Available treatments

By Jeffrey W. Ralph, MD

Treatment for peripheral neuropathy includes:

  • Therapies to repair nerves
  • Therapies for pain relief
  • Therapies to improve function

Therapies to Repair Nerves

The best way to repair the nerves is to identify and treat the underlying disease process causing nerve injury.

Treatment of focal neuropathies may involve surgery to remove pressure on the nerve. Sometimes, as in the case of mild blunt trauma to the nerves, a “tincture of time” is all that is needed.

For polyneuropathies, the job of identifying the root cause of the neuropathy becomes important. To do this, your physician may order various laboratory tests. If the underlying disease can be identified and treated, the neuropathy usually stabilizes and symptoms may improve.

For example, the best way to treat a diabetic polyneuropathy is to optimize blood sugar levels. The best way to treat an alcoholic polyneuropathy is abstinence and proper nutrition. Autoimmune neuropathies may respond to steroids or intravenous immunoglobulin therapy.

When an underlying cause cannot be found (i.e., the idiopathic neuropathies), the therapeutic options to heal the nerve are, unfortunately, limited. Studies of chemical factors and drugs that can directly regenerate nerve endings have been disappointing.

Therapies for Pain Relief

For all types of neuropathies, there are many options available to reduce pain and discomfort.

A number of drugs specifically target neuropathic pain. These medications generally affect the electrical and chemical activity of nerve fibers both in the peripheral and central nervous system. Some drugs suppress the rapid electrical discharges of nerves. Oral medications can target pain throughout the body. Unfortunately, these medications may also impair brain function, causing sleepiness or foggy thinking.

Even with aggressive management, persistent and bothersome neuropathic pain is a frequent problem. This is can be a source of tremendous frustration for neuropathy patients. Because relatives and loved ones are often not familiar with either neuropathy or neuropathic pain, patients feel additionally isolated. Pain is the most common impetus behind neuropathy patients seeking help from their physicians; it is the most common reason patients attend support groups. Without a doubt, there is an enormous need for more effective oral pain treatments that have fewer cognitive side effects.

For some patients, topical pain relieving medications are effective. These medications only have a local effect and do not get absorbed significantly into the bloodstream. Because of this, there are no cognitive side effects with these medications. The main options in this category are topical anesthetics (similar to the numbing medications given by dentists) and chili pepper extract (capsaicin). As one would imagine, the capsaicin creams cause burning sensations when applied. After repeated applications, however, neuropathic pain is mitigated. Topical medications tend to work best for neuropathies in which symptoms are restricted to small regions of the body (e.g., just the feet or toes).

An exercise program is often beneficial for alleviating chronic pain and for promoting general well being. For patients with polyneuropathy, exercises need to be chosen that limit the impact on the soles of the feet. Swimming is an excellent exercise. It is a terrific aerobic exercise that involves many muscle groups without putting much strain on the joints. Other options include bicycling. Other low impact exercises include Tai Chi and Yoga. It is recommended that you discuss an exercise program with your physician.

Other therapies aimed at pain relief include massage therapy, acupuncture, and electrical stimulation.

There are many other devices and nutritional supplements marketed to patients with neuropathic pain. A few have demonstrated benefit in clinical trials, but most of these devices and supplements are experimental. Before spending large amounts of money on any such treatment, I would recommend discussing it with your physician.

Therapies to Improve Function

If significant weakness is present, braces or splints may become necessary. In addition to helping mobility and function, these aids protect the full range of motion of joints. Without them, some neuropathies may result in joint contractures (very stiff joints).

In severe neuropathies, canes, walkers, or even wheelchairs may be necessary for patients to maintain mobility.