Mononeuritis Multiplex

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Treatment

The goals of treatment include treatment of the cause if possible, supportive care to maximize independence and control of symptoms. This may include control of blood sugar levels for diabetics, nutritional supplementation, or medical treatments of conditions as appropriate.

To maximize self-care and independence, physical therapy, vocational therapy, occupational therapy and orthopedic interventions may be recommended. For example, exercises and retraining may increase muscle strength and control. Appliances such as wheelchairs, braces, and splints may enhance mobility.

Safety is an important consideration for people with sensation or movement difficulties. Lack of muscle control may increase the risk of falls or other injury. Decreased sensation can also increase the risk of falls. It may also increase the risk of injury because the person is unable to perceive a potential source of harm.

Safety measures for people with movement difficulty may include railings, removal of obstacles (such as loose rugs that may slip on the floor) and other measures as appropriate.

Safety measures for persons with limited sensations include an awareness of the lack of sensation and compensation through other measures. Specific measures may include the use of adequate lighting (including lights left on at night), testing of water temperature before bathing, the use of protective shoes (no open toes or high heels), and similar measures. Shoes should be checked often for grit or rough spots that may injure the feet.

People with decreased sensation should check their feet (or other affected area) frequently for bruises, open skin areas, or other injuries that may go unnoticed and become severely infected because the pain nerves of the area are not signalling the injury.

People with mononeuropathy multiplex are prone to new nerve injury at pressure points such as knees and elbows. They should avoid prolonged pressure on these areas caused by leaning on the elbows, crossing the knees, or holding similar positions.

Over-the-counter analgesics or prescription pain medications may be needed to control pain (neuralgia). Various other medications may be used to reduce the stabbing pains that some people experience, including anticonvulsants (gabapentin, phenytoin, carbamazepine) or tricyclic antidepressants. Whenever possible, use of medications should be avoided or minimized to reduce the risk of side effects.

Positioning, the use of frames to keep bedclothes off of a tender body part, and other measures may be helpful to control pain. Autonomic symptoms may occur and can be treated symptomatically. These may be difficult to treat or respond poorly to treatment, however.

Use of elastic stockings and sleeping with the head elevated may reduce postural hypotension (low blood pressure when changing positions). Fludrocortisone or similar medications may be beneficial in reducing postural hypotension in some cases.

Medications that increase gastric motility (such as Reglan); small, frequent meals; and sleeping with the head elevated can increase reduced gastric motility (digestion).

Medications such as bethanechol, manual expression of urine, or intermittent catheterization may be necessary to treat bladder dysfunction.

Impotence, diarrhea, constipation, or other symptoms can be treated as appropriate.