Since Peripheral neuropathy affects people of so many ages, physical conditions, and other variables, it can often be confusing for your patients to find consistent information on their own.  Changes in medical research resulting in outdated data, “best guesses” on the parts of sufferers and medical practitioners being reproduced as facts, and just plain likely-sounding rumors all contribute to a host of very basic misinformation about neuropathy.  Your patients rely on you to help them differentiate neuropathy fact from fiction.  This week, we at NeuropathyDR® will be taking a look at some of the most common rumors we’ve found, and will do our best to help you set the record straight!

Isn’t neuropathy only found in people with diabetes?

No.  While neuropathy is common in diabetic patients and is popularly associated with diabetes, neuropathy affects chemotherapy recipients, those suffering from injuries or illness, people who have lost limbs, even sufferers of common minor ailments such as carpal tunnel syndrome (CTS).  If your patients complain of pain, don’t rule out neuropathy as a possible cause.  Of course, be especially on-the-lookout for neuropathic symptoms in patients with diabetes, radioactive therapy, or other commonly-associated causes!

Patients Are LEANING on YOU for Correct Information...

Neuropathy is a natural result of aging, right?  As people get older, they just start to hurt!

Not necessarily.  Neuropathy is more common among seniors, but it affects patients of all ages.  Just because your patients are getting older doesn’t mean neuropathy is a fact of life, either.  Because neuropathy can be caused by injuries, complications with medication, or metabolic issues (among dozens of other causes), taking the right steps early can keep patients from suffering many neuropathic symptoms as they get older.   NeuropathyDR® can help you develop treatment plans that will help patients stay healthy as they age.

My patient’s pain isn’t anything like other cases of neuropathy I’ve seen.  They must have something else!

Neuropathy can present itself as tingling, sharp pains, numbness, loss of motor control, and even very dangerous complications in organ function.  The term describes many different sensations of pain in various areas on the body, so cases can vary wildly from case to case.  Neuropathy is more treatable the earlier it is caught, so don’t take chances!  If your patient has symptoms, be sure to examine all possible causes and presentations before ruling out neuropathy.

There’s no cure, so if my patient has neuropathy, they just have to learn to live with it.

Well, yes and no.  Although most who suffer from nerve damage and neuropathic pain will have to live with some adjustments to their lifestyle and maybe some discomfort (there is, to date, no overall cure), almost all neuropathy patients can keep their symptoms from getting worse and, in most cases, even reverse the symptoms.  A combination of appropriate exercise, good diet, and proper medication can help ensure that you’ll live a happy, normal life.  Whatever you do, don’t let a patient’s neuropathy go untreated!

This website my patient found says they can cure her neuropathy!

Tell her to be careful!  Even though there are some well-meaning, informed, and helpful websites for people with neuropathy, there are also scammers who will try to exploit your patient’s pain and cash in on her desire to be neuropathy-free.  As her clinician, she trusts you to help her identify false or harmful claims.

Inform your patient to be especially wary of any claims of a cure—no actual cure for peripheral neuropathy is known to exist, so any claims to that effect are insincere.  Where treatments are concerned, emphasize that it is almost impossible for a stranger over the internet or phone to develop a treatment plan—a doctor is required to make responsible decisions in the treatment of neuropathy.   Any products or treatments claiming to help without even knowing your patient’s specific symptoms are most likely ineffective at best, and could be dangerous.  Make sure your patient knows to contact you before they begin treatments of any kind!  If you have questions about identifying dubious claims about neuropathy treatments, NeuropathyDRProfessionals(TM) is here to help.

Avoiding some of these myths might seem like common sense, but it can be tricky for desperate or discouraged patients to sort out the good advice from the fiction and hearsay.  Above all, it is important that you, as their authority, have good information!  Don’t believe everything you hear or read.  NeuropathyDRProfessionals(TM) is your best resource for neuropathy-related information.  Contact us and we can answer your questions and keep you up-to-date on the best genuine developments.

http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics

http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131

http://www.medicinenet.com/neuropathic_pain/article.htm

http://www.footpaincenter.com/blog/?p=26

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Neuropathy and Exercise

Pain, muscle control problems, and overall health complications can make even everyday activities for your patients suffering from neuropathy harder to manage.  For some of those patients, the prospect of exercising will seem not only unrealistic but an almost ironic misplacement of their priorities.  As you know, though, exercise is important for everyone. In your patients, it can actually help control blood sugar and slow down the progression and symptoms of the condition.

