Neuropathy Treatment

Neuropathy is very common. By some estimates, over the 5% of the population suffer from it to some extent. Neuropathy treatment can help with daily function and with neuropathy leg pain. However, remember, that neuropathy is also complicated. If a basic evaluation does not reveal the cause, more testing such as nerve conduction (EMG) is necessary and expert consultation might be useful.

Recommendations for Everyone

Even before thinking about specific treatments, neuropathy treatment should start with basic, non-medical recommendations that can fit anyone. These include:

• Foot hygiene – Make sure to clean your feet. Look at them every day and make sure that you don’t have an injury you may not have felt.
• Weight loss – Less weight means less pressure on your feet. And less pressure on your feet means less chances for complications like wounds.
• Proper footwear – One of the most common causes for wounds in people with neuropathy are improper shoes. Silly things like a sock seam that presses on your toes. A tight shoe might create a wound. Later, that wound might take a very long time to heal.
• Gait training (which means, improving how you walk) – By walking better, there is less chance you will put too much pressure on one part of your foot over another.

Treat the Underlying Disease

The first step in the investigation of peripheral neuropathy is to obtain simple blood tests. The reason is to identify the cause for the problem. For instance, diabetes mellitus. This is especially true, if you can find a cause you can treat. Truthfully, often neuropathy is not reversible. But sometimes we can identify a cause that we can treat and reduce or solve the symptoms completely.

Here are a few examples:

• Dietary deficiencies such as vitamin B12 deficiency. There are even publications that show that vitamin B12 can help with diabetic neuropathy. Obviously, there are other dietary deficiencies that can cause neuropathy such as lack of vitamin B1, vitamin B6, folic acid, copper and phosphorus. If the root cause is alcohol abuse, then that should be addressed if there is any hope to treat the neuropathy.
• Low levels of thyroid hormone.
• Blood cancers, which are also known as myeloproliferative diseases.

Obviously, it is easier to supplement vitamin B12 or thyroid hormone than it is to treat a blood cancer. But in theory, if these conditions are identified early enough, treatment might reverse the neuropathy symptoms.

Also, these are not the only reversible causes for neuropathy. For instance, various types of poison can result in neuropathy. One example is arsenic poisoning. But obviously, we don’t test for arsenic poisoning routinely.

Often Neuropathy is Part of a Bigger Picture

There are many other conditions that can cause neuropathy. Some of these are not so straightforward to identify and treat. For instance, nerve involvement can complicate certain types of vasculitis. Medical conditions such as syphilis and HIV can affect the peripheral nerves as well. Also, some medications can cause peripheral neuropathy. For instance, medications to treat multiple myeloma, such as thalidomide and newer versions of this compound. Another common example is taxan, a therapy for certain types of breast cancer. Proper identification is key, because treatment will at least halt the progression of the nerve damage.

Medical Neuropathy Treatments

Sometimes the only way to get relief from symptoms of neuropathy, and reduce the typical night leg pain, will be with medications. There are a few options that might help.

Gabapentin for Neuropathy Treatment

The most common medication for neuropathy treatment is gabapentin. It is marketed under the brand name Neurontin.

Gabapentin is an effective neuropathy treatment. But, it will not work for everyone. First, you have to achieve high doses to obtain symptom relief. Ramping up the dose can take many weeks. Second, only about half of the people will enjoy 50% or more reduction in their pain. The other half or so may not experience improvement, but will have side-effects.

Patients who take gabapentin should know that it may time for an effect to take place. This has two reasons. First, it may take time to achieve a full dose. But another reason is that the effect might take a few weeks to take place.

Unfortunately, gabapentin treatment is associated with side-effects. Perhaps the most common are neurological. Some people who take gabapentin will develop mental fogginess and clumsiness.

The FDA has published more information about the use, side-effects and pharmacology of gabapentin. The prescribing information is published by Pfizer (the company that makes this medication).

Pregabalin (Lyrica®) for Neuropathy Treatment

Another medication, that is similar to gabapentin, is called pregabalin. It is marketed under the brand name Lyrica.

Pregabalin works by limiting the electric current in the nerve-endings. Thus, it basically helps by having the nerve “fire” less. Of course neuropathy is not one disease state. But generally, there are data that show that pregabalin is an effective neuropathy treatment. Also, pregabalin is considered safe, but there are still side-effects. More warnings are listed in the Lyrica package insert. Notably, the FDA has released a warning that both gabapentin and pregabalin might cause respiratory depression in persons who are at risk. For instance, older people may be at risk.

Antidepressants for Neuropathy Treatment

Some medications that were originally designed to treat depression are also effective in the treatment of peripheral neuropathy. These medications actually have different chemical structures and work in variable ways. Examples include amitriptyline, nortriptyline, venlafaxine, duloxetine (also known as Cymbalta) and bupropion (that is marketed as Wellbutrin). A Cochrane review found that these medications were effective. In fact, we need to treat as few as three patients for at least one of them to achieve significant relief.

Like with the other medications that we use for neuropathy treatment, antidepressants also have side-effects. An important side-effect is suicidal thoughts. These are present also with gabapentin and pregabalin. It is important to be proactive and follow this potential terrible side-effect.

Topical Treatment

Topical treatment means treatment that is applied to the skin. Some topical treatments might help with the symptoms of neuropathy. Specifically, lidocaine and capsaicin might help in addition to oral medications. While a Cochrane review did not find lidocaine to be effective in neuropathy treatment, the authors conceded that individual small trials reported benefit for select patients. In small quantities, side-effects are probably limited. A different summary of the usefulness of capsaicin in neuropathy treatment showed even better results. It seems like the effect was as strong as other medications for chronic pain.

Compression Garments for Neuropathy Treatment

If you search online, you will find all sorts of garments you can buy that claim to reduce neuropathy symptoms. In fact, there are very few data that support their use. But, that is not to say that various garments are not used in preventing and treating neuropathy. For instance, there are smart socks to measure foot pressure in diabetic patients, to try to prevent wounds. A study used compression successfully to prevent neuropathy in women who were receiving taxan for the treatment of breast cancer. In another series of 3 patients, compression garments reduced the symptoms of neuropathy.

Biofeedback for Peripheral Neuropathy?

Biofeedback in neuropathy treatment makes sense. But there is very little hard data to back up this claim. So it is hard to recommend. If you search the internet, you will find resources that promote it. While it is probably not going to harm you, you might find yourself wasting time. Or not.

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