|All about neuropathy types of neuropathy causes of neuropathy symptoms of neuropathy diagnosis of neuropathy treatment for neuropathy neuropathic pain relief with medications peripheral neuropathy types of peripheral neuropathies peripheral neuropathy causes risk factors for peripheral neuropathy symptoms of peripheral neuropathy peripheral neuropathy diagnosis treatments for peripheral neuropathy prevention of peripheral neuropathy prognosis of peripheral neuropathy mononeuropathy mononeuropathy types causes of mononeuropathy mononeuropathy treatment common peroneal nerve dysfunction radial nerve dysfunction ulnar nerve dysfunction cranial mononeuropathy VI cranial mononeuropathy VII cranial mononeuropathy III (compression type) cranial mononeuropathy III (diabetic type) axillary nerve dysfunction distal median nerve dysfunction femoral nerve dysfunction tibial nerve dysfunction carpal tunnel syndrome causes of carpal tunnel syndrome risk factors for carpal tunnel syndrome symptoms of carpal tunnel syndrome diagnosis of carpal tunnel syndrome treatment for carpal tunnel syndrome prevention of carpal tunnel syndrome polyneuropathy chronic inflammatory polyneuropathy diabetic neuropathy types of diabetic neuropathy causes of diabetic neuropathy symptoms of diabetic neuropathy diagnosis of diabetic neuropathy diabetic neuropathy treatment autonomic neuropathy causes of autonomic neuropathy symptoms of autonomic neuropathy diagnosis of autonomic neuropathy treatment for autonomic neuropathy lower back pain causes of lower back pain risk factors for lower back pain symptoms of lower back pain diagnosis of lower back pain treatments for lower back pain acute lower back pain relief relieving chronic low back pain physical therapy for low back pain relief exercise for lower back pain prevention of low back pain sciatica causes of sciatica symptoms of sciatica diagnosis of sciatica treatment for sciatica prevention of sciatica brachial plexus injury causes of brachial plexus injury symptoms of brachial plexus injury diagnosis of brachial plexus injury treatment for brachial plexus injury postherpetic neuralgia causes of postherpetic neuralgia symptoms of postherpetic neuralgia treatment for postherpetic neuralgia thoracic outlet syndrome causes of thoracic outlet syndrome symptoms of thoracic outlet syndrome diagnosis of thoracic outlet syndrome treatment for thoracic outlet syndrome
What medications are available to relieve neuropathic pain?
A major goal of treatment for neuropathy is relieving neuropathic pain. Pain medicines can help, but they are best used regularly throughout the day before pain becomes severe. Neuropathic pain can be very difficult to treat; even strong opioid analgesics may provide only partial relief. However, several classes of medications not normally thought of as analgesics are often effective, alone or in combination with opioids and other treatments. Three major classes of medication are
commonly used in the treatment of neuropathic pain: antidepressants, especially tricyclics; anticonvulsants, especially gabapentin and carbamazepine; and sodium channel blockers, especially mexiletine. A primary care provider may initiate tricyclics, carbamazepine, or gabapentin. Most primary care providers should seek consultation before using other anticonvulsants or sodium channel blocking agents. As a special case, neuropathic pain caused by tumor-related nerve compression is often relieved by steroids by alleviating swelling around the tumor, thereby reducing compression and pain. Dexamethasone 4-8 mg qd. is often effective.
Although anticonvulsants such as gabapentin (Neurontin®) and antidepressants such as amitriptyline (Elavil®) are not approved by the FDA to treat neuropathy, they are often prescribed to treat this condition. The mechanisms of action of these two classes of drugs on neuropathic pain is not fully understood, but they seem to be independent of their actions on depression and seizures, respectively. Neuropathic pain usually responds more quickly, and to much smaller doses of the tricyclics than are needed to treat depression, but the newer selective serotonin reuptake inhibitor antidepressants seem to work poorly, if at all, on neuropathic pain. Since the SSRIs only affect serotonin, this has led to the theory that tricyclics reduce neuropathic pain by working on a neurotransmitter other than serotonin. The most likely candidate is norepinephrine, lent weight by the discovery that wellbutrin, an atypical antidepressant that inhibits the reuptake of norepinephrine, is also effective in many cases of neuropathic pain. Side effects of these drugs include drowsiness, dizziness, low blood pressure, and fatigue.
