Neuropathy and Nerve Pain Treatments

Neuropathy is a debilitating and painful condition characterized by damaged nerves outside the brain and spinal cord (peripheral neuropathy), compromising their ability to send and receive messages from the brain. The primary symptom of neuropathy is shooting pains/aches in your extremities, limbs, and other areas, amongst a host of other manifestations.

Causes of Neuropathy

There are over 100 types of possible neuropathies and an equal, if not greater, number of causes. Some principle causes of this disease include −

• Diabetes

• Injuries/Accidents resulting in amputations or loss of limb

• Surgeries that damage nerves

• Nerve disorders such as multiple sclerosis (MS) can cause vision loss and chronic fatigue

• Vitamin B12 deficiency

• Nerve(s) compression due to arthritis or spinal disc herniation

• Exposure to or ingestion of toxins

• Cancer and associated chemotherapy, for example, tumors that compress nerves or an abnormal immune system response i.e., paraneoplastic syndrome causing the body to attack its own nerves.

• Autoimmune diseases like lupus, Sjogren’s syndrome, Guillain-Barre syndrome, and vasculitis

• Infections like HIV/AIDS, leprosy, Epstein-Barr virus, diphtheria, shingles, and Lyme disease

• Alcoholism

• Kidney Disease

• Hormone Imbalances

Types of Neuropathies

Peripheral neuropathy/ neuritis can occur wherever myelin sheaths that cover the neural axons are damaged. With the nerve insulation/coating destroyed, sensory and pain information transmission is disrupted.

This can present across different nerve types in the peripheral nervous system, categorized according to their function.

Autonomic Neuropathies

These involve the nerves that control automatic processes in the body such as breathing, digestion, blood pressure, heartbeats, sweating, and semi-voluntary activities like bladder activity.

Damage to autonomic nerve fibers can disrupt these involuntary movements. These include −

• difficult swallowing

• urinary and fecal incontinence

• digestive issues like nausea and vomiting

• sudden drops in blood pressure when you change position for example, from sitting to standing i.e., orthostatic hypotension causing light-headedness or dizziness.

• Intolerance to heat and excessive sweating

• Arrhythmias / irregular heartbeat

Sensory Neuropathies

These nerves control the ability to touch and feel, particularly pain and temperature. Some symptoms of diminished senses include −

• Numbness, pins-and-needles sensations, and/or tingling, all of which are classified as spontaneous pain without stimulation

• Increased/ decreased sensitivity to touch – increased sensitivity, for example, could lead to easy startling when touched. This phenomenon is called allodynia, or hypersensitivity to external stimuli that don’t normally cause pain or shock

• Unable to sense/feel extreme hot or cold temperatures

• Impaired coordination and tremors/trembling of the hands or fingers which makes it difficult to button shirts or stand straight with your eyes closed

Motor Neuropathies

This kind of damage occurs in nerves that control conscious muscle movement, like those used to walk, talk, and hold objects. Some indicators include −

• Muscle weakness, stiffness, and/or cramps

• Muscle twitching and spasms

• Muscle atrophying during which muscles waste away or there is a reduction in muscle mass

• Muscle weakness particularly of the legs and feet, for example, disintegration of the Achilles’ heel tendon reflex

These neuropathies could occur individually, in pairs, or all together, the latter being known as combination neuropathy. Neuropathy can affect a single nerve i.e., mononeuropathy, or a set of nerves in the same area i.e., mono neuritis multiplex. Alternatively, multiple nerves in different parts of the body are affected i.e., polyneuropathy. When localized to the chest or legs, the condition is called thoracic or proximal/lumbar root neuropathy.

Treatment of Neuropathies

Reversal

The first step in treating neuropathy is figuring out the root cause, which, if reversible provides an easy solution. For example, a Vitamin B12 deficiency can be ascertained quickly through a blood test and reversed with supplements. Similarly, mild diabetes can be addressed by immediate lifestyle changes and drugs. Medication triggering the onset of peripheral neuropathy can be stopped. These methods are the first line of treatment, namely the reversal of causes.

Symptomatic Treatment

Once the cause has been identified, if it can’t be reversed, then the symptoms will have to be addressed to reduce distress and maintain quality of life. Symptomatic treatment can address different needs, illustrated as follows −

Pain Relief

Irrespective of the cause, pain relief is a central treatment modality. Anti-epileptics and tricyclic anti-depressants like gabapentin, pregabalin, venlafaxine, and nortriptyline are often prescribed because they ease the pain. Painkillers like aspirin and ibuprofen are prescribed temporarily, as are over-the-counter (OTC) topical analgesics like capsaicin. But these aren’t effective for severe, chronic pain. Lidocaine injections or oxycodone may be a last resort when other analgesics have failed, but they aren’t recommended as they can cause dependency.

Maintaining Functionality

Motor and sensory neuropathies may require regular physical therapy. Massages, acupuncture, warm baths, and leg/hand braces can aid with pain and balance.

With autonomic neuropathies like gastroparesis (delay in emptying the stomach) and orthostatic hypertension, specific medications are used. These include prokinetics to speed up gut function in the former, or vasopressors to constrict blood vessels in the latter.

The treatment will depend on each person's mobility, age, and specific requirements. Younger individuals could try swimming, aerobic exercise and balance training whereas older or seriously injured patients may need to see specialized physiotherapists or chiropractors.

Complications and Higher-Order Treatments

Further probing through CT/MRI scans, nerve function/ Electromyography (EMG) tests, and biopsies of the nerves and skin may be done if the blood tests don’t yield results. These help to reveal tumors, herniated discs, spinal injuries, and other issues which may need surgery. Other options like TENS i.e., transcutaneous electrical nerve stimulation can be used to alleviate pain for spinal cord injuries, fibromyalgia, and diabetic neuropathy. Plasma exchange and intravenous immune globulin (IVIG) may also be used to soothe inflamed muscle conditions like polymyositis and Kawasaki’s disease. Diabetic foot ulcers or any other wounds/cuts need to be watched carefully to avoid escalation to gangrene or amputations. The same applies to autonomic neuropathies like cardiovascular autonomic neuropathy, which requires regular check-ups and monitoring of heart function alongside specific medication.

Conclusion

Neuropathy is a difficult disease to live with, not all causes can be reversed or cured. Maintain a healthy lifestyle, and take regular treatment to maintain a good quality of life.