Peripheral neuropathy facts
What is it?Peripheral nerves carry information to and from the brain. They also carry signals to and from the spinal cord to the rest of the body. Peripheral neuropathy means these nerves don't work properly. Peripheral neuropathy may be damage to a single nerve or a nerve group. It also may affect nerves in the whole body.SymptomsTingling, burning, numbness and/or deep pain in the arms and legs may be an early sign of nerve damage. These feelings often start in the toes and feet. You may lose feeling in your legs and arms. Damage to the nerves can make it harder to control muscles and cause weakness. The risk of falling increases.Causes, incidence and risk factorsNerve damage is common. Often, no cause can be found. Some nerve diseases run in families. Diabetes is the most common cause of this type of nerve problem. It happens when you have high blood sugar levels over a long time.Nerve damage can be brought on by autoimmune disorders such as rheumatoid arthritis or lupus, chronic kidney disease, infections such as HIV and liver infections, low levels of vitamin B12, poor blood flow to the legs, underactive thyroid gland, drugs that treat infections, cancer or seizures.SOURCE: U.S. National Library of Medicine
Like the estimated 20 million to 25 million patients who have peripheral neuropathy in the United States, Ronnie Banks is all too familiar with the agony that the degenerative nerve condition causes: painful burning, cold sensations, tingling or severe numbness in the feet.
The suffering often worsens at night and affects sleep.
The 75-year-old Summerville resident and former president of Banks Construction started experiencing burning and pain in his feet four years ago. It progressed to numbness so severe that he had to relearn to drive without feeling the accelerator and brake pedals.
“It got so bad that I couldn't get up and down,” says Banks. “I have tremendous strength in my legs — I work out three times a week — and yet the numbness was so bad that I couldn't get up and down.”
After he was diagnosed with peripheral neuropathy, he soon realized he had a lot of company.
“It's surprising how many have it,” says Banks, who has a positive attitude about enduring it.
“What you have to do is have the proper mind-set, to forget you have it and keep on going. Movement is the best thing you can do. The more you walk, the better.”
The coming wave
Peripheral neuropathy can come in many forms and can be traced to many causes, although half of the cases have no apparent cause, according to the National Institutes of Health.
Because the most common cause is diabetes, experts anticipate the obesity epidemic and resulting increase in diabetes will increase the number of sufferers.
The NIH says medical causes of peripheral neuropathy other than diabetes include autoimmune disorders such as rheumatoid arthritis or lupus, chronic kidney disease, infections such as HIV and liver infections, low levels of vitamin B12, underactive thyroid gland and poor blood flow to the legs.
Drugs, including chemotherapy, and toxins also may damage nerves.
While there is no magic pill or surgery to relieve peripheral neuropathy, local neurologists say that offering relief often involves individualizing treatment options or just trying to ease symptoms.
“The main treatments for neuropathy are based on finding a cause and then providing the appropriate intervention,” says Dr. David Stickler of the Medical University of South Carolina, who regularly sees patients with peripheral neuropathy.
“Diabetics benefit from aggressive blood sugar control. When B12 deficiency or thyroid disorders are the cause, then medical management of these conditions can improve the individual's neuropathy. Certain neuropathies due to autoimmune disorders can be treated with drugs that regulate the immune system.”
Relief vs. side effects
Dr. Charles Kelly of Tidewater Neurology says other forms of treatment go after the symptom of peripheral neuropathy.
Drugs such as Lyrica (pregabalin), Cymbalta (dulaxetine) and Neurotin (gabapentin) can help, but Kelly admits the side-effects — dizziness, sedation, sleepiness and swelling — can negate the benefits.
Kelly sometimes recommends anodyne therapy, which uses infrared light to increase blood flow and help relieve pain, stiffness, muscle spasms and circulation irregularities. He adds the therapy hasn't become widespread because coverage by insurance companies and Medicare often is problematic.
Another option is topical ointment designed to relieve localized pain.
One more alternative
Since February, West Ashley Wellness & Rehab, run by chiropractor Mark Luckie, has been offering and advertising a treatment supervised by a medical team that includes family physician Dr. Arthur Labruce, physician assistant Karen Gadol and family nurse practitioner Cassie Frazier.
The treatment, called combination electrochemical therapy, involves injections of a local anesthetic into the nerves above the ankle in twice-weekly office visits over a four-week period.
After injections and at home, the patient applies an electronic signal treatment that sends electrical pulses into the foot using electrodes. The stimulation activates the release of natural pain-suppressing modulators and causes microcirculation to improve healing.
In simpler terms, Luckie compares the treatment to rebooting a malfunctioning computer.
“The technique is to turn the nerves down with the Marcaine (anesthetic) and then turn the nerves on with the electrical therapy,” says Luckie.
So far, Luckie and Gadol say patients such as Banks are finding relief. About 30 percent are reporting a 90 percent improvement, and about half are reporting a 60 percent improvement. About one in 20 say they are getting no relief at all.
Like other peripheral neuropathy treatments, they say results and progress vary. While the initial nerve blocks end at two months, electrical stimulation continues. Recurrence might require future nerve blocks.
“I wish I could say everybody gets 100 percent better. Unfortunately, no modality has that track record,” says Luckie.
Luckie adds that most insurance and Medicare cover the treatment, which is approved by the Food and Drug Administration.
One study, published in the online Regional Anesthesia & Pain Medicine in 2010, found combined electrochemical therapy to show “marked symptom and motor function improvement” in diabetic peripheral neuropathy patients.
“Patient follow-up will be provided to better understand the long-term effects of CET on sensory and motor function,” the study says. “The outcomes discovered are exciting since there are limited treatment alternatives.”