Peripheral Neuropathy


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PERIPHERAL NEUROPATHY:  A CLOSER LOOK

Peripheral Neuropathy is one of the most prevalent chronic conditions in the country. It is a condition in which the peripheral nerves (the nerves that go down the arms and legs) don’t function properly. Some of the symptoms of neuropathy include: pain, numbness, tingling, and pricking sensations; burning pain (especially at night); and/or sensitivity to touch. Many patients have balance problems and feel like they are walking on stumps. If left undiagnosed, neuropathy can lead to deterioration of the muscles and paralysis. Remember that we all need throat muscles to swallow, chest muscles to breathe, and that the heart is a muscle. In the extreme, severe neuropathy can lead to death. The patients that I see with neuropathy are suffering more than most patients coming in and have been for years due to the chronicity of the disorder. Many of these patients have been prescribed Neurontin which is supposed to help with the pain but most patients that present to me have less than desirable side effects from the medication and report that it does not help relieve the neuropathy.

It can be caused by compression of the nerves as in the case of a herniated disc, carpal tunnel syndrome, stenosis, arthritis or entrapment syndromes where spastic muscles are compressing the nerve. These would be examples of mechanical causes of peripheral neuropathy. When I have a patient present with this type of neuropathy I use specific neurological and mechanical treatment protocols to reduce the compression to the nerves that are affected. These therapies are very effective and often prevent a person from undergoing surgery unnecessarily.

There are also metabolic (nutritional) causes as is the case with diabetic neuropathy. This occurs because the nerves are not able to get adequate fuel because of blood sugar dysregulation and complications from the insulin resistant phenomena. I have a patient who began treatment recently who had been suffering with neuropathy in both feet. He had been feeling numbness, tingling, burning pain, and a feeling like a sock was rolled up under his foot for many, many years. After taking a history, performing a neurological exam, and running some lab work I suspected that his neuropathy was caused primarily by blood sugar dysregulation. He had pre diabetic/insulin resistance. After working with him to change his diet and manage his blood sugar spikes and thereby minimizing his insulin spikes he was able to feel his feet again and the pain has all but disappeared. He feels better than he has in years. This is a prime example of someone who had a metabolic cause of peripheral neuropathy.

Furthermore, there is increasingly more research indicating that one of the side effects of statin(cholesterol lowering medications like Lipitor) medications is peripheral neuropathy. Using data from the 1999-2004 National Health and Nutrition Examination Survey, researchers found that 33.5 million older Americans (men age 50 years and older and women age 60 years and older) are currently taking statin drugs (24.4%).While the FDA has deemed statins to be safe to use for their intended purpose –lowering cholesterol — no drug is totally without side effects in susceptible individuals. Since the drug companies that manufacture statins have become aware of the incidence of serious side effects, they’ve added a warning to statin advertising that was not present early on. This warning states, “Unexplained muscle pain and weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away.” Neuropathy, muscle pain, and muscle weakness are three of the main side effects of statin drugs. It is important to note that one should always consult their doctor to determine if they can or cannot alter their statin medications in any way. There are some supplements that have been researched and shown promise in minimizing the effects of some of the side effects. I take this into consideration when I see patients that cannot go off of the medications but would like to minimize the side effects to the nerves.

In conclusion, one can see that peripheral neuropathy is a complex disorder and can have multiple causes. If you are suffering from peripheral neuropathy then it is important to have a thorough exam and history to determine the likely cause from a doctor who is trained in functional neurologic and metabolic disorders and has the expertise to apply the appropriate treatment.

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