Sunday, 14 August 2016

An Overview Of Neuropathy And Its Treatment

Today's post from (see link below) is a long description of neuropathy aimed at promoting a gel produced by the website's author/company. However, because this blog doesn't advertise, I'll leave decisions about that particular product to the reader who can trace it via the link below if they wish. Normally, any advertising would preclude it from inclusion here but there is so much useful and accurate information in this article, it should be shared with readers who want an easy-to-understand overview of what neuropathy is and how it's treated. It's worth a read, even for experienced neuropathy patients because however much we think we know about nerve damage, there's always something more to learn.

Nerve Pain Relief, Nerve Pain Treatment Neuropathy Causes, its Types and Neuropathy Treatment.
JI WellHealth, 2016 Dr J.I is a Board Certified Neurologist with sub-specialty in Neuro-muscular and Musculo-skeletal Disorders

Common neuropathy types, Neuropathy causes, their manifestations and management and neuropathy treatment

Neuropathy - Overview
Peripheral neuropathy refers to damage to the nerves in the peripheral nervous system. there are many neuropathy causes which can damage the nerves. These nerves have sensory fibers, motor fibers and autonomic fibers.
Sensory fibers carry the sensation from the periphery to the central nervous system and they are of various diameters, small fibers carry the pain and temperature sensation, while the large fibers carry proprioceptive information from the joints and tendons.

These fibers are also myelinated and unmyelinated types.
Motor fibers supply the muscles in the body.
Autonomic fibers supply the blood vessels and control the blood pressure and sweating from the skin. there are many neuropathy causes among hereditary and acquired type

There are various types of neuropathies.

Causes of Neuropathy
Acquired neuropathy causes
can be caused by various disease processes which can include systemic metabolic disturbances like diabetes, endocrine disturbances like hypothyroidism, nutritional deficiencies like vitamin B12 deficiency, beriberi, toxicities like excessive use of alcohol, drug toxicities,

Infectious disease processes like Lyme's disease,
Cancer leading to paraneoplastic syndromes or damage to the nerves due to chemotherapy,
Collagen vascular diseases like lupus, rheumatoid arthritis.

Peripheral neuropathy can be accompanied by weakness, wasting of the distal muscles of the legs and arms, loss of sensation, numbness, tingling, pain and burning and stinging sensation involving the toes and feet which can later on spread upwards towards the knees.

Patient can also experience significant degree of stabbing pains involving the distal parts of the legs along with muscle cramps and spasms.

Small fiber peripheral neuropathy can be very painful with constant burning and stinging sensation involving the distal portions of the legs without any accompanying weakness of the muscles, such type of peripheral neuropathy is seen commonly in diabetics.

Pain due to small fiber peripheral neuropathy can be very severe and disabling
Peripheral neuropathy - Symptoms usually presents with sensory symptoms affecting the toes in the feet. Patient usually experience numbness, tingling, burning and stinging sensation involving the toes. In addition, one can also experience sharp shooting stabbing pains in the feet going upwards. Gradually, the numbness and painful sensation involving the toes starts to spread upwards involving the feet, ankles and calves,

Ordinary stimuli become very sensitive and painful. Touching the feet with bed clothing also creates unpleasant sensations involving the feet. A person can also develop restless leg syndrome-type symptoms, where one has an urge to move the feet and legs constantly to get relief from the discomfort, especially at night.
During walking, patient feels that he or she is walking on pebbles and gets unpleasant sensations. 

If the sensory fibers are predominantly involved, it can lead to lack of feeling involving the bottom of the feet and thus leading to loss of balance on uneven surfaces. Once the sensory symptoms extend up to the knees, then the fingertips can also start becoming numb and painful.
In common sensori-motor peripheral neuropathy, motor fibers are also involved leading to wasting of the small muscles of the feet. Muscles controlling the feet and ankles become weak and wasted leading to tripping over uneven surfaces and losing balance. 

