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Treatment of Peripheral Neuropathy

Treatments

Some neuropathies are reversible or temporary if the offending drug or toxin is removed, the virus or bacteria killed, the structural compression is relieved, or the antibodies neutralized.

On the other hand, for many causes, particularly diabetes, peripheral neuropathy can be a tough disorder to care for. It can be favorably affected if caught early and blood sugar levels are strictly controlled, but the longer the disease is present and/or the higher the blood sugar is allowed to rise, the more damage will done and the less likely to respond to care.

Currently, there are no gold standard treatments and no established treatments to reverse diabetic neuropathy. There are, however, many treatments to decrease the symptoms, and some have the potential to help restore damaged nerves.

Medications

Most prescription medications work not on the damaged nerves, but on the exaggerated responses of the central nervous system. This is why anti-convulsants or anti-depressive drugs may be used even when there’s no history of seizures or depression. Narcotics may also be partially effective, at least in the short term.

There are only 2 drugs currently approved by the FDA for the treatment of neuropathy, duloxetine (Cymbalta) and pregabalin (Lyrica). Studies on the latter found 40% of patients had greater than 50% relief.

Other agents commonly used are Gabapentin (Neurontin), tri-cyclic antidepressants (amitryptiline, nortryptiline, and desipramine). Opioid narcotic treatments (oxycontin, hydrocodone) for neuropathy are used as well to treat the condition, but are less favored because of the risk of dependency. There is also recent evidence that using opioids offers only temporary relief as it also stimulates those same cellular systems that promote the central nervous system’s pain amplification responses. Read more on Opiate Drug Failure

Overall, the consensus is that most patients taking prescription medications still experience moderate pain. Medication side effects, including heart arrythmias, gastrointestinal problems, tiredness and weight gain, may further reduce the benefit to the patient..

Topical Treatments

Some topical balms have shown promise for pain reduction of neuropathy. Lidocaine has been recommended by physicians for the treatment of post-herpetic neuralgia (shingles).

Capsaicin is the ingredient in cayenne peppers that makes them hot. In a small double blind study with 54 diabetics with moderate to severe neuropathy, subjects were asked to apply .075% capsaicin cream 4 times a day to the painful areas. After 8 weeks the average pain decrease in the capsaicin group was 49.1% versus 16.5% in the placebo group. Another study of 22 diabetics using the same protocol found that after 22 weeks, 50% experienced good relief, 25% were unchanged, and 25% were worse. Unfortunately, when tested, no improvements were found in the ability of the subjects to feel applications of warmth, cold, or vibration to the affected areas.

Care is needed for those choosing to try capsaicin since it will cause a burning sensation at the site of application, sometimes so severe that people have to discontinue its use. Additionally, and I can speak of personal experience here, applying that stuff with your hands can leave residues on your fingers. Accidentally touching your eyes with capsaicin on your fingers can be a very nasty experience.

Surgical Treatments

As I mentioned previously, one of the consequences of diabetic neuropathy is an increased size of nerve fibers and and increased stiffness of structures the nerves have to rest against or pass through. This combination increases the likelihood of a diabetic nerve to experience mechanical compression.

Over the past decade, there has been an increasing popularity of nerve decompression surgery in the foot and ankle and leg, much like that performed at the wrist for carpal tunnel syndrome. Although not all diabetics with neuropathy have compression injuries to their nerves, if they do, this is worth looking into as the success rates have improved recently.

Neuromodulators, such as spinal cord stimulators, implanted spinal pumps, electrodes that stimulate the motor cortex of the brain, and methods called deep brain stimulation are also intriguing recent technologies, again addressing the central nervous system responses, not the damaged nerves per se.

Nutritional Supplements

Many people with neuropathy have had encouraging results with various nutritional supplements, either to correct deficiencies such as vitamins B1, B6, B12, E, folic acid, and magnesium or to affect physiology through large quantity ingestion of nutrients such as omega-3 fatty acids, gamma linolenic acid, or alpha-lipoic acid.

Not surprisingly, studies have not necessarily shown consistent results. This may be simply because the researchers were not able to pre-identify those people most likely to benefit versus those who already had sufficient quantities of the tested nutrient in their bodies.

Therapy

Near-infrared therapy is a type of light therapy has become more and more popular over the years with various studies (not all though) showing good results with reduction in pain and relief of overall neuropathic symptoms.

Infrared is light just as visible light is. We can’t see infrared light, however, because it has too long a wavelength. Differing wavelengths of visible light create different colors; similarly, there are two basic types of infrared, near-infrared and far-infrared, named for how close the wavelengths are to the visible light wavelengths.

Far infrared lamps are what we are all familiar with. They would be the heat lamps commonly seen in bathrooms or saunas. Unfortunately, the primary effect far-infrared light has on humans is in the generation of heat, which doesn’t seem to be effective in the care of neuropathy.

On the other hand, near-infrared light generates little heat. The therapy application can be either through lasers or more commonly through light emitting diodes placed directly upon the skin.

How near-infrared (and to a lesser extent, visible red light) helps is not exactly clear, but it seems that it operates through two mechanisms. First it significantly increases blood flow, increasing the flow of nutrients to the damaged nerves, and second, it seems to release chemicals that promote better oxygenation of injured tissue. This means that it addresses the damaged tissue directly and if totally successful (i.e., the nerve damage hasn’t gone past its ability to regenerate), can result in both symptom reduction and actual improvements in the health of the nerves, reducing any need for medications.

For this reason, near-infrared therapy is the choice of primary therapy for our clinic. In a recent survey presented at a national convention for laser therapy, a little over 90% of patients at clinics across the nation using a protocol including near-infrared, reported satisfaction with care in as little as 2 weeks. (It should be noted that this therapy program is not a cure-all, and there are people for whom this type of care simply will not work. Luckily we can identify those people most likely to benefit with a good history and evaluation. For those who do qualify, I’ve found it to be an excellent approach for many sufferers both by itself or in combination with the above medicinal, nutritional and therapeutic measures.)

If you are looking for a practitioner near you, check out the group Neuropathy Treatment Centers of America. Although I am no longer associated with this group of doctors, I can attest that they are well-trained and can be of help to you.

And if you are in the Portland, Oregon area, please give us a call at 503-709-8946.

Peripheral Neuropathy doc

– D. Michael Sullivan, D.C.
Doctor of Chiropractic
Portland, OR

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