Neuropathy

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Treatment

In many cases, prompt diagnosis and treatment of the underlying cause can reduce the risk for permanent nerve damage. For example, controlling diabetes may reduce diabetic neuropathy and renal dialysis often improves neuropathy that develops as a result of chronic renal failure.

Treatment options for reducing pain include medication, injection therapy, and physical therapy. Surgery may be needed to treat some causes of neuropathy (e.g., carpal tunnel syndrome, radiculopathy).

Medication

Because analgesics (e.g., aspirin, ibuprofen) are usually ineffective against pain caused by neuropathy, treatment often involves medications that target nerve cells.

Duloxetine hydrochloride (Cymbalta®) has been approved by the Food and Drug Administration (FDA) to treat diabetic peripheral neuropathy. Common side effects include constipation, diarrhea, dry mouth, and nausea. In some cases, Cymbalta® causes dizziness and hot flashes.

Although anticonvulsants such as gabapentin (Neurontin®) and topiramate (Topamax®) and antidepressants such as amitriptyline (Elavil®) are not approved by the FDA to treat neuropathy, they are often prescribed to treat this condition. Side effects of these drugs include drowsiness, dizziness, low blood pressure, and fatigue.

Other medications include anticonvulsants (e.g., carbamazepine [Tegretol®], lamotrigine [Lamictal®]), local anesthetics (e.g., lidocaine [Xylocaine®]), and antiarrhythmics (e.g., mexiletine [Mexitil®]). Anticonvulsants may cause low white blood cell counts, nausea, vomiting, and dizziness. Side effects of lidocaine and mexiletine include nervousness, lightheadedness, drowsiness, and double vision.

Topical treatment with capsaicin cream (Zostrix®) may be prescribed for patients with focal neuropathy. Capsaicin causes stinging upon application and is often combined with a local anesthetic to reduce this side effect. Axsain® (.25% capsaicin in Lidocare® vehicle) contains a higher dose of capsaicin in a cream that reduces stinging and burning. Lidoderm® (lidocaine patch 5%) has been shown to be helpful for localized areas of tingling or burning.

Pregabalin (Lyrica®) has been approved by the Food and Drug Administration (FDA) to treat post-herpetic neuralgia (shingles pain). Common side effects include drowsiness, dizziness, nausea, weight gain, and swelling (edema).

Injection Therapy

Injection therapy involves injecting a nerve block (e.g., lidocaine) into the area surrounding affected nerves, preventing the nerve from carrying impulses to the brain and temporarily reducing symptoms. Injection therapy is often used with other treatments (e.g., medication, physical therapy).

Other Treatments

Discontinuing medication and exposure to the substance may eliminate neuropathy caused by medication and toxins. Vitamin supplements (e.g., thiamine) and metafolin (Metanx®) may be used to treat nutritional neuropathy.

Physical therapy (e.g., exercise, massage, heat) and acupuncture (i.e., insertion of fine needles into specific points on the body) may be used to treat symptoms.

Support groups often help patients cope with feelings of isolation and frustration and improve their quality of life.

Prognosis

Prognosis for neuropathy depends on the underlying cause. The earlier the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or reversed and the better the prognosis.

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