Duloxetine hydrochloride (Cymbalta®) has been approved by the Food and Drug Administration (FDA) to treat diabetic peripheral neuropathy. Common side effects include constipation, diarrhea, dry mouth, and nausea. In some cases, Cymbalta® causes dizziness and hot flashes. Other medications include anticonvulsants (e.g., carbamazepine [Tegretol®], lamotrigine [Lamictal®]), local anesthetics (e.g., lidocaine [Xylocaine®]), and antiarrhythmics (e.g., mexiletine [Mexitil®]). Anticonvulsants may cause low white blood cell counts, nausea, vomiting, and dizziness. Side effects of lidocaine and mexiletine include nervousness, lightheadedness, drowsiness, and double vision.
In some forms of neuropathy, especially post-herpes neuralgia, the topical application of local anesthetics such as lidocaine can provide relief. A transdermal patch containing 5% lidocaine is available. Ketamine in a transdermal gel is also frequently effective when the neuropathy is localized. In some neuropathic pain syndromes, "crosstalk" occurs between descending sympathetic nerves and ascending sensory nerves. Increases in sympathetic nervous system activity result in an increase of pain; this is known as sympathetically-mediated pain. Reducing the sympathetic nerve activity in the painful region with local nerve blocks or systemic medications such as clonidine may provide relief.
The NMDA receptor seems to play a major role in neuropathic pain and in the development of opioid tolerance, and many experiments in both animals and humans have established that NMDA antagonists such as ketamine and dextromethorphan can alleviate neuropathic pain and reverse opioid tolerance. Unfortunately, only a few NMDA antagonists are clinically available and their use is usually associated with unacceptable side effects.
Several opioids, particularly methadone, have NMDA antagonist activity in addition to their μ-opioid agonist properties that seems to make them effective against neuropathic pain, although this is still the subject of intensive research and clinical study. Methadone has this property because it is a racemic mixture; one stereo-isomer is a μ-opioid agonist; the other is a NMDA antagonist.
More information on neuropathy (peripheral neuropathy, autonomic neuropathy, mononeuropathy, diabetic neuropathy, polyneuropathy, lower back pain)
What is neuropathy? - Neuropathy is disease or disorder affecting the cranial nerves or the peripheral or autonomic nervous systems. Neuropathy is a disturbance in the function of a nerve or particular group of nerves.
What types of neuropathy are there? - Types of neuropathies include peripheral neuropathy, polyneuropathy, neuropathic arthropathy, cranial neuropathy, autonomic neuropathy, compression mononeuropathy.
What causes neuropathy? - Diabetes is a frequent cause of neuropathy, the other causes of neuropathy are herpes zoster infection, chronic or acute trauma (including surgery) and various neurotoxins.
What're the symptoms of neuropathy? - Symptoms of neuropathy include loss of sensation, paresthesias and dysesthesias, pain, postural hypotension, impotence, abnormal sweating, and sensory ataxia.
How is neuropathy diagnosed? - Neuropathy may be diagnosed by variety of tests, including electromyography and nerve conduction studies. Nerve and muscle biopsy is useful for autoimmune or vasculitic neuropathies.
What's the treatment for neuropathy? - Treatment of neuropathy is often directed at the symptoms or the underlying cause of the neuropathy. Symptomatic treatments include medical therapy, physical and occupational therapy.
What medications relieve neuropathic pain? - A major goal of treatment for neuropathy is relieving neuropathic pain. Three major of medication are used in the treatment of neuropathic pain.
What is peripheral neuropathy? - Peripheral neuropathy is a common neurological disorder characterized by sensory loss, pain, muscle weakness and wasting of muscle in the hands or legs and feet.
