Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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The management of peripheral neuropathy is multifaceted. It involves treating the underlying condition to stop further damage, managing the neuropathic pain to improve quality of life, and using rehabilitation strategies to maintain function and safety. There is no “one size fits all” approach, and therapy is often a combination of medication, physical activity, and lifestyle changes.
The most critical step is addressing the root cause. For diabetic neuropathy, this means aggressive blood sugar control. While this may not reverse existing damage, it is the only way to slow progression. For autoimmune neuropathies, immune suppressing treatments like IVIG or plasma exchange are used.
Vitamin deficiencies are treated with supplementation, sometimes via injection if absorption is an issue. If a medication is the culprit, the dosage must be adjusted or the drug changed. In compression neuropathies like carpal tunnel, surgical release of the nerve can provide a cure.
Neuropathic pain does not respond well to standard painkillers like ibuprofen. Instead, medications that stabilize nerve membranes are used. Anti seizure medications like Gabapentin and Pregabalin work by calming the overactive electrical signals.
Certain antidepressants, such as Duloxetine and Amitriptyline, are also highly effective. They work by increasing the chemicals in the brain and spinal cord that inhibit pain signals. Topical treatments, such as lidocaine patches or capsaicin cream (derived from chili peppers), can provide localized relief without systemic side effects.
Physical therapy is essential for maintaining mobility. Therapists work on strengthening the muscles that are still functioning to compensate for weakness. Balance training is critical to prevent falls in patients with sensory loss. Stretching exercises prevent contractures, particularly in the Achilles tendon.
For patients with extreme sensitivity to touch (allodynia), desensitization therapy is used. This involves exposing the sensitive skin to different textures and pressures in a graded manner. Over time, the brain relearns to interpret these signals as non threatening, reducing the pain response.
Transcutaneous Electrical Nerve Stimulation (TENS) is a non invasive therapy that uses a small battery operated device to send electrical impulses to the nerve endings. This stimulation blocks the pain signals from reaching the brain, based on the “Gate Control Theory” of pain.
While the relief is often temporary, it provides a drug free option for managing flare ups. More advanced forms of stimulation, such as scrambler therapy or spinal cord stimulation, may be considered for severe, intractable pain that has failed other treatments.
As muscle weakness progresses, assistive devices become necessary to maintain independence. An Ankle Foot Orthosis (AFO) is a brace that holds the foot at a 90 degree angle, preventing foot drop and allowing for a more normal walking pattern. This reduces the energy cost of walking and prevents tripping.
Proper footwear is also a form of treatment. Extra depth shoes with custom inserts can offload pressure points in numb feet, preventing ulcers. Canes or walkers provide the sensory feedback through the hands that is missing from the feet, improving stability.
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No, medications like Gabapentin only mask the pain symptoms to make you more comfortable; they do not repair the damaged nerves.
An AFO (Ankle Foot Orthosis) is a plastic brace worn on the lower leg and foot to hold the foot up, preventing it from dragging if you have foot drop.
Yes, exercise is very important, but you should choose low impact activities like swimming or stationary biking to protect your numb feet from injury.
Capsaicin, made from chili peppers, depletes a chemical in your nerve endings called Substance P that transmits pain signals, eventually numbing the area.
Physical therapy cannot restore sensation, but it retrains your brain to use the remaining sensation and vision to balance better, preventing falls.
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