Peripheral Neuropathy Treatment Options Explained

Peripheral neuropathy is a broad term describing a wide variety of disorders affecting nerves throughout the body. There are many potential causes and subtypes, which can have varying patterns of symptoms and rates of progression. Because of this, there is no single treatment that will work for every patient. Treatment aims to minimize your symptoms (pain, numbness, tingling) and treat the underlying cause of nerve damage if possible. These often require a combination of therapies.

Medications

The most common treatment for neuropathy is medications. Neuropathic pain is very different from the normal musculoskeletal pain you may be familiar with.

Typical medications used to treat neuropathy include:

• Antidepressants like Amitriptyline and Duloxetine help modulate pain. These can be used even if you don’t have depression.

• Anticonvulsants like Gabapentin and Pregabalin help decrease abnormal nerve firing.

• Topical Lidocaine helps relieve localized pain.

You may need to try a few different medications, dosages, and combinations. It’s not uncommon for these medications to cause unwanted side effects (sleepiness, dizziness). Finding the right regimen can take some time.

Physical Therapy

Movement is medicine.

Physical therapy can help you:

• Improve balance and coordination

• Strengthen stabilizing muscles

• Prevent falls

• Maintain mobility

Aerobic exercise (walking, biking, swimming) can increase blood flow to affected nerves. This can improve nerve function and slow progression.

If your neuropathy is causing an abnormal walking pattern, particularly if you have “drop foot” where your foot drags as you walk, orthotics can help correct your gait. This can help you move safer and avoid injuries.

Electrical Stimulation

Using electrical pulses to manage pain is nothing new.

Transcutaneous electrical nerve stimulation or TENS is a treatment that involves using a battery-powered device that sends electrical pulses through electrodes placed on the skin. This can help decrease the perception of pain.

There are other variations that stimulate nerves further down the pathway such as:

• Peripheral nerve stimulation (stimulator placed near affected nerves)

• Spinal cord stimulation (stimulator placed near the spine)

Again, these do not heal the nerves but can help decrease your symptoms.

Address Underlying Issues

I wanted to make sure to include this one.

If you have Diabetic Neuropathy, the single best thing you can do is get your blood sugar under control. Keeping your blood sugar levels as close to normal as possible will slow the progression of neuropathy.

Other lifestyle changes can also have a significant impact on your symptoms.

• Limit or stop alcohol consumption

• Stop smoking to improve circulation

• Eat a healthy diet rich in vitamin B, antioxidants, etc.

• Maintain a healthy weight

These are not “supportive treatments.” These treatments are just as important as anything your doctor will prescribe.

Platelet-Rich Plasma (PRP) and/or Stem Cell Therapy

There are exciting developments in the treatment of peripheral neuropathy that involve trying to promote nerve healing.

This includes:

• Platelet-rich plasma or PRP. This treatment takes your blood’s platelets and injects them into the affected areas. Platelets contain growth factors that help your body heal tissue.

• Stem cell therapy

• Growth factor therapy

While promising, these treatments are still considered somewhat investigational. You will likely have a difficult time finding doctors in your area that offer them. If they are available, they can be expensive. Stay tuned, as these treatments will become more mainstream in the coming years.

Massage & Sensory Treatment

These treatments don’t directly treat the cause of your pain. But they can help.

Many people find treatments like massage, myofascial release, and acupuncture help their symptoms. Applying heat and/or cold can also help but be careful of using heat if you have reduced sensation.

Things like meditation or listening to music can also help reduce the “amplification” of your pain that occurs with chronic neuropathy.

Massage, acupuncture, etc. should be used in conjunction with other treatments, not as a replacement.

Nerve Decompression Surgery

As I mentioned earlier, not all neuropathy is the same.

If you have been diagnosed with nerve compression, surgery can help. By relieving pressure on the affected nerve/s, you can reduce your symptoms and allow the nerve to recover.

One of the more common surgeries for this is for Tarsal Tunnel Syndrome. In this case, the tibial nerve is being compressed as it passes through a tunnel of tissue near the ankle.

It’s important to note that you’ll only want to consider surgery if you have been properly diagnosed with nerve compression. Nerve conduction studies, X-ray, MRI, etc. can help determine if this is the cause of your pain. Neuropathies such as diabetic neuropathy or toxic neuropathy would not be helped by this.

Manage Your Expectations

Nerves grow slowly. If they grow at all outside of regenerating small damaged fibers.

The treatments above can help you:

• Decrease your pain

• Improve your function

• Prevent further progression

You may never be 100% symptom-free but that doesn’t mean you can’t live your life with minimal pain. And remember, slow and steady wins the race. Small improvements over time will have a huge impact.

Frequently Asked Questions

Can peripheral neuropathy be reversed?

Yes, if it’s caught early enough and you address the underlying cause. Many people suffering from neuropathy due to vitamin deficiencies have been able to reverse their symptoms. If you are diabetic and have neuropathy due to uncontrolled blood sugar, reversing the symptoms is much more difficult but not impossible. See your doctor to determine what can be done in your situation.

How long before I feel better?

It depends on the treatment. Medication can work in a matter of weeks. Physical therapy and lifestyle changes can take a few months to show significant results.

What is the best treatment for neuropathy?

Combination therapy! Using medication to manage pain and physical therapy to keep you moving is one of the best things you can do. Treating the underlying cause if possible (such as controlling your blood sugar or having surgery to decompress a nerve) can go a long way towards treating your neuropathy.