What types of peripheral neuropathies are there? - To aid in diagnosis and treatment, the symptoms are classified into principal neuropathic syndromes based on the type of affected nerves.
What causes peripheral neuropathy? - Peripheral neuropathy is nerve damage caused by a systemic illness such as diabetes. Neuropathy involves damage to the axon of the nerve cell or the myelin sheath.
What're the risk factors for peripheral neuropathy? - Diabetes is the biggest risk factors for peripheral neuropathy. Other risk factors including include nutritional deficiencies, medications and chemical exposures.
What're the symptoms of peripheral neuropathy? - Symptoms of a peripheral neuropathy include sensory loss, pain, muscle weakness and wasting of muscle in the hands or legs and feet.
How is peripheral neuropathy diagnosed? - Diagnosis of peripheral neuropathy is based on clinical syndrome. Exact diagnosis requires a combination of medical history, medical tests, and process of exclusion.
What're the treatments for peripheral neuropathy? - Treatment goals for peripheral neuropathy may be to determine underlying cause and treat it, cure of the disorder, and control of symptoms.
Is peripheral neuropathy preventable? - Steps that a person can take to prevent peripheral neuropathy include vaccines against diseases that cause neuropathy.
What's the prognosis of peripheral neuropathy? - Prognosis for neuropathy depends on the underlying cause. The outcome for peripheral neuropathy depends heavily on the cause.
What is mononeuropathy? - Mononeuropathy is disorder of a single nerve or nerve trunk. Mononeuropathy involves damage or destruction of an isolated nerve or nerve group.
What're some of the specific mononeuropathies? - Some of the other common forms of mononeuropathy include sciatic nerve dysfunction, radial nerve dysfunction, cranial mononeuropathy, carpal tunnel syndrome.
What causes mononeuropathy? - Mononeuropathy is most often caused by damage to a local area resulting from direct trauma, prolonged pressure on the nerve and compression.
What's the treatment for mononeuropathy? - Treatment of mononeuropathy is aimed at maximizing the ability to use the affected body part. Physical therapy exercises may be useful.
What's common peroneal nerve dysfunction? - Common peroneal nerve dysfunction is a disorder caused by damage to the peroneal nerve, characterized by loss of movement of or sensation in the foot and leg.
What is radial nerve dysfunction? - Radial nerve dysfunction is a form of peripheral neuropathy involves impaired movement or sensation of the back of the arm and hand.
What is ulnar nerve dysfunction? - Ulnar nerve dysfunction involves impaired movement or sensation in the wrist and hand caused by damage to the ulnar nerve.
What is cranial mononeuropathy VI? - Cranial mononeuropathy VI is a disorder that causes double vision, associated with dysfunction of cranial nerve VI.
What is cranial mononeuropathy VII? - Cranial mononeuropathy VII is a mononeuropathy that involves the seventh cranial nerve, the nerve that controls movement of the muscles of the face.
What is cranial mononeuropathy III (compression type)? - Cranial mononeuropathy III is a disorder associated with dysfunction in the third cranial nerve, which causes double vision and eyelid drooping.
What is cranial mononeuropathy III (diabetic type)? - Cranial mononeuropathy III is a complication of diabetes caused by damage to the third cranial nerve.
What is axillary nerve dysfunction? - Axillary nerve dysfunction is a condition involving impaired movement or sensation of the shoulder because of damage to the axillary nerve.
What is distal median nerve dysfunction? - Distal median nerve dysfunction is a form of peripheral neuropathy affecting movement of or sensation in the hand, caused by damage to the distal median nerve.
What is femoral nerve dysfunction? - Femoral nerve dysfunction is a condition involving impaired movement or sensations in the leg, caused by damage to the femoral nerve.
What is tibial nerve dysfunction? - Tibial nerve dysfunction is a condition involving impaired movement or sensation in the leg, caused by damage to the tibial nerve.
