Peripheral Neuropathy is a common neurologic condition, which affects the peripheral nerves. The most common symptoms associated with peripheral neuropathy are burning, tingling pain, which often feels like sharp electric sensation.
Walking, especially on hard or cold surfaces can be very painful, often described as walking on ground glass or stepping on pebbles. When large nerve fibers are involved, patients are more likely to experience sensory loss and weakness in the feet and sometimes hands.
Small (microscopic) fiber involvement is typically limited to painful sensory symptoms. Often there are changes in the skin such as thinning and body hair loss, as well as muscle wasting in the feet and hands.
There are many common causes of peripheral neuropathy in the US. This includes diabetes, thyroid disorders, certain auto-immune conditions, vitamin B12 deficiency, alcohol abuse and exposure to toxins such as heavy metals or chemotherapy drugs. HIV, other infections and certain types of cancer can also cause this type of pain.
Clinicians and patients alike are well aware of how difficult it is to treat peripheral neuropathy.
In 2011 the American Academy of Neurology issued the latest guidelines for treatment of neuropathic pain and recommended that 4 therapeutic agents are probably effective for the treatment of neuropathic pain – pregabalin (Lyrica), gabapentin (Neurontin), duloxetine (Cymbalta) and amitriptyline (Elavil).
Unfortunately, these medications are for symptomatic management only and do not affect the disease course and they have various side effects including sedation, leg swelling, paradoxical agitation and weight gain.
It may be worth trying certain dietary changes, aimed to reduce systemic inflammation.
Gluten intolerance has been reported in as high as 34% of patients with unexplained peripheral neuropathy. While positive blood tests for Celiac Disease are diagnostic, it may be worth trying a 4-6 week trial of strict gluten-free diet, regardless of test results as certain patients may have gluten intolerance and test negative for celiac disease.
Other dietary changes include a trial of lactose-free diet or refined carbohydrate-free diet, as both are known to be pro-inflammatory and may increase pain sensation. These dietary trials should be performed sequentially and for 4-6 weeks at a time.
Recently we examined the evidence for acupuncture in the treatment of peripheral neuropathy. We systematically reviewed 46 clinical trials and included 13 qualifying randomized controlled trials of acupuncture against sham acupuncture or standard medical therapy and concluded that acupuncture is effective in the treatment of diabetic neuropathy, Bell’s palsy, Carpal Tunnel Syndrome and it is most likely effective for the treatment of HIV-related neuropathy.
In the Neurology Wellness Clinic at OHSU we routinely treat patients with peripheral neuropathy and some of our best results are with idiopathic neuropathy (meaning of unknown cause). A typical treatment course consists of weekly sessions with electroacupuncture for 6-8, sometimes 10 weeks, followed by gradual spacing out to every other week, every third week, once a month and eventually maintenance treatment once every 2-3 months.
Alexandra Dimitrova, MD is an Assistant Professor in Neurology at OHSU, who sees patients with headache and pain in the Neurology Wellness Clinic. In her practice she integrates traditional neurologic treatments with acupuncture, dietary and lifestyle changes and other complementary and integrative treatments.