considerable morbidity.
Commonly used pharmacological treatments include antidepressants (tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs] and serotonin–norepinephrine reuptake inhibitors [SNRIs]), antiepileptic (anticonvulsant) drugs, topical treatments and opioid analgesics. In addition to their potential benefits, all of these drug classes are associated with various adverse effects.
- exercises prescribed by a physiotherapist.
- splints if their ankles are very weak
- one or two sticks or crutches or a frame to help walking
- very rarely, a wheelchair.
- to take great care of their feet to avoid ulcers.
If there is pain, they may be helped by:
- drugs including paracetamol, amitriptyline or nortriptyline, gabapentin or pregabalin, carbamazepine, duloxetine or tramadol
- attending a special pain clinic for a pain management programme.
There are specific treatments for some types of peripheral neuropathy:
- diabetic neuropathy: good blood sugar control
- alcoholic neuropathy: not drinking anymore and vitamin B1
- vitamin-deficiency neuropathy: vitamin supplements. The missing vitamin needs to be identified by a doctor
- drug-related neuropathy: stopping the drug responsible
- inflammatory neuropathy: anti-inflammatory treatment with corticosteroids or other drugs
- hereditary neuropathy: no specific treatment is yet available.]]] cut n paste from http://www.cafamily.org.uk/medical-information/conditions/p/peripheral-neuropathy/
The only man to ever win two Nobel Prizes on their own, Linus Pauling, said that, ”