Peripheral Neuropathy

Treatment

Many treatment strategies for peripheral neuropathy are symptomatic. Some current research in animal models has shown that neurotrophin-3 may oppose the demyelinationpresent in some peripheral neuropathies.

A range of drugs that act on the central nervous system, such as drugs originally intended as antidepressants and antiepileptic drugs, have been found to be useful in managing neuropathic pain. Commonly used treatments include using a tricyclic antidepressant (such as amitriptyline) and antiepileptic therapies such as gabapentin or sodium valproate. These have the advantage that besides being effective in many cases, they are relatively low in cost.

A great deal of research has been conducted between 2005 and 2010 resulting in indications that synthetic cannabinoids and inhaled cannabis are effective treatments for a range of neuropathic disorders.Research has demonstrated that the synthetic oral cannabinoid Nabilone is an effective adjunct treatment option for neuropathic conditions, especially for people who are resistant, intolerant, or allergic to common medications. Oral opiate derivatives were found to be more effective than cannabis for most people. Smoked cannabis has been found to provide relief from HIV-associated sensory neuropathy.Smoked cannabis also was found to relieve neuropathy associated with CRPS type I, spinal cord injury, peripheral neuropathy, and nerve injury

Pregabalin is an anticonvulsant drug used for neuropathic pain. It also has been found effective for generalized anxiety disorder. It was designed as a more potent successor to gabapentin, but is significantly more expensive, especially now that the patent on gabapentin has expired and gabapentin is available as a generic drug. Pregabalin is marketed by Pfizer under the trade name Lyrica.

Duloxetine, a serotonin-norepinephrine reuptake inhibitor, also is being used to reduce neuropathic pain.

Transcutaneous electrical nerve stimulation therapy may be effective and safe in the treatment of diabetic peripheral neuropathy. A recent review of three trials involving 78 patients found some improvement in pain scores after 4 and 6, but not 12 weeks of treatment and an overall improvement in neuropathic symptoms at 12 weeks.A second review of four trials found significant improvement in pain and overall symptoms, with 38% of patients in one trial becoming asymptomatic. The treatment remains effective even after prolonged use, but symptoms return to baseline within a month of cessation of treatment.

Neuropathy has been reported to make winter weather more perilous for older adults.Often, people with neuropathy who live in areas with defined winters (such as the northern United States) report that their symptoms were much less severe after moving to places with an undefined winter, such as Florida or California

Sometimes symptomatic relief for the pain of peripheral neuropathy is obtained by application of topical capsacin. Capsacin is the factor that causes heat in chili peppers. Relief up to 12 weeks is noted with high concentrations of capsacin applied cutaneously. Local anesthesia often is used to counteract the initial discomfort of the capsacin. More information is available in this review by the National Institute of Health.