Entrapment Neuropathy
June 11, 2013 Leave a Comment

Entrapment Neuropathy

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This week on Beating Neuropathy Radio, we’ll talk about Entrapment neuropathy. Entrapment neuropathy occurs when a nerve is pinched or entrapped, particularly in the arms. The most common type of entrapment neuropathy is carpal tunnel syndrome (CTS). CTS happens, for a number of reasons, when the median nerve in the arm is compressed. There are many non-surgical treatments for CTS.

“Double crush” happens when the median nerve is also compressed in another location in addition to the wrist. CTS surgeries are often unsuccessful because the patient, in fact, has a nerve that is pinched in multiple locations. In the majority of cases, a less invasive option is to try manual therapies, neurostimulation, laser therapy, massage, and more before considering surgery. This is also true of other entrapment neuropathies, which can also occur in the legs and feet, such as tarsal tunnel syndrome,

Sciatica may be caused by entrapment neuropathy. The piriformis muscle in the hip may entrap the sciatic nerve, causing pain, tingling, burning, and numbness down the leg.

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Nutritional Factors in Neuropathy and Pain
June 2, 2013 Leave a Comment

Nutritional Factors in Neuropathy and Pain

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Tonight on Beating Neuropathy Radio, we’ll talk again about nutrition and how it relates to neuropathy and chronic pain. Certain habits and nutrient deficiencies can cause or aggravate neuropathy and pain.

Alcoholism or excess alcohol consumption is a major health risk factor. Moderation is key–but Dr. Hayes recommends that patients with neuropathy and chronic pain do not consume alcohol at all. Neuropathy can actually develop from chronic alcohol consumption alone. This type of neuropathy is significant and debilitating. Tobacco smoking, though harmful by itself, tends to occur with alcohol consumption and should also be avoided.

Medications used to control gastrointestinal problems such as heartburn and indigestion can cause harmful side effects. Instead of medicating to alleviate these symptoms, the underlying cause needs to be treated–eating or drinking too much, eating foods you don’t tolerate, et cetera. Listen to your body!

Celiac disease can effect absorption of nutrients. One of the first symptoms of celiac may actually be neuropathy. The only treatment for celiac disease or gluten intolerance is to completely avoid all foods that contain or may be contaminated with gluten. People with gluten intolerance or celiac may test negative–so if you suspect it is causing you problems, try eliminating it from your diet anyway. Dr. Hayes recommends all patients suffering from neuropathy and chronic pain avoid gluten (and dairy) because of its inflammatory properties.

It is important to watch carbohydrate consumption as well–gluten-free breads, crackers, and cookies may also be high in carbohydrates. Proper meal composition requires a lot of care and attention; focus primarily on vegetables and lean protein.

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Small Fiber Neuropathy
May 26, 2013 Leave a Comment

Small Fiber Neuropathy

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Welcome back to Beating Neuropathy Radio! This week, Dr. Hayes will be be talking about Small Fiber Neuropathy.

Small fiber neuropathy is a common type of neuropathy. It is becoming more common and can accompany lifestyle issues such as lack of exercise and poor diet planning. Small fiber neuropathy is nerve damage which affects small, delicate nerve fibers. These fibers are especially vulnerable because they do not have a protective myelin coating, whereas larger nerves do. These small fibers affect perception of pain and temperature. The most common presentation of small fiber neuropathy is pain, burning, tingling, and numbness.

It is estimated that over 20 million people over the age of 40 have neuropathy–most of these cases are, in fact, small fiber neuropathy. This type of neuropathy affects the longest nerves in the body. The feet are usually affected first for this reason. One should never ignore symptoms of burning, tingling, and numbness in the feet, as the condition may progress if untreated.

Small fiber neuropathy may have multiple underlying causes. Treating the underlying cause may reduce or eliminate symptoms. The number one cause of small fiber neuropathy is metabolic syndrome, sometimes known as pre-diabetes. It is caused primarily by weight gain. It may also be caused by connective tissue disease such as lupus.

Untreated thyroid disease may also cause small fiber neuropathy. Fibromyalgia symptoms in some may be caused by underlying thyroid disease. Additionally, some cases of fibromyalgia may actually be small fiber neuropathy.

Diagnosing small fiber neuropathy may be difficult. A thorough sensory examination is necessary, since test results may come back “normal”. There are also several conditions which may mimic the symptoms of small fiber neuropathy. It is important to find a clinician with experience diagnosing and treating small fiber neuropathy.

