Management of Neuropathy
Management of neuropathy centers on treating the underlying process, when one is identified.
Diabetes: if the cause is diabetes, strict glycemic control and maintaining a target hemoglobin A1c level (<7%) will not only control hyperglycemia which impacts the nerves directly and indirectly (by affecting blood supply to the nerves–vasculitis), but will also control symptoms and delay or prevent progression of the neuropathy.
Demyelination disease: immunological conditions such as multiple myeloma and cranial nerve loss of the insulation around nerves (“demyelination”), which decreases the speed of conduction, can be treated with immunologic therapy, which includes anti-inflammatories (corticosteroids) and intravenous immune globulin.
Toxic exposure: treatment relies on removal of the individual from the toxin, be it a suspect medication or an environmental (work-related) danger. In cases of heavy metal toxicity, using chelating agents (chemicals that bind metals in the blood for excretion) may be used.
Neuropathy due to infections which cross-react with peripheral nerves (e.g., Guillain-Barré syndrome) can be treated, when severe enough to cause neuromuscular respiratory failure, with plasma exchange and immunoglobulins. Support for ventilation, when the neuropathy is severe, may be necessary.
Nerve injury resulting in neuropathy is treated by inhibiting the transmission of signals from the damaged nerve. Anticonvulsants, primarily gabapentin and pregabalin, are used to decrease the conduction of pain signals from damaged nerves. Antidepressants can both subjectively lessen a person’s sensitivity to the perceived pain of neuropathy, but also directly impact the pain by adjusting the level of neurotransmitters that are involved (serotonin and norepinephrine). Anti-inflammatories (NSAIDs) are used if chronic inflammation contributes to the neuropathy.
Nerve compression initially can be treated by steroid injections to reduce inflammation, which may be the cause of the swelling creating the compression. More mechanical compressions, such as disc disease and bone displacement, can only be reversed by mechanical means, i.e, surgery to repair the anatomical distortion.
Asymmetric weakness can be addressed with the use of physical therapy, which not only strengthens the weak side of a unilateral weakness, but is used as an educational device to train patients in ways to move and position themselves to maintain the gains made during therapy.