TREATMENT FOR PERIPHERAL NEUROPATHY
Reformatted 27 March 2010

• The best treatment for PN is to treat the underlying vasculitis. 
  

• The most likely to help are corticosteroids to stop progression of the disease. 
  
• Physical therapy and medications may be needed. 
  
• Weakness may require a foot brace, walker, etc., if only temporarily.  
  
• If numbness develops, special care must be taken to avoid injury.

• Medications used for pain due to neuropathy include various antidepressants.

• Tricyclic antidepressant medications, such as amitriptyline and nortriptyline (Pamelor), were originally developed to treat depression. However, they have been found to help relieve pain by interfering with chemical processes in the brain and spinal cord that cause one to perceive pain.
  
• The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) also has proved effective for peripheral neuropathy caused by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite and constipation.
• The fact that it helps depression as well is certainly a bonus when chronic illness likely depresses one.
• Antidepressants of the SSRI type such as Prozac, Zoloft, Paxil , and Lexapro, might help the depression but don't do much for the neuropathy.

• A second category of drugs for treating neuropathy is anticonvulsants, or anti-epileptic drugs (AEDs).

• Drugs such as gabapentin (Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Tegretol) and phenytoin (Dilantin) were originally developed to treat epilepsy. However, physicians often prescribe them for nerve pain.
  
• Side effects may include drowsiness and dizziness.
• Fifteen percent of patients experience very little relief from neuropathy using gabapentin. 
  
• Some small percentage of patients on gabapentin experience mild brain toxicity.
• Gabapentin can cause edema in feet, usually mistakenly attributed to causes other than then medication.
• Pfizer has a newer drug called pregabalin. The Therapeutics Initiative says its benefits and harms are similar to gabapentin, but at a higher cost.  There's now available a generic for Neurontin (gabapentin) at a significantly lower cost.
• The older meds such as amitryptiline (Elavil), doxepin, etc., can be effective as can newer ones, such as Effexor, and Cymbalta (duloxetine). The latter was basically developed specifically for neuropathy.

• If one AED doesn't work, or the side effects are intolerable, try an alternative one. 
• Lyrica (pregabalin) was developed specifically for neuropathy.  Preliminary results suggest that it seems to be effective with tolerable side effects. 
• Any of these AEDs should be started at a low dosage and gradually increased to avoid creating intolerable side effects.

• Ketamine by injection has been used for years, but can be obtained as a pill or a cream and can sometimes have real benefit on neuropathic pain. 
  
• It can be obtained from a compounding pharmacy rather than the usual drug companies. 
  

• Other medications available for topical use include Lidocaine , a numbing medication, available commercially in patches (Lidoderm) which are often very helpful, or in combination with other medications often tried for neuropathic pain, such as clonidine, antidepressants, anticonvulsants, ketamine, antiinflammatory medicines, muscle relaxants, etc.
• The problem with topical medications is that have to applied on the painful area, so if your whole body is burning, they aren't feasible alternatives. 
  
• The side effects of using them are less than taking them by mouth.
• The Lidocaine patch contains the topical anesthetic lidocaine. It is applied it to the area where the pain is most severe.  Up to four patches a day may be used to relieve pain. This treatment has almost no side effects except, for some people, a rash at the site of the patch.
  

• New research is going on for new medications, treatments, and ways of helping the nervous system repair itself. 
  
• New ideas using hormones, growth factors, cell building enzymes, stem cells, etc are being explored.  I
• It is important to keep a positive attitude as there will be better modes of treatment in the future. 
  
• More physicians have come to understand PN, and are better prepared to help their patients. 
  
• More psychologists and other therapists are becoming available to help use the mind's ability to make anti-pain chemicals.

(Edited from msg. posted by Carol (Shedok, a D.O.)     13 March 2006