If the neuropathy is extensive, it can lead to bilateral foot drop where one has difficulty in bringing the toes upwards and therefore causing significant problems during ambulation.
Some of the neuropathies predominantly affect the proximal muscles of the legs, in which case, patient has difficulty in getting out of chair, climbing stairs or walking.

If neuropathy is caused by vasculitis or other processes leading to mononeuritis multiplex, then patient experiences acute onset of weakness and numbness in the distribution of the affected nerve along with significant pain. These processes can affect one nerve after another in different parts of the arms and legs so the clinical picture is of asymmetric sensory and motor disturbances in the limbs which in later stages can appear as symmetrical deficits after having caused damage to many nerves in both arms and legs
Most of the acquired forms of peripheral neuropathy ( metabolic or toxic in nature), have slow onset and progress over months to years.

Demyelinating forms of peripheral neuropathies like Guillain-Barré syndrome have acute onset. Within days, patient starts having progressive type of weakness and numbness involving the distal parts of the legs which extends upwards to involve the proximal muscles, arms are also affected. Patient does experience numbness and tingling involving the toes and distal portions of the legs and arms. Within days, patient is bed bound and unable to ambulate, respiratory muscles can get affected and lead to a life-threatening situation

cranial nerves can also be affected leading to bilateral facial weakness and ophthalmoplegia and also weakness of the swallowing and chewing.

Guillain-Barré syndrome is an acute medical emergency and needs to be taken care of in intensive care unit in a hospital

Tick paralysis can also present in a manner similar to Guillain-Barré syndrome presentation however in this case, sensory symptoms are minimal

Acute intermittent porphyria can also present with acute onset of motor neuropathy leading to weakness of all 4 extremities within hours to days, usually accompanied by abdominal pain and mental status changes like confusion and psychotic behavior

Small fiber peripheral neuropathy

is usually very painful, leading to severe degree of burning and stinging sensation in the toes and feet,
Increased sensitivity to any kind of touch to the affected area, leading to sleep disturbances and trouble in daily life

Distal symmetric sensori-motor neuropathy causes
Neuropathy causes - Systemic and metabolic disturbances
Diabetes mellitus, hypothyroidism, acromegaly, uremia, primary biliary cirrhosis, hypophosphatemia , gout, post gastrectomy syndrome, gastric bypass surgery for obesity Whipple's disease, critical illness polyneuropathy, sarcoidosis, porphyria, amyloidosis

other neuropathy causes are as follows;
Neuropathy causes- Nutritional deficiencies
B-1 deficiency(thiamine), vitamin B12 deficiency, folate deficiency,
Neuropathy causes- Toxins
Vitamin B6 toxicity, alcoholism, drugs like amitriptyline, phenytoin, glue sniffing, ethylene oxide, hexacarbons, acrylamide, organophosphates, mercury, gold, thallium,INH, hydralazide, colchicine, Flagyl, lithium, chloroquine, Tagamet, Myambutol, Antabuse, Cisplatin
Neuropathy causes- Connective tissue diseases
Rheumatoid arthritis, polyarteritis nodosa, lupus, cryoglobulinemia Churg-Straus, vasculitis
Neuropathy causes- Infectious diseases
Lymes disease
HIV infection
CMV infection
Neuropathy causes- Malignancies
Paraneoplastic syndrome
infiltration with carcinoma or lymphomas
Immune disturbances
Guillain-Barré syndrome

Proximal symmetric Motor peripheral neuropathy causes
Motor weakness is more prominent as compared to the sensory symptoms, and proximal muscles of the limbs are more involved than the distal muscles
Symmetrical form of diabetic amyotrophy
Guillain-Barré syndrome
Chronic inflammatory demyelinative polyneuropathy
Monoclonal gammopathy of unknown significance ( MGUS)
Waldrenstrom's macroglobulinemia
Lymes disease
Lead toxicity

