Treatment for Neuropathy

Neuropathy, simply put, is an injury to a nerve or group of nerves.  Some neuropathies can be successfully cured, while others may be permanent in nature.  The diagnosis of a permanent neuropathy, However, does not need to mean having to live in pain.

Neuropathy can be grouped into two categories, central and peripheral. And these categories are further subdivided into primary and secondary.  Central neuropathy involves nerves in the brain and spinal cord, whereas peripheral neuropathy includes any nerve outside of the spinal cord.  

Common central neuropathies include involvement of one of the cranial nerves, brainstem and spinal cord itself.  Examples of these include injury to the ocular nerve (effecting eyesight), Trigeminal neuropathy (causing facial pain), and spinal cord lesions. Common peripheral neuropathy’s include nerve root impingement from a disc herniation, carpal tunnel syndrome (which leads to pain and numbness in the hands), and diabetic neuropathy (causing pain in the hands and feet).

If a secondary cause for the neuropathy is identified, then definitive treatment should be undertaken to lead to a permanent cure. For example, nerve impingement leading to carpal tunnel syndrome, tennis elbow, or disc herniations all can successfully treated surgically.

Primary neuropathies can be more difficult to treat.  Medications can successfully treat some neuropathies. Anti-convulsant, anti-depressants, and other neuroleptics should be trialed.  Tegretal Is known to alleviate a majority of patients suffering from trigeminal neuralgia. Gabapentin and Pregabalin are two anticonvulsants widely utilized as well.  Amytryptaline and SSRI are two different antidepressants which can treat some neuropathies.

Lastly, Interventional therapy can also help alleviate pain from such conditions.  Nerves can be treated either with ablation or stimulation. Nerve root damage in cervical or lumbar radiculopathy can be treated with radiofrequency ablation.  Permanent spinal cord injury after back surgery AKA post laminectomy pain syndrome, or diabetic neuropathy can be treated with spinal cord stimulation. While these therapies do not necessarily “cure” the condition, they block transmission of the pain, leading to symptomatic benefit.

In conclusion, having the diagnosis of neuropathy does not have to mean having to live with pain.  Different treatment options exist, both with medications and interventions, to alleviate a patient’s pain and improve their quality of life.

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