Exercising regularly greatly decreases anyone’s risk of diabetic neuropathy, and has been shown to control symptoms and deterioration in neuropathy patients  by elevating overall blood flow to the limbs and controlling cardiovascular atrophy.  Depending on a patient’s specific type of neuropathy, the areas affected, and the extent of their damage, neuropathy patients should be advised to adjust conventional workout routines to accommodate their condition.  Advise patients with neuropathy to consult you before they begin any workout program.  When they do, be sure to inspect their feet and legs for signs of potential problems, and make sure their shoes are properly fitted so as to avoid neuropathy-related injuries.  Contact us if you have any questions about how to advise patients interested in starting a fitness program; NeuropathyDR® has resources that can help.

Here are some general guidelines to pass along to patients, to help them avoid neuropathic complications:

• To use silica gel or air midsoles
• To use polyester or polyester/cotton blend socks to keep their feet dry
• To avoid any workout clothes that rub against their skin in the same area.

Ann Albright of the Division of Diabetes Translation in Atlanta cautions that neuropathy patients will want to steer clear of most repetitive or weight-bearing exercise, such as running, walking, or extensive weight training (although some sources advocate weight training as beneficial, in moderation).  So which exercises are the most beneficial while reducing risk?

There is no substitute for appropriate PT and Rehab in Specialty Practice

Swimming is one of the best exercises to recommend, as it is an activity adaptable to any age, fitness level, or degree of neuropathy symptoms.  Swimming is also a full-body, “no-impact” workout, and so is less harmful to a patient’s joints, legs, and feet than most other forms of exercise, without sacrificing circulation.  As such, it is highly recommended for almost anyone.

Bicycling, rowing, and use of a stationary bicycle are other excellent, low-impact activities that can be safely integrated into a neuropathy treatment program.  Some organizations have even developed exercise programs for senior citizens suffering from neuropathy, incorporating a heavy emphasis on seated exercises.

In the event a patient does not have regular access to facilities or equipment for more extensive exercise, there are some basic exercises you can teach that can help your patients control their dexterity and neuropathy symptoms:

• For hands, touch the pad of your thumb with your index finger, running the finger down to the base of your thumb. Then, repeat the movement with the index, middle, ring, and little fingers. Do this exercise several times.
• For legs and feet, straighten one knee and point your foot.  Flex your ankle five times, then circle your foot five times in each direction, clockwise and counterclockwise.
• To increase balance, try this exercise: from a standing position, rise up slowly on your tiptoes, and then rock backward onto your heels. Keep your knees straight, but try not to lock them.

Additional precautions are vital for neuropathy patients to observe.  Advise patients that, after every workout session, they should remember to check their feet and any relevant extremities for blisters, irritation, or sores. These could be vulnerable to infections, which themselves could elevate risk for amputation.

It is especially important for neuropathy patients to be mindful of their heart rate and blood pressure.  Especially if they suffer from autonomic neuropathy, which can greatly increase risk of heart failure or cardiac arrest, advise them of their limitations when it comes to exercise.  There is an appropriate level of exercise for almost everyone, even those with heart risks, but the degree of exercise you advise will obviously vary on a case-by-case basis.

Finally, be sure to make your patients aware that neuropathy sufferers are at high risk when it comes to overheating, since some types of neuropathy can reduce the body’s ability to temperature-control.  Advise them to keep a close monitor on their body temperature, and to let you know immediately if their sweating seems overly profuse or the opposite, less than normal.

If you have any questions about how patients diagnosed with neuropathy should exercise, contact us. NeuropathyDR® can answer your questions and has the resources you need to help your patients stay fit, healthy, and active while living with neuropathy!

http://www.ehow.com/how-does_5162775_exercise-peripheral-neuropathy.html

http://journal.diabetes.org/diabetesspectrum/98v11n4/pg231.htm

http://www.livestrong.com/article/99573-exercise-peripheral-neuropathy/

http://www.health.com/health/condition-article/0,,20189334,00.html

http://www.health.com/health/condition-article/0,,20188832,00.html

• Alcoholism as well as long term use can have devastating consequences for our patients. How can you learn to help… http://t.co/wKVUZRRj #
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One of the most serious—but rarely discussed—conditions resulting from extended alcoholism is alcoholic neuropathy.  One of the reasons for its relative obscurity in the public discourse, aside from difficulties inherent in any discussion of substance abuse, is that much of the empirical evidence linking neuropathy and alcoholism is somewhat vague.  Still, there is ample correlation to assume a causal link.

