Since polyneuropathy is generally caused by a systemic illness, we need to find and treat the underlying disease process. The treatment of neuropathy and its success depends on the underlying illness that is causing it. Unfortunately there is not a single treatment that works for all neuropathies. Each type of neuropathy has its own unique treatment.
Diabetic Neuropathy could be a complex problem but it is often a treatable neuropathy. One of the first steps in the treatment is to get good control of glucose levels, which could slow the progression of the neuropathy. However we find that this is often not enough. Patient could have good control of their glucose levels and yet their neuropathy could progress. We often find that diabetic patients generally have a second disease process that is affecting the nerves. It appears that the nerves in diabetic patients become more sensitive to injury. Disease processes that would cause minor injury to the nerves of non-diabetic patients could have more of an effect in diabetic patients. We often find that when we treat the secondary disease process that the patients could have significant relief.
One of the common processes that we see in diabetics is entrapment syndromes. The nerves in the body generally pass through tunnels that are made of muscles and tendons. If the tunnel becomes narrow or the nerve swells, then the nerve could become entrapped. Diabetic patients could have swelling of the nerves which causes entrapment. The most common one is carpal tunnel syndrome which is the entrapment of the nerves that pass through the tendons of the wrist. This causes hand pain, tingling, burning, and numbness (See carpal tunnel syndrome). We have been finding that the same kind of process could occur in the legs. The nerves in the legs could become entrapped in the tendons that they pass through. There are very simple surgical techniques available that are able to release the nerve from the tunnel. We find that once the entrapped nerve is released the patients get significant relief, even from severe pain and burning.
Another category of problems we see in patients that have diabetic neuropathy are vitamin deficiencies or excess levels of vitamins. We often see that once we correct the vitamin levels, the patient could find significant relief.
In some of our diabetic patients we find that they have an immune mediated neuropathy (see below for more details).
We have just mentioned some of the common problems we see as secondary problems in diabetic patients. There are multiple other disease processes that need to be looked at as well. We find that once we have the proper diagnosis, most diabetic neuropathies have treatment.
Another category of diseases that we see are vitamin deficiencies and vitamin excess. With more accurate testing we are finding that a significant portion of our patients have vitamin abnormalities. We not only measure the body’s vitamin levels directly, but we use tests that indicate how the body is using the vitamins. These tests show that some patients might need a change in their levels of vitamins even though they could have near normal blood levels of the vitamin itself. This is because different bodies handle different vitamin levels differently. In one patient a certain vitamin level might be enough but in another a higher level of vitamins might be needed. The vitamins that are known to effect nerves include vitamin B6, B12, B1, and Folic acid. Once the patient gets the proper amount of vitamins they could have significant improvement.
CIDP is a disease process by which body’s own immune system attacks its own nerves (see CIDP for more information). There are now very good treatments to stop the immune system from attacking its own nerves. Once the immune system stops attacking the nerves, this allows the nerves to regenerate. Even patients who have CIDP with severe weakness, numbness, tingling, or burning could have very good response to these treatments. In addition to treating the underlying disease, we use different techniques to control the symptoms including multiple different medications, physical therapy, braces, electrical stimulators, surgical methods, and injections.
We have just mentioned some of the common neuropathies we see and their treatments. There are multiple other disease processes that need to be looked at as well.
Generally when a single nerve of the body is not working properly there is a local cause for it. By finding that part of the nerve that is not working, an attempt is made to relieve the local cause. This could be done by wearing the proper brace, physical therapy, medications, being aware and using the correct posture, and at times surgical intervention is needed to prevent further damage of the nerve and even reverse the symptoms. If proper treatments are not provided and the problem is ignored, the disease could progress and the injury could become irreversible.
