The nervous system enables communication between the brain and the rest of the body. When this system is damaged, people experience numbness or pain.
Your doctor will take a thorough medical history and perform physical and neurological examinations. They may order blood tests to detect diabetes, vitamin deficiencies, and autoimmune disorders.
Medication
Medications can help control symptoms of neuropathy. For example, nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, reduce pain, swelling, and stiffness. Capsaicin cream, containing a substance found in hot peppers, relieves itching. Prescription narcotics and antidepressants may also help with pain. Anti-epileptic medications, such as pregabalin (Lyrica(r)), have been shown to decrease chronic nerve pain by decreasing the transmission of painful signals in your brain.
Nerve deterioration from peripheral neuropathy may weaken the motor signals sent from your brain to your muscles. This can lead to muscle weakness and paralysis. NYU Langone physicians can treat the underlying condition or prescribe medication to relieve nerve pain.
Your doctor will determine the underlying cause of your neuropathy to find treatments that can ease or eliminate your symptoms. For example, if your neuropathy is due to diabetes, maintaining blood sugar within your target range or treatment of any vitamin deficiencies can help. If your neuropathy is caused by autoimmune issues, your doctor may use medications such as azathioprine or prednisone to control inflammation and immune system activity. Plasmapheresis, a procedure in which fluid is removed and then cleansed of antibodies, may also be used to treat some autoimmune causes of neuropathy.
Physical Therapy
A physical therapist can teach you exercises to help you strengthen your muscles and improve the way your body moves. This can reduce your pain and improve your quality of life.
Your muscles can weaken and become deformed in neuropathy therapy due to a loss of nerve connections to them. You may experience muscle atrophy and painful splinting.
You can get relief from neuropathic pain with medication, such as antidepressants or anti-epileptics that interfere with how the brain detects pain. Some people also find that a mind/body approach like deep breathing, yoga or tai chi can lower stress and improve coping skills.
Some types of neuropathic pain can be improved by surgery to take pressure off the nerves. For example, herniated discs in the neck or back can cause a nerve to be pinched, and surgery can relieve the pressure on that nerve. But cutting or cutting out a nerve can actually make the pain worse, as parts of your central and peripheral nervous systems above that cut still send out pain signals (phantom pain). Usually surgery is only recommended for severe cases.
Acupuncture
Acupuncture is an ancient practice that involves inserting small needles into specific points on the body. In Traditional Chinese medicine, this balances the flow of energy and restores the proper function of the nervous system. It can also help with pain relief.
Research shows that acupuncture reduces symptoms for people with diabetic neuropathy, Bell’s palsy, and carpal tunnel syndrome. It also improves nerve conduction studies in patients with HIV-related neuropathy. But it’s less effective for people with idiopathic neuropathy or other conditions that cause nerve damage.
Your doctor can diagnose peripheral neuropathy based on your symptoms and medical history. Your doctor may order blood tests, a skin biopsy, and other diagnostic tests, such as an autonomic reflex test or a sweat test. Some causes of neuropathy include cancer, infections and traumatic injuries, metabolic problems, vitamin deficiencies, and autoimmune diseases. Some medications can also cause nerve damage, including the serotonin and norepinephrine reuptake inhibitors duloxetine (Cymbalta) and venlafaxine XR (Effexor XR). Some chemotherapy drugs also can cause neuropathy.
Surgery
In some cases, surgery is necessary to correct underlying problems. For example, a health care professional may remove the cause of nerve damage, such as a tumor or herniated disc, to prevent further complications.
Nerves that carry signals from the brain to your feet and legs need an insulating coating called myelination, which can be damaged by disease or medications. NINDS-funded research aims to understand how myelination forms and how mutations in genes that control this process lead to neuropathies.
Inflammatory and autoimmune conditions causing neuropathy can be controlled with immunosuppressive drugs, such as prednisone or cyclosporine, or plasmapheresis, which cleanses the blood to reduce abnormal immune system activity. Medications that quiet nerve cell electrical signaling and increase your body’s ability to inhibit pain signals, such as duloxetine hydrochloride, can also help with neuropathic pain. In addition, you can use prescription skin patches containing the local anesthetic lidocaine to relieve milder pain. Behavioral strategies, including meditation techniques and learning how to change your response to pain, can help you cope with neuropathic pain.
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