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Peripheral neuropathy
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Peripheral neuropathy

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DIABETES AND ENDOCRINE SYSTEM

Diabetes Complications

From MayoClinic.com

Treatment

The goal of treatment is to manage the underlying condition causing your neuropathy and to repair damage, as well as provide symptom relief. If your doctor hasn't been able to determine the cause of your neuropathy, he or she may try a variety of medications to see which help ease your symptoms.

Controlling a chronic condition may not eliminate your neuropathy, but it can play a key role in managing it. Here's what your doctor may recommend for treating various underlying conditions:

  • Diabetes. If you have diabetes, you and your doctor can work together to keep your blood sugar level as close to normal as possible. Maintaining normal blood sugar levels helps protect your nerves.

  • Vitamin deficiency. If your neuropathy is the result of a vitamin deficiency, it's likely your symptoms will improve once the deficiency is corrected. Your doctor may recommend injections of vitamin B-12 daily for a few days, then once a month. If you have pernicious anemia, you'll need regular injections for the rest of your life, and possibly additional vitamin supplements. You'll also need to eat a healthy diet.

  • Autoimmune disorder. If your neuropathy is caused by an inflammatory or autoimmune process, treatment will be aimed at modulating your immune response.

  • Nerve pressure. In cases where neuropathy is the result of pressure on a nerve, treatment will likely focus first on eliminating the source of the pressure. That might mean adding ergonomic chairs, desks or keyboards to your home or office, changing the way you hold tools or instruments, or taking a break from certain hobbies or sports. In some cases of nerve compression, you may need surgery to correct the problem.

  • Toxic substances or medications. If toxins or medications are responsible for the neuropathy, it's critical that you stop taking the medication or avoid further exposure to the toxin to prevent the neuropathy from progressing further.

Medications
Medications can ease pain symptoms, but most have side effects, especially if you take them for long periods of time. If you take pain medication regularly, including over-the-counter (OTC) products, discuss the benefits and side effects with your doctor. Medications that may help provide pain relief for neuropathy include:

  • Pain relievers. OTC pain relievers, such as acetaminophen (Tylenol, others), and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), usually help mild symptoms. For more severe symptoms, your doctor may recommend prescription NSAIDs. If you take NSAIDs for long periods of time or in large doses, you may develop nausea, stomach pain, bleeding, or even ulcers.

  • Anti-seizure medications. Drugs such as gabapentin (Neurontin), carbamazepine (Tegretol) and phenytoin (Dilantin) were originally developed to treat seizure disorders (epilepsy). However, doctors often also prescribe them for jabbing pain. Side effects may include drowsiness and confusion.

  • Lidocaine patch. This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe, and you can use up to three patches a day to relieve pain. This treatment has almost no side effects except, for some people, a rash at the site of the patch.

  • Tricyclic antidepressants. Antidepressant medications, such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain. Common side effects of these medications may include balance problems, dry mouth, nausea, tiredness or weakness, constipation, and weight gain. To help reduce these side effects, your doctor will likely start you off at a low dose and slowly increase the amount of drug you take. If you're bothered by insomnia, your doctor may also recommend an antidepressant or a sleeping medication.

  • Other medications. Opioid analgesics, such as codeine or oxycodone (OxyContin) may be used to relieve pain. However, this class of medications produces numerous side effects, including addiction, that make long-term use of these drugs undesirable. Mexiletine (Mexitil), a drug ordinarily used to treat irregular heart rhythms, sometimes helps relieve burning pain. The topical ointment capsaicin (Capzasin, Zostrix) may help ease the pain of diabetic neuropathy, and aside from a mild tingling, burning or slight skin irritation where you apply the ointment, it has few side effects.

Research aimed at finding more effective treatments for peripheral neuropathy is ongoing. For example, researchers are looking at developing nerve growth factors to reproduce the chemicals that signal your body to repair small nerve fibers. Other scientists are studying the use of the antioxidant alpha lipoic acid (thioctic acid) to treat diabetic neuropathy. Unfortunately, no medications can repair nerve damage yet, but the body can regenerate nerves if the offending substance is removed.

Therapies

Several drug-free therapies and techniques may also help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own. They include:

  • Transcutaneous electrical nerve stimulation (TENS). Your doctor may prescribe this therapy, which may help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS doesn't work for everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used in conjunction with other therapies.

  • Biofeedback. This therapy uses a special machine to teach you how to control certain body responses that reduce pain. You then learn how to control these same responses yourself. Biofeedback techniques are often taught in medical centers and hospitals.

  • Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for chronic pain, possibly including the pain of neuropathy. Keep in mind that you may not get immediate relief with acupuncture and may require more than one session.

  • Hypnosis. Many adults can be hypnotized by a trained professional, but for hypnosis to be most effective, you also have to be a willing and motivated participant. During hypnosis you'll typically receive suggestions intended to decrease your perception of pain.

  • Relaxation techniques. Designed to help reduce the muscle tension that makes pain worse, relaxation techniques range from deep-breathing exercises to visualization (imagining yourself floating in a tropical ocean, for example), yoga and meditation. You might want to take classes in one or more of these techniques, or you can learn them yourself using books or tapes.

 

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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