Alcoholic neuropathy presents in patients similarly to other forms of neuropathy, with tingling and numbness in the extremities, loss of heat and cold sensation, loss of fine motor control, impotence in men, and so on.  All this is accompanied by the chronic pain typical in cases of peripheral neuropathy.  Because of the areas of the mind and body targeted by the alcohol, it is common for alcoholic neuropathy patients to exhibit outward signs of intoxication even when sober, such as slurred speech, stumbling gait, and clumsiness.  The American Journal of Clinical Nutrition says that, in severely affected patients, the legs and hands may be nearly useless to the point of paralysis and sensation may be entirely absent in extremities.  In these cases, the skin can also be dry and atrophic.

The specific causes of alcoholic neuropathy are difficult to pin down, and thus, the case can be tricky to diagnose.  If a patient has a known history of alcohol abuse, that is, of course, a good place to start.  Generally, a pattern of heavy alcohol use for a period of ten years or more will be accompanied by neuropathy symptoms.  A leading theory contends that the cause of alcohol-related neuropathy may be the combined effect of direct nerve-poisoning by the alcohol itself, coupled with the long-term poor nutrition that often accompanies alcohol abuse.  Alcoholics typically exhibit erratic eating habits, resulting in poor overall nutrient intake, and the damage to organs reduces the absorption of nutrients from food.  Of course, difficulty in motor control resultant from neuropathy often exacerbates the malnutrition, as the patient becomes socially uneasy about mealtimes and self-conscious about feeding themselves.

Nerve damage from alcoholism is usually permanent.  The first order of business in treating patients with alcoholic neuropathy is to bring the drinking and nutrition problems under control.  If alcohol consumption is not severely limited and adequate nourishment is not supplied, additional treatments will be futile and symptoms will almost invariably compound. Beyond this, treatment seeks three main goals:

• To control symptoms
• To maximize and restore function (quality of life)
  

  Alcoholic Neuropathy requires extraordinary measures to slow or treat...

• To prevent further injury to the patient due to neuropathic vulnerabilities

Most treatments address these three tenets simultaneously.  Pharmaceutical treatments include the use of painkillers, either prescription strength or over-the-counter (such as analgesics).  When treating patients with alcoholic neuropathy, it is advisable to recommend the lightest use of pain medication possible, as the patient in question is by definition susceptible to habitual substance abuse.  Be sure to monitor use of any medications very carefully.

Because of the underlying nutritional deficit usually at the root of alcoholic neuropathy, some patients may benefit from a system of nutritional supplements.  A dietician or other qualified staff person in your office should be consulted to ensure the proper replenishment of nutrients necessary to prevent the spread of neuropathic symptoms.  Parenteral multivitamins are also useful in many cases to assist nutrition.

Several new lifestyle habits can help patients adjust to living with alcoholic neuropathy, such as carefully monitoring the temperature of bathwater to prevent burning, inspecting themselves and their clothing and footwear for points of rubbing or wear on the skin, and so forth.  In alcoholics, the establishment of these habits (which are themselves advisable for all neuropathy patients) can be instrumental in the replacement of the undesirable dependency that caused the problem.

Although nerve damage is usually permanent, the prognosis for sufferers of alcohol-related neuropathy can be very good if the alcoholic successfully refrains from indulging the dependency and works to replenish nutrition.  It is important to emphasize to patients that substantial recovery from degenerating neuropathic symptoms will not be seen for a period of several months.  Of course, subjective improvements in lifestyle and health will begin almost immediately when abstaining from an alcohol dependency as a result of general detoxification.

If you have patients you believe could be suffering from alcoholic neuropathy, we are here to help you determine for certain how best to proceed!

Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from alcohol abuse-related neuropathic symptoms.

http://www.nlm.nih.gov/medlineplus/ency/article/000714.htm

http://www.neillneill.com/alcoholic-neuropathy

http://www.bettermedicine.com/article/alcoholic-neuropathy

http://www.learn-about-alcoholism.com/alcoholic-neuropathy.html

http://www.ajcn.org/content/9/4/398.full.pdf

• http://t.co/46ddGt3N http://t.co/Lvt9RkVw #

If you treat patients with neuropathy and pain, you’re probably very familiar with complaints about lack of sleep, trouble staying asleep, and general restlessness at night.  It’s hardly surprising, given the intensity of many neuropathic conditions, that they make it tough to rest.  Insomnia (lack of sleep) affects almost half of the overall population, but among neuropathy sufferers, that ratio jumps to over seventy percent (according to the Journal of Pain Medicine). Experts recommend between seven and nine hours of sleep for most adults, regardless of their age or gender, an intimidating goal for people whose chronic pain keeps them up at night.

Research suggests that sleep apnea, a common cause of insomnia, can actually cause peripheral neuropathy, as well. Beyond a mere relationship, studies have shown that apnea is a high-risk condition among the insulin-resistant, which could likely be affecting incidents of neuropathy among diabetics in very direct ways. Some doctors have reported that treating patients with obstructive sleep apnea has actually helped their cold or numb extremities recover, indicating another condition (possibly Raynaud’s phenomenon) masquerading as neuropathy.  If patients suffer from sleep apnea, CPAP treatment may be a viable avenue to explore to address their tingling or loss of sensation.

Regardless of the root cause, your patients’ pain can intensify in the evening hours, both in reality and in their own perception (fewer distractions of the day can cause a patient to focus more on their pain the closer they get to bedtime).

Insomnia from neuropathy can perpetuate its own problem, too.  Not only is your patients’ neuropathy prodigious when it comes to nighttime restlessness, but the resulting lack of sleep can make the pain even worse!  Rest is essential to recovery and treatment, and a patient’s lack of sleep can lower their pain threshold drastically.  Take into consideration that insomnia, diabetes, and other imbalances related to neuropathy can also contribute to high stress, depression, and mood disorders, and your treatment plan become that much more complicated.

If you’re treating patients whose insomnia could be caused by neuropathy (or vice-versa), NeuropathyDR® can provide the tools and information you need to help them get a good night’s sleep.  Specifics vary from patient to patient, of course, but here are some general guidelines that might be useful:

Don't Ignore Your Patients Sleep History when Pain and Fatigue are Present

• Instruct them to keep a regular sleeping schedule.  Getting to bed and getting up at the same times each day is one of the best ways for them to teach their body to sleep correctly.
• Patients should limit their intake of caffeine and any medication that incorporates a stimulant, especially in the evening hours.
• Avoiding heavy foods in the evening is important.  Metabolism continues hours after we eat, and the resultant energy boost can be bad for sleep.  Many cultures eat their biggest meal of the day in the morning and only a small snack at dinnertime for this reason.
• Turning off the TV and computer a few hours before bed is a good idea.  Mileage varies from person to person, but electronics tend to stimulate the senses.  Suggest a book or quiet conversation, instead.
• Counsel patients to adjust their environment to be ideal for sleeping.  They should layer covers to ensure they stay warm but not hot, and should minimize light and noise.

In addition to great care from you as a first line, there are a number of herbal and natural sleep aids as well, which may help insomniacs fall asleep quickly.  Sleep expert Elizabeth Shannon recommends entertaining a number of stress-relief methods, psychological conditioning, and homeopathic solutions for insomnia before resorting to pharmaceutical sleep aids, which can often form dependencies and, over time, exacerbate the problems associated with restlessness.

Of course, for severe chronic pain, prescription medications may be necessary.  Ultram, oxycodone, hydrocodone, and acetaminophen, codeine, and morphine might be used in more extreme cases. Some antidepressants or anticonvulsants could be valuable as well, depending on the specific symptoms your patient is presenting.  Benzodiazepine and nonbenzodiazepine anti-anxiety medication is also occasionally helpful, again, depending on specific symptoms.  If you have questions about pharmaceutical sleep aids, NeuropathyDR® can help provide guidance for you.

