What are the treatments for peripheral neuropathy?

My elderly mother was recently diagnosed with neuropathy. The source of the illness is uncertain. The medical information that I was able to review states that treatment with vitamin B sometimes has a positive effect on the progression of the illness, and if there is not extensive nerve damage the condition may clear up. Are there any other treatments that you are aware of?

The term peripheral neuropathy is used to refer to many different types of neuropathy, from those involving only a single nerve, such as Bell’s palsy,
to those producing profound generalized paralysis, such as Guillain-Barre syndrome. (I have discussed both these conditions in recent postings, and they are in my archive) There are also many different causes, ranging from heritary neuropathies to toxic ones caused by heavy metal poisoning.

Doc’s Advice: What are the treatments for peripheral neuropathy?

A neuropathy is any abnormal state (pathy) of a nerve or nerves (neuro). The peripheral nerves are those that are outside the central nervous system, running from the brain or spinal cord to our muscles, organs, skin, etc. The peripheral nerves are usually divided into three types; motor nerves which go to muscles and control their contractions, sensory nerves which run from sensory organs to the spinal cord, and autonomic nerves which regulate many of our automatic functions such as controlling blood pressure, movement of the intestines, sweating, etc. A peripheral neuropathy may involve exclusively one type of nerve, or all three.

Some common conditions are actually neuropathies. I mentioned Bell’s palsy above; in addition there is carpal tunnel syndrome, which occurs when pressure at the wrist causes the nerves running through the wrist not to conduct correctly; trigeminal neuralgia, a painful neuropathy of the nerve going to the face; and shingles, an infection of the nerves by varicella-zoster virus. Some conditions are experienced by many people temporarily — for example, the numbness that can occur in the little finger and side of the hand during sleep when the elbow is bent to its maximum, which stretches the ulnar nerve in the elbow. But when most people, and most doctors, refer to peripheral neuropathy they are talking about numbness, tingling and pain, usually in the feet and legs.

Diabetes is a common cause of neuropathy, as is kidney failure. Maximum control of these underlying diseases may improve the neuropathy. There is an ancient disease, beri-beri, caused by thiamine deficiency, which causes such a neuropathy. No one eating a regular diet will develop beri-beri, and it is therefore seen in this country exclusively in alcoholics. For others, supplementing B complex vitamins will probably not help but won’t hurt, although megadoses should not be taken. (Megadoses of Vitamin B6, pyridoxine, have been shown to cause a neuropathy.)

Some cases of slowly developing neuropathies are hereditary, and usually inherited in a recessive fashion, meaning the parents and siblings will probably not have the disease. A careful family history that includes grandparents, aunts, uncles and cousins may give a clue.

Many drugs may cause a neuropathy, including some used in cancer chemotherapy, in the treatment of HIV infection, isoniazid used to treat tuberculosis, and others less commonly used. Severe alcoholism can cause a neuropathy that is not beri-beri and that will not respond to doses of thiamine. Infections that can cause it include HIV, Lyme disease, leprosy, polio, diptheria, and syphilis. Treatment of the underlying infection will often reduce the symptoms of neuropathy.

It would be appropriate for someone with a peripheral neuropathy to have a consultation with a neurologist if the underlying cause is not obvious, such as many years of poorly controlled diabetes. It is worthwhile to try to sort out the underlying cause in order to offer specific treatment if any is available. Unfortunately in many cases an underlying cause cannot be found, or the cause is one which cannot be treated, and care must then focus on relieving the symptoms. Various physical measures including soaking the feet may offer some relief, and several drugs including the antidepressant amitriptyline are often at least partially helpful.

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