Excerpts from our Books on Peripheral Neuropathy
From Numb Toes and Aching Soles:
Chapter 3, "Pain Medications"
Introduction
Although there is presently no true cure for PN, there are particular neuropathies that can be successfully treated by dealing with their underlying causes. Treatment as used here means attempting to restore the patient to some degree of normalcy, to bring the affected PNer back to where (or as close as possible to where) he or she was before the onset of the disorder. These neuropathies include:
- diabetic neuropathy, which as noted in Chapter 8 can be controlled most effectively by lowering blood sugar levels;
- neuropathies induced by vitamin deficiencies, toxins and certain drugs, corrected by supplementing the deficiency (covered in Chapter 6) or by removing the causative agent;
- autoimmune and inflammatory neuropathies treated by plasmapheresis, IVIg, or immunosuppressive medications, discussed in Chapter 4;
- certain motor neuropathies managed by physical and psychotherapies, covered in Chapter 5, or orthopedic interventions, mentioned in Chapter 9;
- certain autonomic neuropathies treated symptomatically, such as with medications (metoclopramide, for example) which increase gastric emptying, and drugs to maintain standing blood pressure, treat sexual dysfunction, aid in emptying the bladder (such as bethanechol) and treat diarrhea or constipation; and
- paraneoplastic- tumor related- neuropathies, mentioned in a footnote in the previous chapter, treated by eliminating the tumor.
Unfortunately though, most PNers, including many having neuropathies of the types just listed, must also deal with associated pain. This chapter deals mainly with medication therapies designed to alleviate neuropathic pain
Chapter 9, "Coping":
Temperature Effects
A line from an old song, "Some like it hot, some like it cold .... ," fits here. There are people with peripheral neuropathy who can not imagine putting their already burning feet into a pan of warm water. Others find gratifying relief from a warm soak. Then there are PNers who yearn for an ice pack, a cold compress or even a bag of frozen peas to put on their skin when things get tough and their nerves become angry.
1. Cold or Heat?
As to which is best in general- cold or heat- one can only say use whatever works for you. There are some rules of thumb, though. Heat generally relieves sore muscles. Cold on the other hand lessens pain sensations by numbing the affected area. Some think cold relieves pain faster with the relief lasting longer.
One expert on hydrotherapy claims that heated water stimulates your immune system and causes the white blood cells to move into your tissues where they help eliminate toxins and wastes. He says that cold water discourages inflammation by contracting or tightening blood vessels. He also mentions that contrast therapies are sometimes used where a patient goes back and forth between heated and cold water.
From Numb Toes and Other Woes:
Chapter 2, "Pain Medications: New Studies, New Thinking"
Topicals
5. Compounded Preparations
The pharmacists who prepare medications such as the foregoing, are called "compounding pharmacists." They are specially trained to make custom formulations specifically meeting the prescribed requirements of patients.
This practice allows the physician to order a custom-tailored medication not available commercially. Also it permits pharmacists to prepare small quantities of a prescription more frequently to ensure stability of the product for its intended use. Still another- and to me more cogent reason in so far as treating our ailment is concerned- is that compounding permits the pharmacist to use two or more medications at the same time, substances which may work differently but have a synergistic effect when used in combination.
Often a compounding pharmacist will use a transdermal gel (a form intended for absorption through the skin) as a base or vehicle for the topical application of the active ingredients. This permits the medication to be directed to the precise area where it's needed. The method reportedly reduces side effects or adverse events associated with the oral ingestion of some of the tricyclics, for example. Transdermal administration is also said to help assure faster and more effective pain relief in many cases. Another attractive feature is that by combining various medications, smaller concentrations of each medicine can sometimes be used.
Chapter 3, "Other Medical Therapies: Current Views"
Nerve-Based Treatments
2. Direct Nerve Stimulation
of nerves for patients with peripheral neuropathy is not only effective in many cases but avoids the adverse side effects often involved with pharmacological agents. Interesting and positive new developments have taken place in this area over the last few years. Some of them revolve around a technology/therapy called "percutaneous (through the skin) electrical nerve stimulation" or PENS.
(a) PENS
This procedure involves the insertion of very fine needles- usually 32 gauge, about the thickness of a human hair- into soft tissue or muscles. Electrical impulses are then delivered which stimulate peripheral nerves and promote the release of endorphins, according to Dr. Paul White of Texas Southwestern Medical Center. He said that patients describe the feeling variously as sensations of "tapping, raindrops falling or a massage."
From Nutrients for Neuropathy:
Introduction
No one can be sure which of the two dozen or so is going to work (if any at all) for a particular individual. It is often a matter of lengthy trial and error to find a medication that will help. In the meanwhile the patient goes on suffering, being told that he or she needs to give whatever drug is prescribed "enough time to do its job," even if that means weeks of possible agony until the next one is tried.
Also- let's face it- many doctors, well-meaning though they be, are just not up to speed in treating an ailment as challenging as PN. They may not know about the various treatment possibilities such as nutrient supplementation, and they may feel themselves too busy to stay current and try other approaches, particularly when they may secretly suspect that the problem is in the patient's head rather than his or her feet, hands, legs, or arms or wherever the patient, in fact, happens to hurt.
And as for those side effects- whoo! Depending on the particular drug, they can include dizziness, insomnia, mental lapses, headaches, blurred vision, rashes, internal bleeding, constipation, hypotension or hepatitis. Certainly not everyone suffers such consequences, but they occur often enough to make one cautious about using these medications. Read about a few of the patient treatment experiences in Toes and Soles or on Internet bulletin boards. Some of them describe side effects that seem almost worse than the neuropathy itself!
On the other hand, troublesome or dangerous side effects are rather infrequent with most nutrients unless massive doses are taken.
Chapter 5, "Practical Considerations"
Not surprisingly, any seller who can find some peg to hang the word "natural" on to its product when advertising will do so. (One diligent researcher, though, claims he did a computer search of all of the 7 million clinical studies reported at Medline using the two terms and found only 13 dual references. He maintains that no conclusion can be drawn from these as to whether one type is better that the other. I decided not to repeat his effort.)
To start with, there is often confusion in terms. There are no definitive regulations governing the use of the word "natural" so vitamin C made from sugar, for example, which was made in turn from beet or corn sugar, can be called "natural" because it had its beginnings in natural sources: beets and corn. (Most commercial Vitamin C is made from this process.) Synthetic vitamins, on the other hand, can be made from any source. In fact many of them are manufactured from coal tar derivatives.
To further add to the confusion, many of the so-called natural nutrients have synthetics added to increase potency, or to standardize the amount in a capsule or batch. In addition a salt form is often added to increase stability- e.g., acetate, chloride or nitrate. Just take a look at the label on one or two of your vitamin bottles.
There is no intention in these excerpts, elsewhere on this site, or in the books themselves, to prescribe or recommend any particular medication or therapy for anyone. If you have symptoms of peripheral neuropathy you should see your doctor at once.
There seem to be, though, some benefits for nutrients that are more clearly natural. The sources from which these more natural nutrients are derived often contain co-factors that come with the nutrients in nature. For instance, some co-factors that are usually found with vitamin C are various bioflavonoids, which are pigment substances found in plants with excellent antioxidant characteristics and would be lacking in plain ascorbic acid. Man-made synthetic supplements may be a combination of some of the separate factors but under that view they are never the whole complex of synergistic factors found in nature.
Order these Books online
