Asked by Dawn Gerlach, Erie, Pennsylvania
What can be done to alleviate the symptoms of peripheral neuropathy? The pain is sometimes more than I can bear and continually interrupts sleep. I am exhausted.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Peripheral neuropathy is pain in the nerves of the arms or legs. It most commonly affects the legs. A family physician or internist can start the workup for peripheral neuropathy, but severe neuropathy should be evaluated by a neurologist.
Peripheral neuropathy can be caused by compression of the nerves leaving the spine as they travel down the arms or legs. The spine may compress the nerves because of arthritic bone in the spine. This can cause sensations of pain, numbness or tingling shooting up and down the arms or legs. Other causes of peripheral neuropathy are prolonged diabetes, multiple sclerosis and other nerve diseases. Peripheral artery disease (a blockage of small arteries in the leg) can cause these symptoms by keeping the muscles of the legs from getting enough blood.
Most peripheral neuropathies are due to arthritic degeneration at the point where the nerve leaves the spine. Some can be due to trauma of the nerve.
Some chemotherapy drugs especially vincristine and the platinum-containing drugs including cisplatin and carboplatin can cause peripheral neuropathies. They can cause pain, numbness or just a lack of sensation.
The approach to treatment is to find the cause of the discomfort. It might simply require a firmer mattress at night. It might improve with some physical rehabilitation exercise as guided by a physical therapist or chiropractor.
Drug therapy is used only if these physical treatments are not successful. I try to avoid using narcotics in treating this chronic pain. There are a number of drugs that can help with peripheral neuropathy pain. The non-steroidal anti-inflammatories such as ibuprofen or naproxen bring relief to some. A non-prescription topical cream made of peppers (capsaicin) is often quite helpful. Others need stronger treatments which include the tricyclic antidepressants -- which in controlled trials relieve neuropathic pain. Some anticonvulsants are also useful in relieving pain. These include gabapentin and pregabalin.
Transcutaneous electrical nerve stimulation (TENS) units are used in moderate to severe neuropathy when trying to avoid drug therapy or when drug therapy is unsuccessful. A series of local nerve blocks using injections can also be used.
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