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Advances in Diagnosing Neuropathy
April 21, 2013 Leave a Comment

Advances in Diagnosing Neuropathy

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This week on Beating Neuropathy and Chronic Pain, we’ll talk a bit about how neuropathy can be diagnosed. Unfortunately, nowadays, due to insurance hurdles, proper laboratory tests are often not administered in time to make an early diagnosis. Neuropathy-causing conditions such as diabetes and metabolic syndrome can be diagnosed by observing trends in blood tests. Patients with metabolic syndrome that develop peripheral neuropathy are often diagnosed with “idiopathic” (of unknown origin) neuropathy because doctors may overlook all the evidence.

One of the things NeuropathyDR clinicians do is observe all laboratory tests for the past five years to try and observe trends other physicians may have missed. Something that may cause neuropathy, in addition to diabetes and metabolic syndrome, is Lyme Disease. Lyme Disease is endemic to the Northeastern U.S. and some other areas. It is important to seek treatment quickly for Lyme Disease (or ANY infectious disease) if you suspect you have it–even if a rash is not present. Lyme Disease is most accurately diagnosed using the Western Blot test.

Another problem that can arise when diagnosing neuropathy is when not enough tests are performed and conditions can slip under the radar. One of the most under-diagnosed conditions is thyroid disease. The most common symptom of thyroid disease is unexplained fatigue. Tests for thyroid disease include TSH, T3, and others. It is also important to get diagnosis and treatment for thyroid disease early on, because it can cause peripheral neuropathy and other debilitating conditions.

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Sensory and Motor Neuropathies
April 7, 2013 Leave a Comment

Sensory and Motor Neuropathies

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This week on Beating Neuropathy and Chronic Pain, we’re talking about Sensory vs. Motor Neuropathies. There are actually many different kinds of neuropathy. Because everyone is biochemically and genetically different, people who develop neuropathy may develop it in different ways. Neuropathy can be the result of genetics, disease, or injury.

Sensory neuropathies affect the ability to perceive with any of the senses. Most commonly, this presents as tingling or numbness.  Motor neuropathies involve muscle weakness and loss of muscle tone. Sensory neuropathies, which can often be the result of the effects of diabetes or chemotherapy, are more easily treatable. Motor neuropathies are generally much more difficult to treat and can be the result of a genetic condition such as Charcot Marie Tooth (CMT). CMT symptoms include weakness in the legs and feet. There are several types of CMT, and they can vary in severity and age of onset.

CMT can be diagnosed with EMGs and CMVs; genetic testing can be extremely expensive and not covered by insurance. However, even if a diagnosis is definitively made, treatment can be difficult. Nutritional supplements and energy-enhancing treatments, however, have shown promise for CMT patients.

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Autonomic Neuropathy
March 24, 2013 Leave a Comment

Autonomic Neuropathy

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Tonight on Beating Neuropathy & Chronic Pain, we’ll talk about autonomic neuropathy. Autonomic neuropathy is neuropathy that affects the “automatic” functions of the body, such as the heart, breathing, sweating, and digestion. Most cases of autonomic neuropathy is caused by diabetes, but it can also happen with injuries and inflammatory conditions.

There is a screening you can do at home to test for autonomic neuropathy. Take your blood pressure while in a seated position, then stand and immediately take it again. Your blood pressure should rise by 10 points both systolic and diastolic. Though it is possible to get a false positive while doing this, it can be an indicator that autonomic neuropathy is happening.

Making sure you are well-hydrated is important for everyone, but especially in autonomic neuropathy. Add a bit of salt to your water for electrolytes. Diet is important as well. Consuming enough water and fiber will help your digestive system stay healthy. Eat small, frequent meals instead of two or three large ones.

Autonomic neuropathy requires careful evaluation and close supervision. We do not know if there is a significant or long-term cure for it right now. However, the types of treatment we advocate for peripheral neuropathy can also be useful.

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Restless Legs Syndrome
March 17, 2013 Leave a Comment

Restless Legs Syndrome

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Tonight on Beating Neuropathy & Chronic Pain, we’ll discuss Restless Legs Syndrome, or RLS. RLS affects middle-aged and older people and can result from several underlying causes. Some of these include kidney disease, iron deficiency, Parkinson’s disease, spinal problems, pregnancy, or either not enough or too much physical activity. It can also be the result of withdrawal from certain drugs, including caffeine. Often, RLS is associated with patients who have peripheral neuropathy.

RLS symptoms occur when one is at rest (sitting or lying down) and can manifest as sensations of pain, discomfort, pulling, and so on. These feelings can usually be immediately alleviated by walking around. These symptoms can also occur occasionally in someone who is dehydrated or low in magnesium. As with neuropathy patients, it is important to determine the underlying cause because it could be serious. If laboratory tests are not definitive, a trend in past tests can be observed.

