Managing Peripheral Neuropathy: Therapies and Interventions

Certain neurological disorders can cause acute episodes of peripheral neuropathy, and for individuals diagnosed with chronic peripheral neuropathy, can physical therapy help improve the ability to move around safely along with medications, procedures, and lifestyle adjustments to help control and manage symptoms?

Peripheral Neuropathy Treatments

Peripheral neuropathy treatment includes symptomatic therapies and medical management to help prevent worsening nerve damage.

• For acute types of peripheral neuropathy, medical interventions and therapies can treat the underlying process, improving the condition.
• For chronic types of peripheral neuropathy, medical interventions and lifestyle factors can help to prevent the condition’s progression.
• Chronic peripheral neuropathy treatment focuses on controlling the pain symptoms and protecting areas of diminished sensation from damage or infection.

Self-Care and Lifestyle Adjustments

For individuals who have been diagnosed with peripheral neuropathy or are at risk of developing the condition, lifestyle factors play a significant role in managing symptoms and preventing nerve damage from worsening and can even prevent the condition from developing. (Jonathan Enders et al., 2023)

Pain Management

Individuals can try these self-care therapies and see if and which help reduce their discomfort and then develop a routine that they can work off of. Self-care for pain symptoms include:

• Placing a warm heating pad on painful areas.
• Placing a cooling pad (not ice) on painful areas.
• Covering the area or leaving it uncovered, depending on comfort levels.
• Wear loose-fitting clothes, socks, shoes, and/or gloves not made with material that can cause irritation.
• Avoid using lotions or soaps that can cause irritation.
• Use soothing creams or lotions.
• Keeping the painful areas clean.

Injuries Prevention

Diminished sensation is one of the most common effects that can lead to problems like stumbling, difficulty getting around, and injuries. Preventing and regularly checking for injuries can help avoid complications like infected wounds. (Nadja Klafke et al., 2023) Lifestyle adjustments to manage and prevent injuries include:

• Wear well-padded shoes and socks.
• Inspect feet, toes, fingers, and hands regularly to look for cuts or bruises that may not have been felt.
• Clean and cover cuts to avoid infections.
• Use extra caution with sharp utensils like cooking and work or gardening tools.

Disease Management

Lifestyle factors can help prevent disease progression and are closely correlated with the risks and underlying causes. To help prevent peripheral neuropathy or its progression can be done by: (Jonathan Enders et al., 2023)

• Maintain healthy glucose levels if you have diabetes.
• Avoid alcohol for any peripheral neuropathy.
• Maintain a well-balanced diet, which can include vitamin supplements, especially for vegetarians or vegans.

Over-the-Counter Therapies

A few over-the-counter therapies can help with painful symptoms and can be taken as needed. Over-the-counter pain therapies include: (Michael Überall et al., 2022)

• Topical lidocaine spray, patch, or creams.
• Capsaicin creams or patches.
• Topical Icy Hot
• Non-steroidal anti-inflammatory medications –  Advil/ibuprofen or Aleve/naproxen
• Tylenol/acetaminophen

These treatments can help relieve painful symptoms of peripheral neuropathy, but they do not help improve diminished sensation, weakness, or coordination problems. (Jonathan Enders et al., 2023)

Prescription Therapies

Prescription therapies for treating peripheral neuropathy include pain medications and anti-inflammatories. Chronic types of peripheral neuropathy include:

• Alcoholic neuropathy
• Diabetic neuropathy
• Chemotherapy-induced neuropathy

The prescription treatments for chronic types differ from the treatments for acute types of peripheral neuropathy.

Pain Management

Prescription treatments can help manage the pain and discomfort. Medications include (Michael Überall et al., 2022)

• Lyrica – pregabalin
• Neurontin – gabapentin
• Elavil – amitriptyline
• Effexor – venlafaxine
• Cymbalta – duloxetine
• In severe cases, intravenous/IV lidocaine may be necessary. (Sanja Horvat et al., 2022)

Sometimes, a prescription strength supplement or vitamin B12 given through injection can help prevent progression when peripheral neuropathy is associated with a severe vitamin deficiency. Prescription treatment can help treat the underlying process in some types of acute peripheral neuropathy. Treatment for acute peripheral neuropathy, such as Miller-Fisher syndrome or Guillain-Barré syndrome, can include:

• Corticosteroids
• Immunoglobulins – immune system proteins
• Plasmapheresis is a procedure that removes the liquid portion of blood, returning the blood cells, which modifies the overactivity of the immune system. (Sanja Horvat et al., 2022)
• Researchers believe there is an association between these conditions and inflammatory nerve damage, and modifying the immune system is beneficial for treating symptoms and the underlying disease.

Surgery

In some cases, surgical procedures can benefit individuals who have certain types of peripheral neuropathy. When another condition is exacerbating the symptoms or process of peripheral neuropathy, surgery may help relieve symptoms and prevent disease progression. This has proved effective when nerve entrapment or vascular insufficiency are factors. (Wenqiang Yang et al., 2016)

Complementary and Alternative Medicine

Some complementary and alternative approaches can help individuals cope with the pain and discomfort. These treatments can serve as an ongoing option for those who have chronic peripheral neuropathy. Options can include: (Nadja Klafke et al., 2023)

• Acupuncture involves the placement of needles in specific areas of the body to help reduce pain symptoms.
• Acupressure involves applying pressure on specific areas of the body to help reduce pain symptoms.
• Massage therapy can help relax muscle tension.
• Meditation and relaxation therapies can help manage symptoms.
• Physical therapy can also serve as an important component of living with chronic peripheral neuropathy and recovering from acute peripheral neuropathy.
• Physical therapy can help strengthen weak muscles, improve coordination, and learn how to adapt to sensory and motor changes to get around safely.

Individuals considering complementary or alternative treatment are encouraged to speak with their primary healthcare provider to determine whether it is safe for their condition. Injury Medical Chiropractic and Functional Medicine Clinic will work with the individual’s healthcare provider and/or specialists to develop an optimal health and wellness treatment solution to provide pain relief and improve quality of life.

Peripheral Neuropathy: A Successful Recovery Story

References

Enders, J., Elliott, D., & Wright, D. E. (2023). Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxidants & redox signaling, 38(13-15), 989–1000. doi.org/10.1089/ars.2022.0158

Klafke, N., Bossert, J., Kröger, B., Neuberger, P., Heyder, U., Layer, M., Winkler, M., Idler, C., Kaschdailewitsch, E., Heine, R., John, H., Zielke, T., Schmeling, B., Joy, S., Mertens, I., Babadag-Savas, B., Kohler, S., Mahler, C., Witt, C. M., Steinmann, D., … Stolz, R. (2023). Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Medical sciences (Basel, Switzerland), 11(1), 15. doi.org/10.3390/medsci11010015

Überall, M., Bösl, I., Hollanders, E., Sabatschus, I., & Eerdekens, M. (2022). Painful diabetic peripheral neuropathy: real-world comparison between topical treatment with lidocaine 700 mg medicated plaster and oral treatments. BMJ open diabetes research & care, 10(6), e003062. doi.org/10.1136/bmjdrc-2022-003062

Horvat, S., Staffhorst, B., & Cobben, J. M. G. (2022). Intravenous Lidocaine for Treatment of Chronic Pain: A Retrospective Cohort Study. Journal of pain research, 15, 3459–3467. doi.org/10.2147/JPR.S379208

Yang, W., Guo, Z., Yu, Y., Xu, J., & Zhang, L. (2016). Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 55(6), 1185–1189. doi.org/10.1053/j.jfas.2016.07.004