Neuropathy Treatment Options

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Neuropathy is a disease characterized by damage to the nerves of the body, resulting in pain, sensory loss, and weakness.

If you have neuropathy, you may have already been told that it is a difficult condition to treat and that neuropathy is not curable. There is indeed, no treatment available that can cure or reverse neuropathy. There are, however, several medical approaches that can help stop neuropathy from getting worse.

And there are effective ways to help alleviate the symptoms of neuropathy.

Overall Treatment of Neuropathy

When it comes to managing neuropathy itself, the available medical interventions work by preventing the disease from becoming worse. There are a few different causes of neuropathy, and therefore the medical approaches that are used to prevent neuropathy from getting worse are tailored to the specific cause of the neuropathy.

Vitamin B12 Deficiency

Neuropathy is one of the consequences of vitamin B12 deficiency. This nutritional deficiency is common among vegetarians, vegans, individuals with certain stomach or intestinal disorders and people who consume large amounts of alcohol. Vitamin B12 deficiency often requires supplementation with vitamin B12 injections rather than with pills taken by mouth because many people who are vitamin B12 deficient are not able to reach adequate levels through oral pills.

Critical Care Neuropathy  

Critical care neuropathy often develops in the setting of severe, acute illness. It is not quite clear exactly what causes critical care neuropathy, and it is believed to be caused by a number of factors, including infections, inflammation, fluid and electrolyte imbalances and immobility (lack of physical movements).

Often, critical care neuropathy improves once the overall medical condition improves, but sometimes it can take months or years after the other medical illnesses resolve before the weakness and sensory loss of critical care neuropathy completely improve.

Treatment of critical care neuropathy includes management of infections, fluid and electrolyte replacement, and physical therapy.

Guillain-Barré Syndrome (GBS)

This progressive and aggressive type of neuropathy is described as an ascending neuropathy that begins in the feet and gradually travels up the body to eventually weaken the muscles that control breathing.

GBS is a neuropathy associated with dysfunction of the immune system. The treatment of GBS may include a procedure called plasmapheresis (plasma exchange) or treatment with a powerful medication called immunoglobulin (IVIG). Plasmapheresis is a procedure that involves filtering of the blood with removal of harmful antibodies and other substances produced by the abnormal immune cells that are damaging the nerves. IVIG consists of immune proteins that interact with the immune system to prevent the attack on the nerves.

In the vast majority of cases, these treatments for GBS help prevent severe consequences, although often, respiratory support is needed for a temporary time period when the weakness interferes with breathing.

Most people with GBS experience almost complete recovery and may experience a few recurrent episodes of weakness that can typically be managed with IVIG treatment or with corticosteroid treatment.

Diabetic Neuropathy 

Diabetic neuropathy can occur as the long-term consequence of type l or type ll diabetes. The best management of diabetic neuropathy is control of blood sugar levels to prevent worsening of the neuropathy and to halt damage to other organs. Some people with diabetic neuropathy notice an improvement of symptoms and even experience improvement of the neuropathy itself with good control of blood sugar, particularly if the neuropathy is caught early and diabetes is well managed before the neuropathy progresses.

Alcoholic Neuropathy 

The best treatment for alcoholic neuropathy is discontinuation of alcohol to prevent the neuropathy from worsening. Sometimes, discontinuation of alcohol consumption can allow symptoms to improve and may even allow the neuropathy itself to improve. Often, nutritional deficits associated with heavy alcohol use can contribute to alcoholic neuropathy, and correcting these nutritional deficits may help the neuropathy as well.

Chemotherapeutic and Medication Induced Neuropathy

Several medications are associated with neuropathy, particularly some chemotherapeutic medications. It is not possible to completely avoid medications that cause neuropathy, because many of them provide important medical benefits, and they do not always cause neuropathy for everyone who takes them. Depending on the severity of the neuropathy, discontinuing the medication can help prevent the neuropathy from worsening.

Management of Neuropathic Pain

There are several different treatments for neuropathic pain, and the best treatment is not always the same for everyone, as you may not experience the exact same outcome and side effects as everyone else. This means that you and your doctors may need to spend some time trying a few different options before discovering which is right for you. The most common medications used for relief of neuropathic pain include:

  • Over the counter pain meds
  • Creams with anti-pain components
  • Prescription pain meds
  • Anti-seizure medications (anti-convulsants): While these medications are not specifically approved for the treatment of neuropathic pain, they do provide relief for many people, and therefore doctors frequently prescribe them for this problem.
  • Antidepressants: As with anticonvulsants, these medications may not be formally indicated for neuropathic pain, but because many people experience relief of neuropathic pain, and because there are few treatment options, they are often considered the most useful option.

Management of Weakness 

There are not effective medications to heal or regrow nerves damaged by neuropathy. But there are a few instances in which specific neuropathic muscle weakness can be managed:

  • Physical therapy: Often, physical therapy is the most effective way to gain better control of nerves that are not affected by neuropathy, which can help compensate for the weakness caused by nearby damaged nerves.
  • Incontinence: Neuropathy may affect bladder control, and sometimes medications used to control the bladder muscles can help regain better bladder control. Although these medications do not cure damaged nerves, they can help through their effect on nearby nerves and muscles that contribute to bladder control.
  • Erectile dysfunction: This is often one of the consequences of neuropathy, and medications that are used for the treatment of erectile dysfunction may help alleviate this issue.

Management of Sensory Loss

As with muscle weakness, it is not possible to repair the damaged nerves that control sensation. However, it is vital not to ignore this problem, as the sensory loss of neuropathy can lead to severe injuries and infections:

  • Wound care: If you have neuropathy, your injuries and wounds may not be as painful as they normally would have been without neuropathy. However, this lack of pain is a real problem, as you may not notice a wound becoming larger or becoming infected due to the lack of pain. Therefore, if you have neuropathy, whenever you have a wound or an injury, you need to pay close attention to keeping it clean and watching for signs of infection, even if you cannot feel the pain.
  • Physical therapy for balance: Sensory loss interferes with balance, and physical therapy can help you learn how to maximize your abilities and compensate for your deficits so that you can maintain better balance.
  • Electrical stimulation has been proposed as a possible approach to reducing the sensory loss of neuropathy, and some research studies point to benefits of this method.

Prevention of Neuropathy

Because neuropathy is a condition that does not generally heal, prevention is particularly important. There is little you can do to prevent some of the common types of neuropathy, but you should get medical attention if you notice the early symptoms of neuropathy, which typically include tingling, numbness, and a burning sensation. If you have early signs of alcoholic neuropathy, diabetic neuropathy, or medication induced neuropathy, there are steps you can take to prevent the condition from becoming worse. Furthermore, if you have diabetes or if you are a heavy drinker, you can prevent neuropathy by managing these issues even before neuropathy starts.

A Word From Verywell

If you have neuropathy, you may already know that this condition is not usually curable. However, sometimes, addressing the cause of the neuropathy can help prevent worsening and may even reverse some of the disease. The symptoms are not always the same for everyone, as some individuals with neuropathy may predominantly experience pain, while others predominantly experience weakness. Typically, symptoms can at least be partially managed with a combination of medication and therapy.

Sources:

Najafi B, Talal TK, Grewal GS, Menzies R, Armstrong DG, Lavery LA, Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy, J Diabetes Sci Technol. 2017 Feb 1.

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