The Mazes And Minefields Of Neuropathy Treatments And Therapies

Today's post from everydayhealth.com (see link below) attempts the virtually impossible in that it tries to sum up both the symptoms and current treatments of nerve damage in one relatively short article. Unfortunately, this article pretty much sums up the problem with treating neuropathy because neuropathy is no single disease but a condition with over 100 causes and over 100 forms...all this and incurable too! So trying to cover all the bases is extremely difficult and often leads to this sort of article which, however well-meaning, is unfortunately a little confusing and disconnected. That said, ten years ago, finding information about neuropathy on the internet was a needle in a haystack exercise, so we must be grateful for anything that seeks to educate patients about their condition and how it's treated. There are many other such articles here on the blog (use the Search button), some more cohesive and some less but the point is that you can learn something new from each one of them. Basically, neuropathy patients face minefields of information everywhere they turn and doctors don't have the time to go into it all, so extensive research is the only way you'll find the answers you're looking for. That's why some articles are more reader-friendly than others but sifting through the information will educate you in ways that home-doctors and neurologists simply don't have the time or resources to do.
 

Which Treatments and Therapies Are Available for Neuropathy and Nerve Pain?
By Sheryl Huggins Salomon Medically Reviewed by Samuel Mackenzie, MD, PhD  Last Updated: 5/29/2018

The cause and symptoms of your case of neuropathy will help your doctor determine the appropriate treatment approach.

Just like neuropathy (also called peripheral neuropathy) isn’t just one condition, neither is there a single treatment option that’s best for all forms of this group of health issues.

Ultimately, your treatment will be determined by the cause of your nerve damage, as well as the symptoms of neuropathy that you develop. (1)

A Closer Look at the Types of Neuropathy, and Their Causes and Symptoms

Nerve damage doesn’t show up the same way in everyone. But potential signs and symptoms of neuropathy include temporary or permanent numbness; a tingling, prickling, or burning sensation; increased sensitivity to touch; pain; muscle weakness or wasting; paralysis; dysfunction in organs or glands; or impairment to urination and sexual function. (2,3)


More on Signs of Neuropathy



What Neuropathic Pain Feels Like and the Causes of the Symptom The symptoms you develop depend on which nerves are affected. For example, autonomic nerve damage can lead to changes in blood pressure or cause symptoms impacting your gastrointestinal system. On the other hand, sensory nerve damage may impact your sense of balance. Last, motor nerve damage can lead to issues with your reflexes and movement.


Sometimes, damage can affect a combination of your nerves. Sensorimotor polyneuropathy occurs when your motor nerves and sensory nerves become damaged and cause body-wide nerve damage.

This combo may stem from various diseases, disorders, and even treatments, including: (4)
Sjögren's syndrome and lupus (two autoimmune conditions) 

Alcoholism
Type 2 diabetes
Chemotherapy
Guillain-Barré syndrome
Hereditary disorders
HIV/AIDS
Vitamin B12 deficiency or deficiency of vitamins B1 and E
Zika virus infection

Symptoms of neuropathy and their severity can also vary according to the types of damage that occur within nerves. For instance, axonal neuropathies are a result of damage to the axons, the nerve fibers that conduct impulses away from the neuron cell body. Axonal damage can make the nerve stop working.

Demyelinating neuropathies are a result of damage to the myelin sheath, a fatty covering that protects many nerve fibers and helps with the transmission of electrical impulses along nerve cells. If the myelin sheath is damaged, the nerve impulses will slow down. Some neuropathies involve both demyelinating and axonal damage. For instance, although axonal loss is responsible for many of the symptoms of neuropathy in people with diabetes, demyelination can also be involved. (5)

What Are the Main Ways That Neuropathy Is Treated?

Treating neuropathy in general focuses first on identifying and then addressing the underlying condition to help prevent further damage and give nerves the time they need to heal to the extent that they can.

“The treatment for the neuropathy is to reverse whatever it is that is causing the neuropathy,” says Clifford Segil, DO, a neurologist at Providence Saint John's Health Center in Santa Monica, California. “We try to reverse the insult to the nerves first and then do symptomatic control.”

More on the Basics of Neuropathy



6 Possible Complications of Neuropathy and How They’re Treated



The Health Benefits of Exercising With Neuropathy For people with diabetic neuropathy, the first step physicians take is getting the person’s blood glucose level under control, says Matthew Villani, DPM, a podiatrist at Central Florida Regional Hospital in Sanford, Florida.

This treatment approach aims to remove the “insult” created by the excess sugar to peripheral nerves throughout the body — but especially the extremities, Dr. Segil explains.

Here are some other ways diabetic neuropathy may be treated: (6,7,8,9,10,11,12,13, 14,4)
Pain, burning, and tingling are treated with over-the-counter and prescription medication such as nonsteroidal anti-inflammatory drugs (NSAIDs), topical creams, COX-2 inhibitors, antidepressants, anticonvulsants, and opioids. 

Numbness or complete loss of sensation can lead to complications such as ulcers, sores, and limb amputations. It is addressed by monitoring the affected areas — often the feet — for injuries and addressing wounds before they become more serious, as well as prescribing protective footwear and braces. 

