Ultimately, your treatment will be determined by the cause of your nerve damage, as well as the symptoms of neuropathy that you develop. (1,2)
A Closer Look at the Types of Neuropathy and Their Causes and Symptoms
Nerve damage doesn’t show up the same way in everyone. But potential signs and symptoms of neuropathy include temporary or permanent numbness; a tingling, prickling, or burning sensation; increased sensitivity to touch; pain; muscle weakness or wasting; paralysis; dysfunction in organs or glands; or impairment to urination and sexual function. (2) The symptoms you develop depend on which nerves are affected. For example, autonomic nerve damage can lead to changes in blood pressure or cause symptoms impacting your gastrointestinal system. On the other hand, sensory nerve damage may impact your sense of balance. Last, motor nerve damage can lead to issues with your reflexes and movement. Sometimes, damage can affect a combination of your nerves. Sensorimotor polyneuropathy occurs when your motor nerves and sensory nerves become damaged and cause body-wide nerve damage. This combo may stem from various diseases, disorders, and even treatments, including: (4)
Sjögren’s syndrome and lupus (two autoimmune conditions)AlcoholismType 2 diabetesChemotherapy side effectsOther medication side effectsGuillain-Barré syndromeHereditary disordersHIV/AIDSVitamin B12 deficiency or deficiency of vitamins B1 and EZika virus infectionKidney failureToxicity, including heavy metals like copper, lead, and those found in pesticides (3)
Symptoms of neuropathy and their severity can also vary according to the types of damage that occur within nerves. For instance, axonal neuropathies are a result of damage to the axons, the nerve fibers that conduct impulses away from the neuron cell body. Axonal damage can make the nerve stop working. Demyelinating neuropathies are a result of damage to the myelin sheath, a fatty covering that protects many nerve fibers and helps with the transmission of electrical impulses along nerve cells. If the myelin sheath is damaged, the nerve impulses will slow down. Some neuropathies involve both demyelinating and axonal damage. For instance, although axonal loss is responsible for many of the symptoms of neuropathy in people with diabetes, demyelination can also be involved. (5) “The treatment for the neuropathy is to reverse whatever it is that is causing the neuropathy,” says Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, California. “We try to reverse the insult to the nerves first and then do symptomatic control.” For people with diabetic neuropathy, the first step physicians take is getting the person’s blood glucose level under control, says Matthew Villani, DPM, a podiatrist based in Orange City, Florida. This treatment approach aims to remove the “insult” created by the excess sugar to peripheral nerves throughout the body — but especially the extremities, Dr. Segil explains. Here are some other ways diabetic neuropathy may be treated: (4,6,7,8,9,10,11,12)
Pain, burning, and tingling are treated with over-the-counter and prescription medication such as nonsteroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors; topical creams; antidepressants; anticonvulsants; and opioids.Numbness or complete loss of sensation can lead to complications like nonhealing sores or ulcers. Nontraumatic ulcers can occur as well due to peripheral vascular disease associated with diabetes. The peripheral vascular disease also makes wound healing difficult, which can ultimately lead to the need for limb amputations. The risk of nonhealing wounds and limb amputation can be reduced by monitoring the affected areas — often the feet — for injuries and addressing wounds before they become more serious, as well as prescribing protective footwear and braces.Orthostatic hypotension (a drop in blood pressure upon standing up), which is an autonomic symptom, can be treated with increased sodium intake, a vasopressor such as midodrine (Proamatine) to constrict blood vessels, a synthetic mineralocorticoid such as fludrocortisone (Florinef Acetate) to help maintain the balance of salt in the body, or a cholinesterase inhibitor such as pyridostigmine (Mestinon), which affects neurotransmitters.Gastroparesis (a delayed emptying of the stomach), another autonomic symptom, can be treated with medication to increase gut mobility (called prokinetics), such as metoclopramide (Reglan) or erythromycin (MY-E). Antiemetic medications are used to control nausea and vomiting, and other drugs, such as antidepressants and pain medications, may be used for symptomatic control.Motor neuropathy symptoms can include weakness and muscle wasting, particularly in the lower extremities, as well as deformities of the feet and loss of the Achilles’ heel tendon reflex. Treatments can include physical therapy to regain strength, as well as braces and orthotics.
That said, if the neuropathy is caused by a vitamin deficiency, a medication side effect, or exposure to a toxin, it’s possible that it can be reversed if the cause is removed. Common methods of treating neuropathic pain include:
Over-the-counter medication, such as NSAIDsAntidepressants, such as serotonin and norepinephrine reuptake inhibitors (SNRIs)AnticonvulsantsCannabinoids, such as tetrahydrocannabinol (THC) and cannabidiol (CBD)Topical medications, such as capsaicin or CBD oilCognitive behavioral therapy (CBT)NeuromodulationSurgery (16,17,18,19,20,21,22)
Another fatty acid, carnitine, is sometimes deficient in people with diabetic neuropathy and nondiabetic types of neuropathy caused by an insufficient blood supply to nerves. In healthy children and adults the body makes all of the carnitine that it needs, so it is not necessary to get more from supplements or nutritional sources such as meat, poultry, and dairy products. But supplementation of the form of the fatty acid known as acetyl-L-carnitine is used to treat neuropathy, says Dr. Smith. Some studies have shown nerve regeneration and an improvement in nerve pain after acetyl-L-carnitine supplementation. (23,24,25,26,27)
Chelation Therapy
Heavy metal toxins, such as mercury and arsenic, can cause neuropathy if you take in too much. The first course of action is to avoid the source of the toxin — for instance, avoiding fish from waters that are highly contaminated with mercury. Then the toxin may be removed from the blood using a chelating agent that is administered orally or intravenously, and binds to the heavy metal so that it can be excreted in urine. Among the common medications used in chelation therapy are dimercaptopropanesulfoxid acid (DMPS), dimercaptosuccinic acid (DMSA), and dimercaprol. But Smith cautions against using these treatments outside of a clinical setting. “There are those who have made a big business out of offering chelation therapy, and unfortunately it has been overused in some patients. These medicines have lots of side effects, and some of them can kill if used improperly.” (28)
Intravenous Immunoglobulin Therapy
Intravenous immunoglobulin (IVIG) therapy is sometimes used to treat underlying infections and autoimmune disorders that can lead to neuropathy, such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIPD), lupus, and vasculitis. (29) “We try to stop the immune process that is creating the damage,” explains Smith. Other treatments used in these cases include corticosteroids and plasmapheresis, a process in which blood plasma is extracted and then treated and returned or exchanged. (30) Additional reporting by Joseph Bennington-Castro.
