Peripheral Neuropathies

Most neurologists and primary care doctors will tell you that one of the most frustrating groups of conditions to treat are the peripheral neuropathies. It’s estimated that somewhere on the order of 20 million people suffer from peripheral neuropathy and while diagnosis is fairly straightforward, treatment is definitely problematic.

The available medications are generally given a C-grade by patients because they honestly don’t work very well and are usually accompanied by side effects ranging from really annoying to intolerable.

The largest group of peripheral neuropathies is labeled sensory because the predominant symptom is a change in sensation that ranges from numbness to a constant feeling of tingling to actual pain. People with these symptoms can find sleep next to impossible and pain medications mostly useless.

You can feel neuropathic misery just about anywhere in your body, but feet and legs are most common.

Causes

Pain called post-herpetic neuralgia can occur where you had a shingles rash. Facial pain can be caused by trigeminal neuralgia. Some people, after experiencing Guillain-Barre or other viruses, feel as if their whole body is wrapped in a sausage casing.

Take a look at this list of known causes of peripheral neuropathy:

• Physical trauma.
• Diabetes, usually after a long period of having been poorly controlled.
• Poor circulation.
• Certain system-wide autoimmune diseases (especially Sjogren’s syndrome, lupus, and rheumatoid arthritis).
• Autoimmune diseases that attack the nerves only (such as Guillain-Barre).
• Hormonal, kidney, and liver imbalances.
• Nutritional deficiencies (and also too much vitamin B6).
• Certain cancers and some infections (including Lyme, HIV/AIDS, West Nile).
• Side effects of several drugs, including some chemotherapy drugs and other cancer treatments.
• Idiopathic (cause unknown).

Diagnosing peripheral neuropathy

The diagnostic workup is fairly straightforward: seek out and then treat the underlying condition that has triggered the neuropathy with the goal of arresting further progression.

If diagnostic tests are negative, a referral to a neurologist will follow. The neurologist’s workup may include tests of nerve function including nerve conduction velocity/NCV, electromyography/EMG, or a nerve biopsy.

Once the underlying condition (be it diabetes, hormone imbalances, or any of the others listed above) is addressed, the real challenge becomes relief of symptoms.

Treatment

The two most commonly prescribed medications, gabapentin (Neurontin) and pregabalin (Lyrica), act to quiet nerve signals. They are sometimes effective, but side effects include dizziness, drowsiness, and weight gain.

The antidepressant family, including amitriptyline, nortriptyline, and duloxetine (Cymbalta), block pain signals to the brain. Again, the main side effect is drowsiness.

If the area of neuropathy is small, sometimes a topical anesthetic cream, like lidocaine or capsaicin (hot pepper), provides relief without side effects.

Supplements for peripheral neuropathy have been proven effective, but unfortunately they’re rarely recommended because they’re not FDA approved. I can assure you these are safe and without annoying side effects:

• SPM Active, twice daily (this is an anti-inflammatory extracted from fish oil).
• Theracurmin HP, twice daily.
• B Supreme, twice daily.
• Alpha Lipoic Acid, 300 mg twice daily for diabetic neuropathy (call the Apothecary to order).

Also, topical CBD oil applied at bedtime has been shown in a clinical trial to reduce discomfort.

Lastly, consider intravenous ozone therapy along with acupuncture. Your treatment schedule would be two treatments of each for four weeks. If you find it effective, maintain at one treatment each per month.

Be well,

David Edelberg, MD