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.
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