Non-pharmacologic management of peripheral neuropathy pain
By Bonnie Nock, D.O.
Peripheral neuropathy is a disease or disorder that has damaged the nerves in the body. This disorder may impair sensation or movement of the body, but can also affect the glands and organs in the body. There are a multitude of causes of peripheral neuropathy but the most common are:
- Diabetes mellitus
- Medications such as chemotherapy
- Excess alcohol usage
- Autoimmune disorders such as rheumatoid arthritis
- Exposure to toxins/poisons and infections
Frequent problems noted by persons with peripheral neuropathy are:
- Muscle cramps
- Changes in skin and hair
- Impaired balance and coordination
- Burning, numbness, tingling, pins and needles
- Stabbing pain
- Abnormal heart rate and blood pressure control
- Impaired bladder control
- Increased sensitivity to touch and temperature
The majority of cases of peripheral neuropathy are not reversible, but can be managed. The pain related to peripheral neuropathy is frequently controlled with prescription medications such as Gabapentin, Lyrica and Cymbalta. Other non-pharmacologic prescription options are available to help people manage the pain and physical changes associated with the disease. These treatments have not been extensively tested, but there are some studies demonstrating benefit over placebo, as well as anecdotal evidence. Also, be aware there is a perception among most people that over the counter medications and alternative therapies are harmless. This is not always the case, so it would be wise to check with your physician.
Non-pharmacologic management of peripheral neuropathy can be divided into two categories. The first is lifestyle changes and alterations in the home environment and the second is alternative medicine.
Lifestyle Changes and Alterations in Home Environment include:
- Exercise—studies have demonstrated the need to maintain ROM (range of motion), strength and balance. Activities such as aquatics, yoga and Tai Chi have been shown to be beneficial.
- Eat a balanced diet and avoid excess alcohol.
- Quit smoking—smoking decreases circulation to the nerves.
- Massage—improves circulation and stimulates the nerves
- Warm water—relaxes the muscles
- Comfortable shoes with large toe box
- Cotton socks with padding at the ball of the foot and heel
- Semicircular hoop to keep bed covers off feet when in bed
- Clean and inspect feet daily for sores or cracks in the skin to prevent infections and further pain
- Avoid prolonged pressure on nerves—do not cross legs or lean on elbows
- Splints for hands and feet to maintain range of motion and function
- Mobility devices—canes, walkers, wheelchairs, scooters
- De-clutter the home to allow for adequate room for maneuvering around the home
- Remove throw rugs to prevent falls
- Adaptive equipment—large handle kitchen devices and utensils, button/zipper aids, large button remote, key turner, reacher, elevated toilet seats, tub benches or seats
- Biofeedback/relaxation techniques
- TENS units—application of electrical current to the skin over the painful or adjacent body region. Studies have shown a 44-52% reduction in pain after 3 weeks of daily use.
- Acupuncture—involves insertion of thin needles into various parts of the body. Studies have shown that 50% of patients have a 50% reduction in pain after 6 sessions.
- Magnet therapy insoles for shoes—more effective than placebo but only show a 25% reduction in pain.
- Low intensity laser therapy—demonstrated a 50% reduction in pain for a month
- FREMS—modulated electromagnetic stimuli. Has been shown to decrease pain after 3 weeks.
- Capsaicin—cream made from hot chili peppers—must be used regularly. You must get used to the heat before experiencing any pain relief. Must be careful not to touch eyes, nose or mouth after applying to feet and hands, until you have thoroughly washed hands.
- Vitamins—vitamins B1, B6 and B12 are essential for nerve health
- Herbs and oils—all may interact with medications and patients should discuss these with their physician prior to starting them.
- Alpha lipoic acid is an anti- oxidant that has been used in Europe for many years for peripheral neuropathy. It may affect blood sugar levels.
- Primrose oil and botanical oils
- Fish oil—acts as an anti-inflammatory and may increase blood flow
Non pharmacologic strategies work best when combined with prescription medications in managing pain related to peripheral neuropathy. Neuropathic pain can be difficult to manage and generally requires multiple approaches to control.