What is carpal tunnel syndrome? - Carpal tunnel syndrome is a painful disorder in the hand caused by compression of a nerve in the carpal tunnel, characterized by discomfort and weakness in the hand.
What causes carpal tunnel syndrome? - Carpal tunnel syndrome is caused by the swelling of the nerve that runs through the carpal tunnel in the wrist due to repetitive and forceful movements of the wrist.
What're the risk factors for carpal tunnel syndrome? - Risk factors for carpal tunnel syndrome include diseases, some drugs, direct injury, activities that require repeated motions, and even pregnancy.
What're the symptoms of carpal tunnel syndrome? - Symptoms of carpal tunnel syndrome include burning, tingling or numbness of the fingers, difficulty gripping tools or other implements, and problems making a fist.
How is carpal tunnel syndrome diagnosed - An accurate medical history and the clinical examination will establish the diagnosis of carpal tunnel syndrome.
What's the treatment for carpal tunnel syndrome? - Carpal tunnel syndrome is initially treated with splints. Nonsteroidal anti-inflammatory drugs may be used to relieve pain.
How to prevent carpal tunnel syndrome? - Prevention of carpal tunnel syndrome is aimed at becoming aware of the repetitive motions. Early use of a splint is helpful.
What is polyneuropathy? - Polyneuropathy refers to any illness that attacks numerous nerves in the body. Polyneuropathy affects the nerves of the autonomic nervous system.
What is chronic inflammatory polyneuropathy? - Chronic inflammatory polyneuropathy is a disorder involving slowly progressive or repeated episodes of loss of movement or sensation.
What is diabetic neuropathy? - Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. Diabetic neuropathies occur in both type 1 and type 2 diabetes.
What types of diabetic neuropathy are there? - There are three types of neuropathy that occur in people with diabetes. They're peripheral neuropathy, autonomic neuropathy, focal neuropathy.
What causes diabetic neuropathy? - The exact causes of diabetic neuropathy are unknown, several factors may contribute to diabetic neuropathy.
What're the symptoms of diabetic neuropathy? - Symptoms of diabetic neuropathy depend on the types of neuropathy. Diabetic neuropathies are classified as peripheral, autonomic, proximal, and focal.
How is diabetic neuropathy diagnosed? - A diagnosis of diabetic neuropathy is based mostly on your medical history and physical examination.
What's the treatment for diabetic neuropathy? - The goal of treating diabetic neuropathy is to relieve discomfort and prevent further tissue damage. Analgesics may be prescribed for relief of pain.
What is autonomic neuropathy? - Autonomic neuropathy is a disease of the non-voluntary, non-sensory nervous system caused by damage to nerves supplying the internal body structures.
What causes autonomic neuropathy? - Autonomic neuropathy is a form of peripheral neuropathy affecting the autonomic portion of the peripheral nervous system. The causes are multiple.
What're the symptoms of autonomic neuropathy? - The symptoms of autonomic neuropathy depend upon what organs are affected and may include abdominal swelling, heat intolerance, nausea, vomiting.
How is autonomic neuropathy diagnosed? - Diagnosis of autonomic neuropathy can be made by eye examination and other tests guided by the suspected cause of the disorder.
What's the treatment for autonomic neuropathy? - Treatment for autonomic neuropathy is supportive and may need to be long-term. Several treatments may be attempted before a successful therapy.
What is lower back pain? - Lower back pain is pain in the low lumbar accompanied by pain radiating down one or both buttocks or legs in the distribution of the sciatic nerve (sciatica).
What causes lower back pain? - There is no single identifiable cause for an episode of back pain. Most back pain comes from the soft tissues of the spine.
What're the risk factors for lower back pain? - Lower back pain is often triggered by some combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine.
What're signs and symptoms of lower back pain? - Symptoms of the back pain will depend on the condition that's causing the pain. Pain can be constant or intermittent.
How is lower back pain diagnosed? - The diagnosis of low back pain can be complicated. Most cases are initially evaluated by primary care physicians rather than by specialists.
