Janice Wiesman, MD, has a simple question for patients uncertain as to whether they want to treat neuropathy symptoms without medicine.
The adjunct assistant professor of Neurology at the Boston University School of Medicine and the author of Peripheral Neuropathy: What It Is and What You Can Do to Feel Better told MD Magazine that she understands some patients may not be interested in supplemental care. Already tasked with a burdensome regimen of therapy for nerve damage, some patients may just be looking for simpler relief.
So when a patient gauges Wiesman on symptomatic treatment — means to relieve pain and tingling resulting from the nerve damage — she asks them if the pain is truly making them crazy.
“I just say, ‘Are these symptoms making you crazy? Crazy enough that you would want to try something you would have to take every day to take care of the pain?’,” Wiesman said. “And if they say yes, we have a discussion.”
That discussion can be a lengthy one, as the field of non-medicine neuropathy symptom relief is deep and varied in results. Prior presenting a lecture on the subject at the 70th annual meeting of the American Academy of Neurology (AAN) in Los Angeles, CA, Wiesman shared some of the most common non-opioid options she shares with her patients.
Here they are, in her words:
- I try simple things, like using a warm-water massaging foot bath. It stimulates large fibers, which conduct very quickly (60 meters per second), run up to the spinal cord and substantia gelatinosa and block the input from small pain-emitting fibers that conduct at about 10 meters per second.
- Using the same underlying physiological trick, sometimes people will bind up their feet with compression stocking or Kinesio tape. So it’s the same thing: stimulating large, heavily mylenated, fast-conducting fibers that are going to get that input to the spinal cord before the small fibers.
- Other ways that people warm their feet that are more expensive are things like cold laser therapy. It’s really just using a laser with a wavelength that just goes under the surface of the skin, and all it’s really doing is causing dilation of blood vessels and warming up the person’s feet and legs.
- Even something as simple as acupuncture: the studies are very mixed, and there’s probably a big placebo effect. But, I think part of it is actually doing something for themselves. They’re going to see somebody. I think just the act of getting yourself going and doing something for yourself — and the providers are usually comforting and they talk with them. I think there’s a big placebo effect there, and it’s lovely.
- Topical creams — just plain, old lidocaine cream. It’s very inexpensive. You can only really use it when the pain is in a small area. I don’t want people slathering lidocaine cream all over their whole body. People can use nonsteroidal anti-inflammatory cream.
- There’s things like botulinum injections. I know — who would have ever thought of that? There’s some nice studies where they’ve injected under a grid of the skin on the dorsin of the feet, and that decreases pain. There’s a lot of mechanisms theorized to come into play to explain that.
- Some people don’t want any kind of medicine, whether it’s a cream, a pill, or anything. And for some of those people, cognitive behavioral therapy and mindfulness training work. At the University of Massachusetts, they have a big program for mindfulness training with some really great data. Relaxation therapy in general, meditation, bio-feedback, things like that are particularly for people who have an anxiety component to their pain, which is common and quite understandable.
- As far as pills that aren’t medicine — or at least that I don’t consider medicine — there’s this alpha-lipoic acid. The studies show that giving it intravenously actually helps quite a bit for the pain of diabetic retinopathy. The oral stuff that people buy online or at the health food store, the results for that are variable.
- There’s the electricity route, for which there are some wacky things online. There are 3 standards: transcutaneous nerve stimulation, percutaneous nerve stimulation, and scrambler therapy, which has variable results. Electrodes are put around the area of pain, not on the area of pain, and nerves are stimulated. The idea is to re-train the brain to interpret the painful stimulation from that area more like this non-focused area around the pain.
Another crucial conversation Wiesman covers with patients is the limitations of these treatments. She emphasized that treating symptoms starts and ends there. The benefit is that comes at the call of the patient.
“My takeaway message is that this is just a symptomatic treatment,” Wiesman said. “This is something they can decide they want, it’s something they can control, and it’s something they can get good relief from without adding another pill to their regimen.”
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The American Academy of Neurology Annual Meeting (AAN) delivers the latest developments in science, education, and networking, and further coverage can be found at MD Magazine‘s new sister site, NeurologyLive.
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