Peripheral Neuropathy

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Peripheral Neuropathy Treatment

The goal of treatment may be to identify and treat the underlying cause, cure the disorder (if possible), give the patient maximum independence and self-care ability; and/or control the symptoms. As a rule, treatment of the underlying medical problem (e.g., diabetes) or removal of a causative agent (e.g., alcohol) are the first steps.

Physical therapy, vocational therapy, occupational therapy, and orthopedic interventions may be recommended to promote self care ability and independence. For example, exercises and retraining may be used to increase muscle strength and control. Appliances such as wheelchairs, braces, and splints may improve mobility or ability to use an affected extremity.

Safety is an important consideration for people with neuropathy. Lack of muscle control or decreased sensation increase the risk of falls or other injuries. The person may not notice a potential source of injury because he or she can't feel it. For this reason, people with decreased sensation should check their feet or other affected areas frequently for bruises, open skin areas, or other injuries, which may go unnoticed (because there is no pain) and become severely infected. Often a podiatrist can determine if special orthotic devices are needed.

Safety measures for people experiencing difficulty with movement may include railings, various appliances, removal of obstacles (such as loose rugs that may slip on the floor), and other measures as appropriate. Safety measures for people having difficulty with sensation include adequate lighting (including lights left on at night), testing water temperature before bathing or immersing the body in water, use of protective shoes (no open toes, no high heels, and so on) and similar measures. Shoes should be checked often for grit or rough spots that may cause injury to the feet.

People with neuropathy (especially those with polyneuropathy or mononeuropathy multiplex) are prone to new nerve injury at pressure points (knees and elbows, for example). They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or similar positions.

Over-the-counter analgesics or prescription pain medications may be needed to control nerve pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin), tricyclic antidepressants or various other medications may be used to reduce the stabbing pains that some people experience. Whenever possible, medication use should be minimized to avoid side effects.

Adjusting position, using frames to keep bedclothes off of a tender body part, or other measures may also be helpful to reduce pain.

Autonomic changes may be treated symptomatically. They may be difficult to treat or respond poorly to treatment.

• Postural hypotension -- use of elastic stockings and sleeping with the head elevated may help. Fludrocortisone or similar medications may be beneficial in reducing postural hypotension for some people.
• Reduced gastric motility -- medications that increase gastric motility (such as metoclopramide), eating small frequent meals, sleeping with the head elevated, or other measures may help.
• Bladder dysfunction -- manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications such as bethanechol may be necessary.
• Impotence, diarrhea, constipation or other symptoms are treated as appropriate.