Peripheral neuropathy treatments

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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No medical treatments now exist that can cure most forms of peripheral neuropathy. However, there are therapies for some forms.

If there is a specific treatable condition that is causing the neuropathy, then treatment for that should be initiated concurrently with symptomatic treatment. Peripheral nerves have the ability to regenerate.

The most common avoidable and potentially treatable causes include metal toxins, vitamin deficiencies, excessive alcohol consumption, diabetes, and cigarette smoking.

Self-care skills such as meticulous foot care and careful wound treatment in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and improve quality of life. These changes create conditions that encourage nerve regeneration.

Systemic diseases frequently require more complex treatments. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage.

Although less common, inflammatory and autoimmune conditions leading to neuropathy can be controlled. Immunosuppressive drugs such as prednisone, cyclosporine, or azathioprine may be beneficial. Plasmapheresis-a procedure in which blood is removed, cleansed of immune system cells and antibodies, and then returned to the body-can suppress immune system activity. High doses of immunoglobulins, proteins that act as antibodies, also can suppress abnormal immune system activity.

Neuropathic pain is often difficult to control. Several classes of drugs have recently proved helpful to many patients suffering from more severe forms of chronic neuropathic pain.

Several antiepileptic drugs, including gabapentin (Neurontin), pregabalin (Lyrica), phenytoin (Dilantin), and carbamazepine (Tegretol); and some classes of antidepressants, including tricyclics such as amitriptyline have been used.

Injections of local anesthetics such as lidocaine or topical patches containing lidocaine may relieve pain.

Mechanical aids can help reduce pain and lessen the impact of physical disability. Hand or foot braces can compensate for muscle weakness or alleviate nerve compression. Orthopedic shoes can improve gait disturbances and help prevent foot injuries in people with a loss of pain sensation.

Surgical intervention often can provide immediate relief from mononeuropathies caused by compression or entrapment injuries. Nerve entrapment often can be corrected by the surgical release of ligaments or tendons.

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