What're the treatments for lower back pain? - Treatment of low back pain is aimed at symptom relief or preventing interference with the processes of healing. Acute back pain is treated with nonsteroidal anti-inflammatory drugs.
How to relieve acute lower back pain? - Acute back pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Applications of heat or cold compresses help to relieve lower back pain.
How to relieve chronic low back pain? - Patients with chronic low back pain are treated witha combination of medications, physical therapy, andoccupational or lifestyle modification.
What's the physical therapy for low back pain relief? - Types of treatment used by the physical therapist will depend on the nature of low back pain being treated.
What's lower back pain exercise? - Low-stress aerobic exercise can prevent debilitation due to inactivity during the first month of symptoms and thereafter may help patients relieve lower back pain.
How to prevent low back pain? - Low back pain due to muscle strain can be prevented by lifestyle choices, including regular physical exercise and weight control, avoiding smoking.
What is sciatica? - Sciatica is pain, tingling, or numbness produced by an irritation of the sciatic nerve. The sciatic nerve supplies the back of the leg and buttocks.
What causes sciatica? - Sciatica is a form of peripheral neuropathy. Of the identifiable causes of sciatic pain, lumbosacral radiculopathy and back strain are the most frequently suspected.
What're the symptoms of sciatica? - The symptoms of sciatica vary widely, the most common symptom is pain that radiates through one buttock and down the back of that leg.
How is sciatica diagnosed? - Diagnosis of sciatica involves a straight-leg-raising test, magnetic resonance imaging (MRI) and computed tomography scans (CT scans).
What's the treatment for sciatica? - Most cases of sciatica can be effectively treated by physical therapy and appropriate changes in environment. Initial treatment for sciatica focuses on pain relief.
How to prevent sciatica? - Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning.
What is brachial plexus injury? - brachial plexus injury is an injury to the nerves that travel from the neck and down the arm. These peripheral nerves are called the brachial plexus nerves.
What causes brachial plexus injury? - A brachial plexus injury is caused when the head and neck are forcibly moved or hit to one side, stretching the brachial plexus on the opposite side.
What're the symptoms of brachial plexus injury? - A brachial plexus injury usually causes intense pain from the neck down to the arm. Loss of strength in the affected arm or hand is a common symptom
How is brachial plexus injury diagnosed? - To diagnose a brachial plexus injury, a doctor may ask the patient about his or her symptoms and examine the head, neck, shoulder, arm and hand.
What's the treatment for brachial plexus injury? - The goal of treatment for brachial plexus injury is to enable the patient to return to sport or activity as soon as possible while not worsening the injury.
What's postherpetic neuralgia? - Postherpetic neuralgia is pain that persists after an episode of shingles (herpes zoster) has resolved. Postherpetic neuralgia causes pain after shingles heals.
What causes postherpetic neuralgia? - Postherpetic neuralgia results when nerve fibers are damaged. The condition is caused by damage to and then regrowth of nerves affected by shingles.
What're the symptoms of postherpetic neuralgia? - The symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred.
What's the treatment for postherpetic neuralgia? - Treatment for postherpetic neuralgia also depends on the type of pain the patient experience. Tricyclic antidepressant medications relieve pain.
What is the thoracic outlet syndrome? - Thoracic outlet syndrome is a condition in which the nerves or vessels behind the collar bone (clavicle) become compressed or stretched.
What causes thoracic outlet syndrome? - The common underlying cause of the thoracic outlet syndrome is compression of the nerves and arteries of the arm in the Thoracic Outlet.
What're the symptoms of thoracic outlet syndrome? - Symptoms of thoracic outlet syndrome include pain, numbness and tingling, weakness and fatigue or swelling and coldness in the arm and hand.
How is thoracic outlet syndrome diagnosed? - There are no specific diagnostic tests for thoracic outlet syndromes. The diagnosis is made by ruling out other diseases.
What's the treatment for thoracic outlet syndrome? - Treatment of thoracic outlet syndrome focuses on relief of the symptoms caused by compression of the nerves and blood vessels.