Drugs such as Requip/Ropineral can help with RLS symptoms. Patients who are more fit, in general, are less likely to get RLS. Stretching, massage, and yoga can be beneficial. Warm baths with epsom salts can be helpful as well. Supplementing with oral magnesium malate is also indicated with a physician’s consent.

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Chemotherapy Neuropathy Treatment
March 10, 2013 Leave a Comment

Chemotherapy Neuropathy Treatment

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Tonight on Beating Neuropathy and Chronic Pain, we will again be discussing chemotherapy-related neuropathy. Chemotherapy given for cancer–or other conditions, such as autoimmune diseases–can, unfortunately, cause nerve damage (neuropathy).

Patients may or may not develop neuropathy based on which medications they are taking. Platinum-based chemotherapies in particular will usually cause neuropathy. Patients who undergo hormone or radiation therapy in addition to chemotherapy also have a high chance of developing peripheral neuropathy.

Symptoms of chemotherapy neuropathy include tingling, numbness, and burning, usually in the hands, feet, and legs. Drugs prescribed to alleviate these symptoms can actually worsen the condition. The good news is, a neurostimulator is a drug-free alternative that can actually be used during chemotherapy. Other options light therapies such as include Low-Level Laser Therapy (LLLT) and LED Therapy. Manual therapies such as massage and spinal and joint manipulation are also crucial. Work with your team of medical professionals to find out which combination of these work best for you.

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Beating Shingles Pain
February 24, 2013 Leave a Comment

Beating Shingles Pain

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This week on Beating Neuropathy and Chronic Pain, we’re going to talk about shingles. Shingles is a recurrence of the chicken pox virus, varicella zoster. If you had chicken pox as a child, the virus can be reactivated in your body and become shingles. It can present as unexplained acute mid-back pain and should be treated with antiviral medication within the first 72 hours of onset. Early diagnosis and treatment will lessen the duration and likelihood of complications from shingles.

One of the side effects of shingles is difficulty performing daily activities, pain, lesions, and postherpetic neuralgia. Post-herpetic neuralgia is a significant complication that occurs in about 50% of shingles sufferers. It presents as shooting pains, burning, or tingling that can last to months–or even–years after a shingles episode.

Treatment for shingles complications often consists of strong drugs, pain injections, and radio frequency ablation. There are some recent studies showing the effectiveness of other, less invasive modalaties for treating shingles and postherpetic neuralgia. These include TENS (transcutaneous electric nerve stimulation) and LLLT/LED (low-level laser therapy and light-emitting diode therapy).

One study showed that treatment with TENS showed a significant lessening in the development of postherpetic neuralgia. This kind of treatment must be administered by a trained clinician. Another study showed LLLT was effective in treating both active shingles and postherpetic neuralgia. Yet another, related article shows LLLT was also effective in treating the same kind of herpes that causes cold sores.

To learn more about these exciting new treatments, visit us at NeuropathyDR.

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Exercise and Peripheral Neuropathy
February 17, 2013 Leave a Comment

Exercise and Peripheral Neuropathy

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This week on Beating Neuropathy and Chronic Pain, we’ll again be discussing the benefits of exercise for patients for patients who suffer from peripheral neuropathy. A new exercise program should only be performed with approval of your treating medical professional. If you have difficulty with balance, or experience numbness in your feet, please perform exercise only under the guidance of a personal trainer or physical therapist. Good, proper-fitting footwear is important as well, both to support and protect the feet.

Some may be concerned that exercise may not be good for people experiencing peripheral neuropathy. This can be true. People with diabetic ulcerations or skin fragility should use extreme caution. Treadmills should also be avoided. Even though they are popular, they create a lot of vibration which can aggravate neuropathy and chronic pain conditions. A better way to exercise the large muscles of the thighs is to use an exercise bike. Pedal wheels are an option for those who may not easily be able to ride a bike. Another option is a “trainer”, which a regular road bike can be placed on and used indoors.

The purpose of exercise is to create more blood flow, which will creae a rise in temperature which will be beneficial to people suffering from peripheral neuropathy. As treatment progresses, the easier it will become to increase body temperature through vasodialation. This is another reason why supervised exercise is beneficial.

References:

A Moderate-Intensity Weight-Bearing Exercise Program for a Person With Type 2 Diabetes and Peripheral Neuropathy

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Effects of peripheral neuropathy on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases

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