Idiopathic Neuropathy Health Article

Treatment

Treatment for idiopathic neuropathies is mostly symptomatic, including pain therapy for paresthesias, physical and occupational therapy to help improve mobility and function, supportive measures to maintain blood pressure, and bowel and bladder function if the autonomic system is involved.

Treatment options for reducing pain include medication, injection therapy, and physical therapy. Surgery may be needed to treat some causes of neuropathy (e.g., carpal tunnel syndrome, radiculopathy).

Because analgesics (aspirin, ibuprofen) are usually ineffective against pain caused by neuropathy, treatment often involves medications that target nerve cells. Antidepressants such as gabapentin and amitriptyline are usually the first medications prescribed. Side effects of these drugs include drowsiness, dizziness, low blood pressure, and fatigue. Other medications include anticonvulsants (carbamazepine and lamotrigine), local anesthetics (lidocaine), and antiarrhythmics (mexiletine). Anticonvulsants may cause low white blood cell counts, nausea, vomiting, and dizziness. Side effects of lidocaine and mexiletine include nervousness, lightheadedness, drowsiness, and double vision.

Topical treatment with capsaicin cream may be prescribed for patients with focal neuropathy. Capsaicin causes stinging upon application and is often combined with a local anesthetic to reduce this side effect.

Injection therapy involves injecting a nerve block (lidocaine) into the area surrounding affected nerves, preventing the nerve from carrying impulses to the brain and temporarily reducing symptoms. Injection therapy is often used with other treatments such as medication and physical therapy.

Discontinuing medication or exposure to toxic substances may eliminate neuropathy caused by drugs or toxins. Vitamin supplements may be used to treat nutritional neuropathy. Physical therapy, including exercise, massage, and heat, and acupuncture (insertion of fine needles into specific points on the body) may be used to treat symptoms.

Treatment for the causes of neuropathy include antibiotics or antiviral agents for infectious neuropathies, immunomodulating agents for immune-mediated neuropathies, improved glycemic control for diabetic neuropathies, and surgery for compressive neuropathies.

Over-the-counter pain relievers can help treat mild-to-moderate pain associated with peripheral neuropathy. There are two main types of over-the-counter pain relievers: acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen is used to treat mild-to-moderate pain and reduce fever, but it is not very effective at reducing inflammation. Acetaminophen provides relief from pain by increasing the pain threshold. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain, swelling, stiffness, and inflammation. Two drugs in this category, ibuprofen and naproxen, also reduce fever. When these drugs are taken regularly, they build up in the blood to levels that fight pain caused by inflammation and swelling, and also provide general pain relief.

Support groups often help patients cope with feelings of isolation and frustration and improve their quality of life.

Clinical trials

As of 2004, there were no clinical trials for idiopathic neuropathies; however, there are several that aim at other types of neuropathies, such as the diabetic neuropathy.

Prognosis

Prognosis and complications depend on the type and severity of the neuropathy. Idiopathic neuropathies range from a reversible problem to a potentially fatal complication. In the best-case scenario, a damaged nerve regenerates. Nerve cells cannot be replaced if they are killed, but they are capable of recovering from damage. The extent of recovery is tied to the extent of the damage, to the patient's age, and to the general health status. Recovery can take weeks to years due to the slow neuronal regrowth rate. Full recovery may not be achieved in some cases.

Special concerns

Complementary and alternative therapies can help manage pain caused by neuropathies. These are noninvasive, drug-free treatments that support natural body healing. They may be used alone or combined with other medications and treatments. Some alternative therapies are biofeedback, acupuncture, and relaxation techniques.

PERIODICALS

Donofrio, P. D. "Immunotherapy of Idiopathic Inflammatory Neuropathies." Muscle Nerve 28 (2003): 273–292.

Lacomis, D. "Small-Fiber Neuropathy." Muscle Nerve 26 (2002): 173–188.

Low, P. A., S. Vernino, and G. Suarez. "Autonomic Dysfunction in Peripheral Nerve Disease." Muscle Nerve 27 (2003): 646–661.

Kelkar, P., W. R. Mcdermott, and G. J. Parry. "Sensory-Predominant, Painful, Idiopathic Neuropathy: Inflammatory Changes in Sural Nerves." Muscle Nerve 26 (2002): 413–416.

OTHER

Neurology Channel. Neuropathy. January 4, 2004 (April 4, 2004). <http://www.neurologychannel.com/neuropathy>.

The Jack Miller Center for Peripheral Neuropathy, University of Chicago. Idiopathic Neuropathy. January 4, 2004 (April 4, 2004). <http://millercenter.uchicago.edu/learnaboutpn/typesofpn/idiopathic/index.shtml>.

ORGANIZATIONS

The Jack Miller Center for Peripheral Neuropathy, University of Chicago. 5841 South Maryland Avenue, MC2030, Chicago, IL 60637. (773) 702-5546. maa@myositis.org. <http://millercenter.uchicago.edu/index.shtml>.

The Neuropathy Association. 60 East 42nd Street, New York, NY 10165-0999. (212) 692-0662 or (800) 247-6968; Fax: (212) 696-0668. info@neuropathy.org. <http://www.neuropathy.org>.

Bruno Marcos Verbeno

Iuri Drumond Louro