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Treating neuropathy focuses first on addressing the cause of nerve damage, and then controlling the symptoms. By Sheryl Huggins SalomonMedically Reviewed by Michael R. Yochelson, MD, MBAReviewed: October 1, 2022Medically ReviewedThe cause and symptoms of your case of neuropathy will help your doctor determine the appropriate treatment approach.Getty ImagesJust like neuropathy (also called peripheral neuropathy) isn’t just one condition, neither is there a single treatment option that’s best for all forms of this group of health issues. 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)More on Signs of Neuropathy What Neuropathic Pain Feels Like and the Causes of the Symptom
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) Most Recent in Neurology
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What Are the Main Ways That Neuropathy Is Treated
Treating neuropathy in general focuses first on identifying and then addressing the underlying condition to help prevent further damage and give nerves the time they need to heal to the extent that they can. “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.”More on the Basics of Neuropathy 6 Possible Complications of Neuropathy and How They re Treated
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. Editor s Picks in Neurology
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How Is Neuropathic Pain Typically Treated
Vernon Williams, MD, a sports neurologist who is director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, says neuropathic pain tends to be “burning” or “electric.” Pain medication can help with such symptoms and improve sleep and quality life, but unfortunately neuropathy isn’t reversible or curable, he explains. 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) 11 Must-Know Risk Factors for Neuropathy
Everything from chemo to infections may lead to neuropathic symptoms. Learn more about the top causes of nerve damage here.Article How Nutritional Supplements May Also Be Used to Help Treat Nerve Pain
Furthermore, nutritional supplements have suggested promising results for people with neuropathy, says R. Glenn Smith, MD, a neurologist at Houston Methodist in Houston. “We are using alpha-lipoic acid for many of our patients who have diabetic neuropathy,” he says. The antioxidant is a naturally occurring fatty acid found in many foods, such as yeast, spinach, broccoli, Brussels sprouts, yams, potatoes, and organ meat such as liver and kidney. Some studies have shown an improvement of nerve pain specifically in people with diabetes.More on Diet and Neuropathy How Your Eating Habits May Affect Neuropathy Management and Progression
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) Most Popular in Neurology
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Other Possible Therapies for Neuropathy
Other emerging therapies have the potential to help treat neuropathy. Here are a handful: 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) If You Have Psoriasis Are You At Risk for Other Conditions
Learn more about the connection between the skin condition and other ailments that may cause neuropathy, such as Sjögren’s syndrome, lupus, and rheumatoid arthritis.Article Physical Therapy
In some cases of motor neuropathies involving weakness and muscle wasting, physical therapy can help. “When we are using a muscle continuously or we are releasing growth factors, we are trying to get those nerves to grow back,” says Smith. The success of physical therapy can depend on the extent of the nerve damage and the age of the patient, with older patients less likely to experience the extent of recovery that younger patients do, he adds. Additionally, in the case of diabetic neuropathy, exercise can help with controlling blood glucose levels. (31) Additional reporting by Joseph Bennington-Castro. Resources We Love
The Foundation for Peripheral NeuropathyMayo ClinicNational Institute of Diabetes and Digestive and Kidney DiseasesNEWSLETTERS Sign up for our Diabetes Newsletter
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How Does the Nervous System Work? InformedHealth.org. August 19, 2016.Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke. July 25, 2022.Staff NP, Windebank AJ. Peripheral Neuropathy Due to Vitamin Deficiency, Toxins, and Medications. Continuum. October, 2014.Sensorimotor Polyneuropathy. MedlinePlus. November 9, 2021.Valls-Canals J, Povedano M, Montero J, et al. Diabetic Polyneuropathy: Axonal or Demyelinating? Electromyography and Clinical Neurophysiology. January–February 2002.Diabetic Peripheral Neuropathy. The Foundation for Peripheral Neuropathy.Figueroa J, Basford J, Low P. Preventing and Treating Orthostatic Hypotension: As Easy As A, B, C. Cleveland Clinic Journal of Medicine. May 2010.Definition and Facts for Gastroparesis. National Institute of Diabetes and Digestive and Kidney Diseases. January 2018.Treatment for Gastroparesis. National Institute of Diabetes and Digestive and Kidney Diseases. January 2018.Jacobs AM. A Closer Look at Motor Neuropathy in Patients With Diabetes. Podiatry Today. September 2008.Misra UK, Kalita J, Nair PP. Diagnostic Approach to Peripheral Neuropathy. Annals of Indian Academy of Neurology. April–June 2008.Shields RW. Peripheral Neuropathy. Cleveland Clinic Center for Continuing Education. August 2010.Deleted, September 16, 2022.Deleted, September 16, 2022.Deleted, September 16, 2022.Treatments. The Foundation for Peripheral Neuropathy.Jensen TS. Anticonvulsants in Neuropathic Pain: Rationale and Clinical Evidence. European Journal of Pain. 2012.Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for Chronic Neuropathic Pain in Adults. Cochrane Database of Systematic Reviews. June 9, 2017.Shamji MF, De Vos C, Sharan A. The Advancing Role of Neuromodulation for the Management of Chronic Treatment-Refractory Pain. Neurosurgery. March 1, 2017.Carpal Tunnel Release. Johns Hopkins Medicine.Barrett S, Nickerson D. Nerve Decompression Surgery Can Reverse Neuropathy of the Foot. Practical Pain Management. June 17, 2020.Treatment at the Peripheral Nerve Center. NYU Langone Health.Sima AAF, Calvani M, Mehra M, Amato A. Acetyl-L-Carnitine Improves Pain, Nerve Regeneration, and Vibratory Perception in Patients With Chronic Diabetic Neuropathy: An Analysis of Two Randomized Placebo-Controlled Trials. Diabetes Care. January 1, 2005.Scarpini E, Doneda P, Pizzul S, et al. L-Carnitine and Acetyl-L-Carnitine in Human Nerves From Normal and Diabetic Subjects. Journal of the Peripheral Nervous System. 1996.Carnitine. National Institutes of Health Office of Dietary Supplements. March 29, 2021.McIlduff CE, Rutkove SB. Critical Appraisal of the Use of Alpha Lipoic Acid (Thioctic Acid) in the Treatment of Symptomatic Diabetic Polyneuropathy. Therapeutics and Clinical Risk Management. September 5, 2011.Golbidi S, Badran M, Laher I. Diabetes and Alpha Lipoic Acid. Frontiers in Pharmacology. November 17, 2011.Wax PM. Current Use of Chelation in American Health Care. Journal of Medical Toxicology. December 2013.Jolles S, Sewell WAC, Misbah SA. Clinical Uses of Intravenous Immunoglobulin. Clinical and Experimental Immunology. October 2005.CIDP. GBS/CIDP Foundation International.Exercise and Physical Therapy for Neuropathy. Foundation for Peripheral Neuropathy.Additional SourcesSerpell M, Ratcliffe S, Horvorka J, et al. A Double-Blind, Randomized, Placebo-Controlled, Parallel Group Study of THC/CBD Spray in Peripheral Neuropathic Pain Treatment. European Journal of Pain. August 2014.Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Current Pharmaceutical Biotechnology. 2020.Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. January 4, 2022.Show Less The Latest in Neuropathy
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