Orthostatic hypotension (a drop in blood pressure upon standing up), which is an autonomic symptom, can be treated with increased sodium intake, a vasopressor such as ProAmatine (midodrine) to constrict blood vessels, a synthetic mineralocorticoid such as fludrocortisone to help maintain the balance of salt in the body, or a cholinesterase inhibitor such as pyridostigmine, which affects neurotransmitters. 

Gastroparesis, a delayed emptying of the stomach, is another autonomic symptom, which can be treated with medication to control nausea and vomiting, such as Reglan (metoclopramide), Ery-Tab (erythromycin), antiemetics, and antidepressants, as well as pain medication for abdominal discomfort. 

Motor neuropathy symptoms can include weakness and muscle wasting, particularly in the lower extremities, as well as deformities of the feet and loss of the Achilles’ heel tendon reflex. Treatments can include physical therapy to regain strength, as well as braces and orthotics.

How Is Neuropathic Pain Typically Treated?

Vernon Williams, MD, a sports neurologist who is director of the Center for Sports Neurology and Pain Medicine at Cedars-Sini Kerlan-Jobe Institute in Los Angeles, says neuropathic pain tends to be “burning” or “electric.” Pain medication can help with such symptoms and improve sleep and quality life, but unfortunately neuropathy isn’t reversible or curable, he explains.

Common methods of treating neuropathic pain include: 
 
Over-the-counter medication, such as NSAIDs
Prescription medication (15)
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) (16)
Anticonvulsants (17,18)
Neuromodulation (19)
Surgery (20,21,22)





Article
11 Must-Know Risk Factors for Neuropathy


Everything from chemo to infections may lead to neuropathic symptoms. Learn more about the top causes of nerve damage here.

How Nutrient Supplements May Also Be Used to Help Treat Nerve Pain

Furthermore, nutrient supplements have suggested promising results for people with neuropathy, says R. Glenn Smith, MD, a neurologist at Houston Methodist in Houston. “We are using alpha lipoic acid for many of our patients who have diabetic neuropathy,” he says. The antioxidant is a naturally occurring fatty acid found in many foods, such as yeast, spinach, broccoli, Brussels sprouts, yams, potatoes, and organ meat such as liver and kidney. Some studies have shown an improvement of nerve pain specifically in people with diabetes.


More on Diet and Neuropathy




How Your Eating Habits May Affect Neuropathy Management and Progression Another fatty acid, carnitine, is sometimes deficient in people with diabetic neuropathy and nondiabetic types of neuropathy caused by an insufficient blood supply to nerves. In healthy children and adults the body makes all of the carnitine that it needs, so it is not necessary to get more from supplements or nutritional sources such as meat, poultry, and dairy products. But supplementation of the form of the fatty acid known as acetyl-L-carnitine is used to treat neuropathy, says Dr. Smith. Some studies have shown nerve regeneration and an improvement in nerve pain after acetyl-L-carnitine supplementation. (23,24,25,26,27)

Other Possible Therapies for Neuropathy

Other emerging therapies have the potential to help treat neuropathy. Here are a handful:

Chelation Therapy

Heavy metal toxins, such as mercury and arsenic, can cause neuropathy if you take in too much. The first course of action is to avoid the source of the toxin — for instance, avoiding fish from waters that are highly contaminated with mercury. Then the toxin may be removed from the blood using a chelating agent that is administered orally or intravenously, and binds to the heavy metal so that it can be excreted in urine. Among the common medications used in chelation therapy are dimercaptopropanesulfoxid acid (DMPS), dimercaptosuccinic acid (DMSA), and dimercaprol. But Smith cautions against using these treatments outside of a clinical setting. “There are those who have made a big business out of offering chelation therapy, and unfortunately it has been overused in some patients. These medicines have lots of side effects, and some of them can kill if used improperly.” (28)
Intravenous Immunoglobulin Therapy

Intravenous immunoglobulin (IVIG) therapy is sometimes used to treat underlying infections and autoimmune disorders that can lead to neuropathy, such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIPD), lupus, and vasculitis. “We try to stop the immune process that is creating the damage,” explains Smith. Other treatments used in these cases include corticosteroids and plasmapheresis, a process in which blood plasma is extracted and then treated and returned or exchanged. (29,30)

Physical Therapy

In some cases of motor neuropathies involving weakness and muscle wasting, physical therapy can help. “When we are using a muscle continuously or we are releasing growth factors, we are trying to get those nerves to grow back,” says Smith. The success of physical therapy can depend on the extent of the nerve damage and the age of the patient, with older patients less likely to experience the extent of recovery that younger patients do, he adds. Additionally, in the case of diabetic neuropathy, exercise can help with controlling blood glucose levels. (31)

Additional reporting by Joseph Bennington-Castro.

Resources

The Foundation for Peripheral Neuropathy Mayo Clinic National Institute of Diabetes and Digestive and Kidney Diseases

Editorial Sources and Fact-Checking

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https://www.everydayhealth.com/neuropathy/guide/treatment/