Today's post from fosters.com (see link below) is something everybody learning to live with neuropathy should read - from beginners to those who've endured years of suffering. Strictly speaking it tells us nothing that can't be found in hundreds of other articles but it is so clearly written and so easily understood, it may well trigger several light-bulb moments in your brain and explain things you thought you knew and understood about the disease but really never got to the bottom of. Worth a read over your morning coffee.
By Karen Dandurant
news@seacoastonline.com
Posted May. 31, 2015
EXETER — Neuropathy, defined as a disease causing nerve pain, has many possible causes, but in more than half the cases it is associated with diabetes.
Dr. Geoffrey Starr, of Core Neurology at Exeter Hospital, said there are two types of neuropathy, polyneuropathy, meaning many nerves are affected, and peripheral neuropathy, dealing with pain in nerve endings.
“The most common is peripheral neuropathy, usually in the fingers and toes,” Starr said. “The patient can have numbness, tingling, a lack of sensation, cramps, muscle loss and imbalance and, in some cases, it affects the blood pressure.”
Starr said diabetes is the No. 1 cause and it affects people with both type 1 and type 2 diabetes. Other causes can be a thyroid problem, endocrine imbalances, a vitamin B12 deficiency or an excess of vitamin B6.
“Overuse of alcohol and smoking can cause neuropathy because of the toxins,” Starr said. “Chemotherapy can be another factor.”
For about 20 percent of the cases, there is no clear cause. Starr said it can be familial, genetic or age related.
Dr. Karen Lauze, a neurologist at Portsmouth Regional Hospital, said nerves have multiple functions in the body and which one is affected has a bearing on how treatable the disease is.
“The central nervous system controls the brain and the spine. Other systems control sensory perception, muscles and can be responsible for making the organs, like the heart, function. There are so many ways for nerves to be injured, so neuropathy is a very wide field.”
Lauze said a pinched nerve in the neck or carpal tunnel can cause the disease. Autoimmune diseases like lupus or rheumatoid arthritis can be responsible. Exposure to toxins such as heavy metals, imbalances in the B vitamins, Vitamin E or niacin, or a poor diet can be factors.
“If we can find the cause, we can usually treat it,” Starr said. “We may be able to correct it, control it or lessen the symptoms. We can deal with the pain. Tingling sensations do not respond well to medication but taking the pain away will help the person cope so the disease is not as functionally limiting.”
Diagnosing neuropathy involves sensory examination, assessing the nerve endings. Star said nerve conduction testing can be more definitive in sorting out the source of the problem.
“The initial signs are usually tingling in the fingers or toes,” Starr said. “People should seek help then, because addressing this early can have better results.”
Lauze said neuropathy usually starts with longer nerve fibers, because there is a larger area. That's why the feet are the most common initial site.
“Beside the pain and tingling, it can cause imbalances,” Lauze said. “That puts people at risk of falling and receiving other injuries.”
Autonomic nerves can be affected, resulting in the heart racing, or fainting. Lauze said doctors have little control over that condition.
Michael Davidson, DO, of Endocrinology and Diabetes Consultants, affiliated with Wentworth-Douglass Health Partners in Dover, said his practice deals mostly with diabetics, representing the largest population of people suffering from neuropathy.
“Twenty-six percent of people, at the time they are diagnosed with Type 2 diabetes, will have clinical manifestations of neuropathy,” Davidson said. “That's partly because type 2 diabetics are not diagnosed right away. Of the 29 million people with Type 2 diabetes in the U.S., it is estimated that 8 million do not know they have it. Neuropathy is often their first indication.”
Davidson said it is thought that neuropathy tingling is directly related to the length of time and the severity of blood sugar issues.
“Other factors can play a role, like high blood pressure, smoking and cholesterol, but blood sugar is the main factor,” Davidson said. “Diabetic amputations are directly related to neuropathy. If a patient cannot sense pain in their extremities, cannot feel temperature differences, or may not have a visual of the damage occurring, they may not respond appropriately. If they are not responding to the injury, or if another condition like heart failure is causing edema, that sensory deprivation and lack of self-care can be devastating.”
Davidson talked about a patient who had neuropathy and tended to wear Mary Jane style shoes. Her neuropathy got so bad, the strap of the shoe had cut right down to the bone. It sounds extreme, but he said he has had patients who have stepped on tacks and not discovered them for six months, after the damage has been done.
“Their symptoms are related to the distal nerves, farthest away from the body core,” Davidson said. “Generally it's the feet before the hands or legs. It travels in a predictable fashion.”
Treating diabetic neuropathy begins with treating blood sugar levels. Davidson said getting the blood sugar under control can lessen symptoms and will arrest the factors leading to the disease.
“For a diabetic, care of the feet is crucial,” Davidson said. “When patients come to see me, their shoes are off. Examination of the feet is always important. There is no way to stop nerve fibers from dying, but medication can change the perception of pain and calm the symptoms.”
Two drugs are approved by the Food and Drug Administration to treat diabetic neuropathy. They are Cymbalta (duloxetine) and Lyrica (pregabalin). Davidson said sometimes the use of specific antidepressants can help.
“The antidepressants change the way the brain processes the signals,” Davidson said. “By treating the central nervous system, it changes how patients perceive the symptoms. Pain relievers like Tramadol can also help.”
Over-the-counter medications can be tried first, with less invasive impacts. Davidson said alphalipoic acid or vitamin D have been shown to be effective in some patients.
Opiods for pain are the last line of defense because of addiction concerns.
“We have some success with capsaicin, a cream for the feet,” Lauze said. “The cream sucks out a specific protein in the pain fibers (protein C). Basically, it depletes the the fiber's ability to feel pain. Antiseizure medication might help. The sooner we find the cause, the better for the patient.”
http://www.fosters.com/article/20150531/ENTERTAINMENTLIFE/150539991
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