Conservative Treatment of Peripheral Neuropathy and Neuropathic Pain
Section snippets
Differential diagnosis
The significance of the diabetic etiology of peripheral neuropathy is easy to recognize when one considers that nearly 1 in 10 American adults has diabetes. Prevalence of neuropathy in these patients ranges from 25% to 100%. The World Health Organization estimates that 220 million people will have diabetes worldwide by 2010 [6].
Many other causes of neuropathy exist and should be considered during the initial patient evaluation. Traumatic and entrapment neuropathies are common and often
Pharmacologic therapy
Pharmacologic management of pain associated with diabetic peripheral neuropathy must be rational and balanced. The underlying pathophysiology of diabetic neuropathy and the mechanism of action of each drug used must be evaluated each time pharmacologic therapy is being considered. The overall goal of therapy is to administer drugs that use different mechanisms of action and that will cause broad and balanced analgesic effects in treated individuals.
Diabetes is a systemic illness, which causes
Nutritional supplements
From a physiologic standpoint, the path to neurotoxic destruction in the hyperglycemic state is broad and wide. Numerous machinations conspire to rob the diabetic patient of a functioning peripheral nervous system. Hyperglycemic lipid dysmetabolism which results in accelerated atherosclerosis of the vasonervorum, accumulation of advanced glycosylation end products, impaired axonal plasmic flow, the production of reactive oxidative species, reduced activity of nitric oxide synthetase, and the
Topical modalities
Once the diagnosis of neuropathy has been established, its etiology should be ascertained by all means possible. Successful amelioration of this condition is dependent upon therapies directed to correct the underlying cause. If the origin of the malady eludes diagnosis, symptomatic treatment can be initiated. In either case, topical therapy can be a safe primary or adjunctive therapy; untoward systemic side effects are unlikely.
Since the time of Dante's inadvertently apt description of
Physical modalities
Although several advances have occurred in the understanding and use of pharmacological agents for treatment of neuropathic pain, dangerous or debilitating side effects, costs, and drug interactions have left many physicians and patients searching for other options. One of the most studied conservative physical modalities has been the application of monochromatic infrared energy [60].
The Anodyne Therapy System (ATS) (Fig. 1, Fig. 2) produces monochromatic infrared energy (MIRE) through therapy
Summary
Although numerous modalities are now available for the treatment of peripheral neuropathy, it can be difficult to find an effective treatment for each particular patient. Fig. 3 shows a suggested treatment algorithm. The intention of this algorithm is not to create a recipe to follow for every situation. Consultation with a pain specialist, neurologist, or peripheral nerve surgeon who has knowledge and training in the latest neuropathy treatments is prudent for cases that are recalcitrant to
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