29 Apr Top Peripheral Neuropathy Treatment
Peripheral neuropathy (PN) is a condition that develops as a result of peripheral nervous system damage, which transmits information between the brain, spinal cord, and every other body part. Neuropathy means “nerve disease” or “nerve damage.”
How common is peripheral neuropathy?
According to statistics, an estimated 20 million Unites States citizens have some type of peripheral neuropathy. The incidence of PN in the general population is 2.4%, and 8% of people older than 55 years are affected.
What causes peripheral neuropathy?
Peripheral nerves transmit sensory information back to the brain and spinal cord from the extremities (hands, arms, feet, and legs). These nerves also generate movement. Any damage to the peripheral nervous system will interfere with these nerve signals. PN distorts and interrupts messages between the brain and the rest of the body. Common causes of peripheral neuropathy are:
- Diabetes – This is the most common cause of PN with around 45% of patients who have type 2 diabetes for more than 10 years developing this condition. This occurs from nerve damage related to high blood glucose levels that damage blood vessels and limit blood flow to the nerves.
- Cancer – Another at-risk group are cancer patients who receive chemotherapy medications that are toxic to the peripheral nervous system.
- Certain medical conditions – PN frequently occurs in patients with amyloidosis, Sjogren’s syndrome, lupus, rheumatoid arthritis, and human immunodeficiency virus (HIV).
- Physical injury or trauma – This could occur from a fall, accident, sports-related activity, or surgical procedure where nerves are severed, crushed, stretched, or compressed.
- Repetitive stress – This leads to entrapment neuropathies where there is irritation of ligaments, tendons, and muscles and constriction of nerve passageways. Examples include carpal tunnel syndrome (CTS) and ulnar neuropathy.
- Infections – Bacteria and viruses attack nerve tissues. Examples include Epstein-Barr virus, herpes varicella zoster, West Nile, cytomegalovirus, and Lyme disease. The pathogens trigger inflammation that damages nerve fibers.
What are the symptoms of PN?
The symptoms associated with peripheral neuropathy include:
- Pain and numbness of the affected extremity(ies)
- Altered mobility and balance
- Decreased quality of life
- Impaired digestion
- Sexual dysfunction
- Distorted experience of touch (called allodynia)
- Pain in response to light stimulus
- Muscle weakness
- Painful cramps and uncontrolled muscle twitching
- Muscle atrophy
- Decreased reflexes
How are the peripheral neuropathies classified?
Experts have identified more than 100 kinds of peripheral neuropathy. These disorders are classified according to the type of nerve damage that occurs. Mononeuropathies affect only one nerve, whereas polyneuropathies affect multiple nerves.
How is peripheral neuropathy diagnosed?
The San Diego neuropathy doctor will conduct many tests to diagnose the disease causing nerve damage. Evaluation includes:
- Blood tests – Used to assess for infection, diabetes, and various medical conditions.
- Nerve conduction velocity (NCV) testing – Done to determine the nature and extent of neuropathy and assesses the degeneration of the myelin sheath.
- Electromyography (EMG) – This involves insertion of a fine needle into a muscle, which records electrical activity when muscles contract and are at rest.
- Magnetic resonance imaging (MRI) – This is used to detect muscle quality and size, rule out tumors, herniated discs, and structural problems, and detect fatty replacement of muscle tissue.
- Nerve biopsy – Removal of nerve tissue of the lower leg to assess for damage.
How is peripheral neuropathy treated?
The first aspect of treatment for PN is to address the underlying medical problem. Options include:
- Immunosuppressive drugs – Certain autoimmune conditions are treated with medications like cyclosporine, prednisone, rituximab, and azathioprine.
- Pain relievers – Chronic neuropathic pain responds to antidepressants (amitriptyline and nortriptyline), anticonvulsants (Tegretol and Neurontin), and anti-inflammatory agents (naproxen and ibuprofen). For severe pain, narcotic analgesics are prescribed short-term. In addition, mexiletine is an antiarrhythmic drug often used for painful neuropathies.
- Topical agents – Capsaicin is a substance found in hot peppers that modifies peripheral pain receptors. Another agent used topically is lidocaine, which blocks pain signals.
- Transcutaneous electrical nerve stimulation (TENS) – This is a noninvasive intervention that involves attaching electrodes to the skin near the site of pain. A gentle electrical current is transmitted to interfere with pain signal transmission. In a literature review, TENS used once a day for 4-12 weeks was found to be significantly superior to placebo for pain reduction in symptoms of PN.
- Surgical intervention – For entrapment neuropathies, surgery is performed to release the nerve from compressing tissues.
- Lumbar sympathetic block – When PN affects the lower extremities, a nerve block can be performed. The doctor uses x-ray guidance to position a needle near the low back nerves, and an anesthetic and/or neurolytic agent is injected. According to a research report, participants had 50% pain relief and improve function. Overall, the efficacy rate for the block was 85%.
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Jin D-m, Xu Y, Geng D-F, & Tan T-B (2010). Effect of transcutaneous electrical nerve stimulation in symptomatic diabetic peripheral neuropathy: A meta-analysis of randomized controlled trials. Diabetes Res Clin Pract, 89:10-15.
Manchikanti L, Singh V, Falco FJE, et al. (2010). Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: A randomized, double-blind, controlled trial with a 2-Year follow-up. Int J Med Sci, 7(3), 124-135.
National Institute of Neurological Diseases and Stroke (2016). Peripheral neuropathy fact sheet. Retrieved from: http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm