Neuropathy and Neuropathic Pain
Written by Dan Wagner, Pharm.D., R.Ph., MBA edited By Gregory H. Hoeper, DC
Neuropathy is the inflammation and wasting of nerve tissues. Neuropathic pain is classified as a type of chronic pain. The hallmark characteristics of neuropathic pain are lowering of the pain threshold and excitation of the nerve pathways. This pain usually occurs long after the initial injury has occurred and healed. The pain becomes chronic in nature and is often severe. Many times, neuropathic pain does not respond to the usual treatments used for acute pain.
In most situations of acute pain, the central nervous system (CNS) is primarily affected. The CNS is composed of the spinal cord and the brain. The peripheral nervous system includes nerves to the hands, feet, legs, arms, and the rest of the body. Neuropathic pain results from damage to or changes in the central and/or peripheral nervous system. The injury and malfunction to the nervous system become the source of the pain and progresses into a chronic disease.
Recent research has discovered that viruses can cause neuropathy without affecting nerve cells. The virus infections that can cause neuropathy are well known, such as Herpes Zoster or shingles. Neuropathy, however, can also be caused by viruses such as Hepatitis C, Cytomegalovirus (CMV), and HIV-1. Neuropathy may also follow infection by any of a number of other viruses including those transmitted by common insects. Idiopathic neuropathies are expected to be caused unidentified viral agents.
It can be difficult for the patient to separate the neuropathic pain from other chronic pain, particularly if there is tissue damage. Patients find it difficult to describe the pain and complain of exaggerated responses to slightly painful stimuli. It can best be described as: shooting, burning, numbness, cold, tingling, and/or stabbing. Patients suffering with chronic pain for a long period of time seek treatment from a number of sources; pharmaceutical drugs, chiropractic, acupuncture, massage, electrical-stimulation (TENS unit), and ultimately surgery.
Recognized Types of Neuropathy
Peripheral neuropathy is a disease caused by damage to the nerves that extend from the brain and spinal cord to the rest of the body. It may be caused by free radical damage, hypertension, vascular disease, atherosclerosis, or thrombosis.
Diabetes causes nerve conduction and perfusion deficits, especially associated with a fatty acid imbalance. The disease will hasten progressive vascular retinal disorders that negatively affect the blood vessels in the retina of the eye.
Drug-induced neuropathy is caused by the side effects of drugs. The symptoms are often improved when the drug is removed.
- Vitamin and nutritional deficiency
Neuropathy can be caused by a prolonged lack of B vitamins, vitamin E, and vitamin C..
Drinking alcohol and smoking tobacco are significant risk factors for developing neuropathy, as is the use of cocaine, methamphetamine, heroin or other narcotics. A heavy metal accumulation (lead, mercury, arsenic) may also be involved. One study showed that high levels of copper binds to proteins and may blunt the relaxation of diabetic arteries. A metal chelator in the therapy of neuropathy and vasculopathy may be useful.
- Infectious neuropathies
Infectious neuropathies are caused by unidentified bacteria or viruses.
- Immune-mediated neuropathies
Immune-mediated neuropathies are related to auto-immune disease states and are inflammatory in nature.
There is a wide range of symptoms associated with neuropathies, including (but not limited to) numbness, irritation, tingling, burning, weakness, loss of reflexes, paralysis, weight loss, poor gait/balance when walking, acute inflammation, ataxia, and unremitting pain in the extremities. Some patients describe neuropathic pain as being “electric shock-like,” and/or “pins and needles.” Severe nerve damage and pain are common complications in diabetes. In most cases there is sensory loss, especially in the feet, legs, and/or arms.
Recently, researchers found that a new risk factor for diabetic neuropathy- oral contraceptives. There is a greater risk for women who have diabetes than non-diabetics. Oral contraceptives remain a major predictor of the development of neuropathy.
The most common cause of neuropathy is thiamin (Vitamin B1) deficiency. A well-balanced diet with minimal seed oils and processed carbohydrates should be maintained. Diabetics should conform to a diet low in inflammatory fats from seed oils and vegetable oils, sugar and refined/processed carbohydrates, hydrogenated oils, and alcohol. Deficiency neuropathies can be corrected by dietary and nutritional therapies. The long-term presence of severe deficiency can result in permanent damage.
Diabetics frequently develop neuropathy caused by nerve damage from elevated blood-glucose levels. Free radicals cause oxidative stress (oxidation of the body causes premature aging and immune deficiency), especially in diabetic neuropathy. Toxins from the environment, drug abuse, smoking, and alcohol are significant risk factors in developing certain forms of neuropathy (i.e. toxin-induced and general peripheral).
- VITAMIN B-COMPLEX (with benfotiamine)
A high dose of vitamin B complex helps improve nerve-conduction velocity and optimal nervous system function. All the B vitamins (thiamin, folic acid, niacin) have demonstrated a therapeutic benefit for neuropathy. FOLATE deficiency is often an unrecognized cause of neuropathy. THIAMIN (Vitamin B1) or BENFOTIAMINE supplementation may resolve peripheral neuropathy symptoms in two weeks. Patients treated with B-complex vitamins have shown improvement in reflexes and vibration sense, as well as decreased motor-neuron weakness and sensitivity to pain. Pyridoxal-5-phosphate has been shown to help prevent neuropathy and can inhibit the formation of advanced glycosylated end products, a conditioned tied to diabetes. A deficiency of vitamin B12 is especially acute in diabetic neuropathy. Biotin assists in the metabolism of fats, proteins, and carbohydrates. Enhanced metabolism is important in diabetics. Diabetic neuropathy responds well to high dose biotin supplementation.
- ALPHA LIPOIC ACID (ALA)
ALA is a potent antioxidant that regenerates other antioxidants (vitamins C and E) and raises intracellular glutathione levels. ALA appears to bolster the sciatic nerve against damage and has been shown to significantly reduce the pain, burning, numbness, and paresthesia of diabetic peripheral neuropathy. ALA is licensed in Germany and has demonstrated efficacy in both experimental and clinical use against diabetes-associated neurological deficits.
Acetyl-L-carnitine is an amino acid that the body needs to metabolize fats properly. Some studies have demonstrated a link between imbalances in L-carnitine metabolism and several metabolic abnormalities associated with diabetic polyneuropathy. Supplementing with L-carnitine protects against diabetic neuropathy and is efficacious in alleviating symptoms, particularly pain, and improves nerve fiber regeneration and vibration perception in patients with established diabetic neuropathy.
- OMEGA 3, 6 ESSENTIAL FATTY ACIDS
EFAs, including Gamma-linolenic acid (GLA), evening primrose oil, and fish oil concentrate (EPA/DHA) help to correct a fatty-acid imbalance by enhancing blood flow to nerves and protecting against free radicals. Omega-6 fatty acids are required for healthy nerve tissue and myelin production. EPO was found to be particularly effective in the relief of distal diabetic polyneuropathy.
- OPCs (OLIGOMERIC PROANTHOCYANADINS)
OPCs (bilberry, grapeseed extract, French Maritime pine, and pycnogenol) are extremely effective for neuropathy, especially in optical nerve damage. PYCNOGENOL from the French maritime pine shows promise in the treatment of diabetic retinopathy by improving vision and slowing the deterioration of visual acuity.
- 8. VITAMIN E
Vitamin E may be a deficiency factor in all types of neuropathy. It is usually related to fat malabsorption or genetic abnormalities in lipoprotein metabolism.
- VITAMIN C (with BIOFLAVONOIDS) in a super antioxidant that can help to quench free radicals that mayy play a role in poor circulation to the extremities.
The bioflavonoid QUERCETIN has been used to decrease oxidative stress associated with diabetic neuropathy.
- N-ACETYLCYSTEINE (NAC)
NAC is a precursor of glutathione and a free radical scavenger. Glutathione is an important water-phase antioxidant and an essential cofactor that protects the mitochondria of the cell against damage. NAC inhibits peripheral neuropathy by improving motor-nerve-conduction velocity.
- COENZYME Q-10
This super antioxidant has been shown to improve peripheral neuropathy pain.
- DHEA AND SAMe
These two supplements are recommended by physicians at the Harvard Medical School to be used in combination with prescription drugs for patients suffering with peripheral neuropathy.
ACUPUNCTURE– Is an alternative therapy that originated 3,000 years ago in China.
Acupuncture commonly is used for pain reduction in many types of diseases or conditions.
The result of a small number of studies of patients with diabetes neuropathy, who received acupuncture therapy, showed pain improvement or resolution in the majority of patients.
INFRARED SAUNA THERAPY– A non-invasive, drug-free device that delivers infrared light. The therapy results in increased circulation to the area, increased blood supply, pain relief, and stimulation of healing.
ELECTRICAL STIMULATION– Electrical stimulation encompasses a variety of techniques, including trans-cutaneous electrical nerve stimulation (TENS).
Electrical stimulation involves the use of electrodes provides a series of electrical shocks to an area of the body to lower pain and relieve neuropathy.
A Guide to the Peripheral Neuropathies, The Neuropathy Association, Inc, 1999. New York Publication.
Berdine, HJ. Neuropathic Pain. Pharmacy Times, Sept. 2005. 17(9); 97-110.
Brian, A. Painful Diabetic Neuropathy: Alternative Treatments. Pharmacy Times, May 2006. 72(5): P. 81.
Blumenthal, M. The ABC Clinical Guide to Herbs, Austin, TX. American Botanical Council. 2003.
Chase, C. Pycnogenol Pine bark Extract Shows Promise in Diabetic Neuropathy. HerbalGram #56. 2002. Pp. 20-21.
Dean, W. Peripheral Neuropathy. VRP, Oct 1998, firstname.lastname@example.org. pp. 1,6.
Disease Prevention & Treatment. Third Edition. Life Extension Media, Hollywood, FL. 2000.
Eaton, JW. Interactions of Cooper with Glycated Proteins. Alternative Medicine Review, Oct 2002. 7(5):439.
Fogel, BS. Peripheral Neuropathy Concepts. Lecture notes, 2002.
Furlong, JH. Acetyl-L-Carnitine: Metabolism and Applications in Clinical Practice. Alternative
Medicine Review. July 1996. 1(2): 85-93.
Gaby, AR, Wright, JV. Nutritional Therapy in Medical Practice. Lecture Notes, October 1996. Seattle, WA.
Keen, H, et al. Treatment of Diabetic Neuropathy with Linolenic Acid. Diabetes Care, 1993 #16. Pp 8-15.
L-Carnitine- Monograph. Alternative Medicine Review, March 2005. 10(1): 42-47.
Latov, N. Neuropathy Association Researcher Discovers How Viruses Can Cause Neuropathy, Neuropathy News, 16(8): 3.
Lieberman, S. OPCs and B-vitamins for Neuropathy. Better Nutrition, Sept 1999. P. 12.
Lukaczer, D. ALA Eases Diabetic Neuropathy Symptoms. Nutrition Science News. Oct. 2000 5(11): 470.
Meletis, CD, Wagner, E. Natural Techniques for Analgesia: Part 2. Natural Pharmacy. May 2001. 5(5): 6,8.
Meletis, CD, Barker, J. Alternative Tactics for Pain Management. Natural Pharmacy, April 2005. 9(2): 11-12.
Methylcobalamin. Alternative Medicine ReviewMonographs, Vol 1, Thorne Research Inc, Dover, ID. 2002.
Sagaram, M, Satoh, J, Wada, R. et al. Inhibition of Development of Peripheral Neuropathy in Diabetic Rats. Pharmacy Times, October 2005. 71(10); 60.
Valensi, P. A Multicenter, Safety Study of QR-333 for Treatment of Symptomatic Diabetic Neuropathy. Alternative Medicine Review, December 2005. 10(4): P. 357.
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