No medical treatments now exist that can cure inherited peripheral
neuropathy. However, there are therapies for many other forms. Any
underlying condition is treated first, followed by symptomatic treatment.
Peripheral nerves have the ability to regenerate, as long as the nerve cell
itself has not been killed. Symptoms often can be controlled, and
eliminating the causes of specific forms of neuropathy often can prevent new
damage.
In general, adopting healthy habits-such as maintaining optimal weight,
avoiding exposure to toxins, following a physician-supervised exercise
program, eating a balanced diet, correcting vitamin deficiencies, and
limiting or avoiding alcohol consumption-can reduce the physical and
emotional effects of peripheral neuropathy. Active and passive forms of
exercise can reduce cramps, improve muscle strength, and prevent muscle
wasting in paralyzed limbs. Various dietary strategies can improve
gastrointestinal symptoms. Timely treatment of injury can help prevent
permanent damage. Quitting smoking is particularly important because smoking
constricts the blood vessels that supply nutrients to the peripheral nerves
and can worsen neuropathic symptoms. Self-care skills such as meticulous
foot care and careful wound treatment in people with diabetes and others who
have an impaired ability to feel pain can alleviate symptoms and improve
quality of life. Such changes often create conditions that encourage nerve
regeneration.
Systemic diseases frequently require more complex treatments. Strict
control of blood glucose levels has been shown to reduce neuropathic
symptoms and help people with diabetic neuropathy avoid further nerve
damage. Inflammatory and autoimmune conditions leading to neuropathy can be
controlled in several ways. Immunosuppressive drugs such as prednisone,
cyclosporine, or azathioprine may be beneficial. Plasmapheresis-a procedure
in which blood is removed, cleansed of immune system cells and antibodies,
and then returned to the body-can limit inflammation or suppress immune
system activity. High doses of immunoglobulins, proteins that function as
antibodies, also can suppress abnormal immune system activity.
Neuropathic pain is often difficult to control. Mild pain may sometimes
be alleviated by analgesics sold over the counter. Several classes of drugs
have recently proved helpful to many patients suffering from more severe
forms of chronic neuropathic pain. These include mexiletine, a drug
developed to correct irregular heart rhythms (sometimes associated with
severe side effects); several antiepileptic drugs, including gabapentin,
phenytoin, and carbamazepine; and some classes of antidepressants, including
tricyclics such as amitriptyline. Injections of local anesthetics such as
lidocaine or topical patches containing lidocaine may relieve more
intractable pain. In the most severe cases, doctors can surgically destroy
nerves; however, the results are often temporary and the procedure can lead
to complications.
Mechanical aids can help reduce pain and lessen the impact of physical
disability. Hand or foot braces can compensate for muscle weakness or
alleviate nerve compression. Orthopedic shoes can improve gait disturbances
and help prevent foot injuries in people with a loss of pain sensation. If
breathing becomes severely impaired, mechanical ventilation can provide
essential life support.
Surgical intervention often can provide immediate relief from
mononeuropathies caused by compression or entrapment injuries. Repair of a
slipped disk can reduce pressure on nerves where they emerge from the spinal
cord; the removal of benign or malignant tumors can also alleviate damaging
pressure on nerves. Nerve entrapment often can be corrected by the surgical
release of ligaments or tendons.