Pure Sensory Neuropathy causes
Diabetes, Sjogren syndrome, Paraproteinemias, Carcinomatous sensory neuronopathy
Toxic effects of certain medications
Primary biliary cirrhosis
Crohn's disease
Chronic gluten enteropathy
Vitamin E deficiency
Vitamin B6 toxicity,
cisplatin toxicity leading to sensory neuronopathy
Paraneoplastic syndrome
sensory neuronopathy
Idiopathic sensory neuropathy
Diabetes Alcoholism, Vitamin B-1 (thiamine) deficiency Paraneoplastic sensory neuropathy
Acute pandysautonomia with sensory neuropathy
Arsenic, mercury, thallium toxicity

Neuropathy Causes- Hereditary
common are ;
Charcot-Marie-Tooth type 1,
Charcot-Marie-Tooth type II,
Dejerine-Sottas neuropathy,
hereditary sensory neuropathy with congenital insensitivity to pain
There are many more forms of hereditary peripheral neuropathies

Nerve Pain Relief/ Nerve Pain Treatment
Neuropathic pain can be very difficult to control. Following categories of the medications have been helpful to control the discomfort, There is no medicine which can cure peripheral Neuropathy, all help in lessening or controlling the pain

Nerve Pain Relief/ Nerve Pain Treatment
Antidepressants agents
Nerve pain treatment with Tricyclic antidepressants like amitriptyline and newer antidepressants which help to increase the levels of serotonin and norepinephrine have been proven to be of help to control the pain. Following are the brand names of these medications


with these agents increase the levels of serotonin and norepinephrine by blocking the re-uptake of these neurotransmitters at the nerve terminals. They enhance the efficacy of the descending serotonergic and norepinephrine pathways in the spinal cord and thus block the ascending pain carrying spinal tracts

Nerve Pain Relief/ Nerve Pain Treatment with
Antidepressants which have been proven to be of help, block both the serotonin and norepinephrine rather than blocking only one of them. The dosage of these medications for control of pain are much less as compared to the dosage required for controlling depression and they are widely used for neuropathy treatment of the underlying pain
the above medications help to control constant burning and stinging pain but they do not help sharp shooting jabbing pains which also occur in peripheral neuropathy, for sharp shooting jabbing intermittent pains.

Nerve Pain Relief/ Nerve Pain Treatment
Neuropathy Treatment -Anticonvulsant medications
Use of anticonvulsant medications have been helpful to bring nerve pain relief, they decrease the nerve impulses in the peripheral nerves, they act on the sodium channels and are important part of nerve pain relief treatment regimen. These drugs are as follows;


gabapentin and Lyrica seem to work through calcium channels and they have been proven to be helpful in controlling the sharp shooting pains.
Nerve Pain Relief/ Nerve Pain Treatment
Neuropathy Treatment- Alpha Lipoic Acid 600 mg per day and Benfotiamine 400 mg daily
have been proven to decrease the pain and uncomfortable sensation in diabetic peripheral neuropathyNerve Pain Relief/ Nerve Pain Treatment
Neuropathy Treatment -Topical ointments and gels
Lidocaine 5% patch
Capsaicin cream can be also of help
Ketamine topical Gel can also be of help

Dr. JI's Arthritis Plus Gel is helpful in bringing pain relief

Nerve Pain Relief/ Nerve Pain Treatment
In nerve injuries leading to RSD beta blockers, calcium channel blockers and clonidine have been helpful

Nerve Pain Relief/ Nerve Pain Treatment with Narcotics
This should be the last resort if other treatment is not successful. Judicious use of tramadol or methadone can be of help to control the pain.

Nerve Pain Relief/ Nerve Pain Treatment

with TENS Unit and sympathetic nerve blocks
Can be of help to some patients
It is very important to have very good control of the underlying disease process leading to peripheral neuropathy to avoid worsening of the condition in the future

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