What Is Neuropathy Therapy

Peripheral neuropathy therapy results from damage to the nerves that send information about touch, temperature and movement from the brain and spinal cord to your arms and legs. Your doctor will ask you about your symptoms and do a physical exam. They may order blood tests to check for diabetes, vitamin deficiencies and underlying diseases that affect nerve function.

Anti-seizure drugs

Neuropathic pain, which is caused by nerve damage, can be very challenging to treat. Studies suggest that anticonvulsant drugs, which are usually used to treat seizures and epilepsy, can offer some pain relief. These drugs also help control the abnormal electrical activity that causes nerves to fire. They do this by regulating the concentration of calcium and sodium channels, inhibiting NMDA receptors and activating GABAergic transmission.

Carbamazepine (Carbatrol, Tegretol) and gabapentin (Neurontin, PGB) work well to ease neuropathic pain in diabetic neuropathy and postherpetic neuralgia. They may also help with fibromyalgia, a chronic condition that causes muscle pain and tenderness in different parts of the body. These drugs can make you feel sleepy for a while. They can also increase your chances of developing liver or kidney problems if you have poor kidney function.

Electromyography (EMG)

Your doctor may recommend an EMG to check how well your muscles respond to nerve signals. These tests are usually done after NCS and are done with a needle electrode that is placed in your muscle.

You will lie down for the test. Small stickers (electrodes) will be put on your skin and connected to wires that go to an EMG machine. Then the doctor will ask you to relax and contract your muscle. The electrical activity of your muscle at rest and when it is contracted will be recorded on a computer screen.

Both the NCS and EMG are low-risk tests. The needle EMG can cause a little pain or soreness, but it is rare to develop a complication from the procedure. You can take a mild pain reliever such as ibuprofen before the test to help with this discomfort.

Nerve and muscle ultrasound

If you have a nerve disorder that causes muscle weakness or pain, a neuromuscular ultrasound scan can identify alterations in the muscles that are supplied by the affected nerve. This test doesn’t use radiation and can be done on an outpatient basis.

Medications that help relieve painful, neuropathic symptoms may include antidepressants (duloxetine hydrochloride, amitriptyline hydrochloride, and serotonin-norepinephrine reuptake inhibitors), painkillers (gabapentin and pregabalin, and topiramate), and medications to suppress abnormal immune system activity (cyclosporine and azathioprine). Plasmapheresis–an outpatient procedure in which blood is removed, cleansed of antibodies and cells, and returned to the body–can also reduce inflammation and autoimmune disorders that lead to peripheral neuropathy.

Peripheral neuropathy affects how your brain sends signals that your feet and hands are touching, which can cause balance problems and clumsiness. Nerve damage can also change how and when your brain sends pain signals, making them more intense or happening too often (hyperalgesia) or lessening their sensations (allodynia).

Nerve blocks

Nerve blocks are a pain management technique in which local anesthetic is injected near nerves to interrupt the coded messages that send pain signals to the brain. These blocks can be therapeutic or diagnostic, and are conducted by a pain specialist.

Your doctor will start by performing a physical and neurological exam, checking for muscle weakness or numbness. They will also order blood tests to check for diabetes, liver and kidney problems, vitamin deficiencies, and autoimmune disorders. Muscle and nerve ultrasound can also be used to detect a severed or compressed nerve, while a genetic test can determine if you have an inherited muscle or nerve disorder.

A variety of different nerve blocks are available depending on the body area and cause of a patient’s pain. Examples include sympathetic, stellate ganglion, and facet joint blocks.

Surgery

Some neuropathies that are caused by nerve compression may benefit from surgery to release the pressure on the nerve. This includes protruding disks in the back or neck, and occasionally tumors. Surgery is usually not recommended for polyneuropathies, as cutting or injuring the nerves can worsen the pain and sensory loss (phantom pain).

Nerves carry sensations that your brain uses to balance and coordinate movements. If these sensations are damaged, you may develop imbalance and clumsiness in the hands and feet.

A few medications — including a class of drugs first used to treat depression, called serotonin-norepinephrine reuptake inhibitors, such as duloxetine hydrochloride; and the anticonvulsant medications topiramate and carbamazepine — may help relieve neuropathic pain. Inflammation can cause some neuropathic symptoms, such as severe pain (allodynia) from touch that is normally painless and the feeling of needles or pins poking into the skin (paresthesia). Treatment for inflammation may include plasma exchange, steroids or intravenous immune globulin.

Additional Resources:

Advanced MMC, Inc
8401 Chagrin Rd Suite 20A Chagrin Falls OH 44023.
440-557-5011

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