Be sure to remind patients that altering their sleep pattern won’t happen overnight (so to speak)!  It could be three to four weeks before any changes made to their routine begin to have meaningful impact on their success.  Often, since changes in routine can be unsettling in themselves, restlessness can become worse before it gets better.  Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from neuropathy to get the rest they need.

http://ajrccm.atsjournals.org/content/159/1/213.full

http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics

http://www.sleeplessnomore.com/

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8145&news_iv_ctrl=1221

• Pain, Numbness, Tingling and Burning- What They Might Mean: http://t.co/5Dhekh6l #
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If your patients are presenting with tingling, numbness, burning sensations, or motor function issues, they may be suffering from peripheral neuropathy.  Neuropathy can be tricky to diagnose, but becoming as informed as possible about its symptoms, treatments, and which of your patients are the most susceptible will equip you to effectively recognize this painful and often dangerous condition.

The main symptoms of peripheral neuropathy with which you and your patients should be familiar are:

• Shooting pain or burning sensations
• Weakness or loss of dexterity in the arms and legs
  

  Falls Due To Sensory Impairments are Frightening...

• Tingling and numbness, especially in the extremities
• Loss of fine motor control (dropping things frequently becomes an issue)
• False sensory signals (reduced ability to sense temperature, sensations of being touched or wearing gloves, hats, or stockings when they are not

Other symptoms can also occur, of course, resultant from the above: sleep deprivation, restlessness, inability to sit still, irritability and nervousness, and so on.

So many groups are at-risk for neuropathy, it is practically guaranteed that learning to identify, diagnose, and even treat the condition will be a valuable asset to your practice and to the lives of your patients.  Spotting neuropathy early in a patient can mean the difference between debilitation and a comparatively normal life!

Some of the most common causes of neuropathy include (this is a partial list!):

• Diabetes
• Chemotherapy (increasingly over the past few decades, as cancer treatments become more and more effective)
• Kidney disorders
• HIV
• Nerve damage from injury or surgery
• Shingles
• Genetic diseases such as Ataxia, or even hereditary neuropathy

Discussing Neuropathy with your patients can be challenging.  Start by making certain your patient understands whatever underlying cause is behind the neuropathy (diabetes, for example, is the most common).  Explain the symptoms of neuropathy, and encourage the patient to identify any they may be suffering, even intermittently.  Don’t forget to reassure them that, while there is no miracle cure for neuropathy, it is both common and very treatable in terms of pain.  Also, be certain to emphasize the importance of monitoring their condition for signs of further degeneration or additional symptoms (as these could be signs of dangerous progression).

Medical Treatment options for neuropathy vary widely, and are rapidly changing with technology and as we learn more about the condition. Some studies recommend non-steroid painkillers such as Motrin or Aleve for mild cases of pain, whereas cases involving more pain usually require prescription  pain reducers containing morphine or similar.  Surgical treatments also utilize implants.  Of Course external therapeutic devices should always be applied by the most qualified neuropathy treatment specialists.

Where your patient’s neuropathy is resultant from chronic or persistent illness, management of that underlying illness is, of course the priority.  Proper control of diabetes, appropriate physical therapy after an injury or surgery, or treatment of other relevant conditions will, in almost all cases, help to minimize neuropathic injuries.

Patients suffering from neuropathy are already familiar with its discomfort, and inconvenience to their lives.  It is important for you both to realize that many types of neuropathy can also be very dangerous, even life-threatening.  It is not uncommon for neuropathy to be degenerative and, if left unmonitored or untreated, it can cause intestinal blockages or complications in the function of bodily organs.  Needless to say, take no chances!

While there’s no cure for neuropathy, there is plenty you can do to help your patients enjoy healthier, full lives while living with the condition.  Early intervention with a NeuropathyDR® clinician is the best route; we put at your disposal all the resources you will need to effectively treat and advise your neuropathy patients.

For more tips on your patients or growing your specific practice, contact us at http://neuropathydrprofessionals.com

http://www.medicinenet.com/neuropathic_pain/article.htm#tocd

http://pain.about.com/od/typesofchronicpain/a/neuropathic_causes.htm

http://www.neuropathy.org/site/PageServer?pagename=About_Symptoms

http://www.joslin.org/info/diabetic_neuorpathy_nerve_damage_an_update.html

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