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What Is Nerve Pain (and How Does It Differ From Other Kinds of Pain?)

What Is Nerve Pain (and How Does It Differ From Other Kinds of Pain?)

“Can you describe your pain?” This will likely be one of the first questions your doctor asks if you complain of chronic pain. Unless there’s an obvious reason for pain, your doctor needs a lot of information to identify the underlying cause. This includes the location, type, intensity and frequency of pain. The doctor is partly trying to determine whether the pain is nociceptive or neuropathic (also called nerve pain), or possibly both.

“This can be tricky because all pain is experienced through the nerves,” says sports medicine specialist Dominic King, DO. Damage to bodily tissues, such as muscles, tendons, ligaments or the capsules around joints, causes nociceptive pain. Nerve receptors adjacent to the damaged tissue, called nociceptors, transmit a pain signal to the brain. This type of pain tends to feel sharp, achy, dull or throbbing.

Understanding ‘electric pain’

If you’re experiencing something that feels more like burning, stabbing, or shooting pain ― especially if there also is numbness or tingling ― it’s likely to be neuropathic pain. This means there is direct damage or irritation to a nerve. “It can cause a lightning strike type of electric pain,” says Dr. King.

Nerve pain can arise from a variety of causes, including diabetes, infections (such as shingles), multiple sclerosis, the effects of chemotherapy or trauma. When it comes to orthopeadic issues, nerve pain often stems from a nerve being pinched by nearby bones, ligaments and other structures.

For example, a herniated disk in the spine or a narrowing of the spinal canal (stenosis) can press on a nerve as it leaves the spinal canal. This can cause pain along the path of the nerve. When nerves that originate in the lower spine are affected, symptoms might be felt in the buttocks or down a leg. If the compressed nerve is in the upper spine, the pain and other symptoms can shoot down the arm. Numbness or tingling may also occur because the brain is not receiving a consistent signal due to the compression.

Another common cause of nerve pain is carpal tunnel syndrome. A nerve and several tendons travel through a passageway in the wrist (the carpal tunnel) to the hand. Inflammation in the tunnel can press on the nerve, causing numbness and tingling in the thumb and fingers.

How is the cause of nerve pain found?

“There are so many orthopaedic conditions that overlap between pain stemming from problems with tendons, muscles, joints and nerves that you need a very discerning physician to do a good physical exam to figure out the cause,” says Dr. King. “I make my determination based on when the patient experiences pain, where the pain is located and what the pain feels like.”

Pain related to joints, such as from arthritis, will feel more like stiffness when going from sitting to standing. With tendon pain, it will feel sore when you push on the affected area. “Nerve pain is more of a burning, fiery pain,” says Dr. King. And it tends to come and go.

“Nerve pain typically gets worse with more and more use and can be associated with numbness,” says Dr. King.

Ultimately, getting the right treatment depends on getting the right diagnosis. For many bone and joint conditions, nondrug treatment will be tried first. Sometimes pain medication is needed. However, neuropathic pain does not respond to drugs commonly used for nociceptive pain, such as nonsteroidal anti-inflammatory drugs.

This article originally appeared in Cleveland Clinic Arthritis Advisor.

 

Article Provided By: clevelandclinic

 

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC

If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

 

 

 

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Does Neuropathy from Chemo Go Away?

Does Neuropathy from Chemo Go Away?

What is peripheral neuropathy?

Peripheral neuropathy is a blanket term for pain and discomfort and other symptoms that result from damage to peripheral nerves, which are the nerves that extend away from the brain and spinal cord.

The peripheral nervous system carries signals from the brain and spinal cord to the rest of your body, and then returns nerve signals from the periphery to be received by the spinal cord and brain. Any problems along the way can affect the skin, muscles, and joints of your hands, feet, and other parts of the body.

Many things can cause neuropathy, including certain chemotherapy drugs. Damage to peripheral nerves by these drugs is called chemotherapy-induced peripheral neuropathy, abbreviated as CIPN.

CIPN isn’t uncommon. Of people with cancer who are treated with chemotherapy, about 30 to 40 percent develop CIPN. It’s one of the reasons that some stop cancer treatment early.

What are the symptoms of CIPN?

CIPN generally affects both sides of your body the same way. Symptoms are likely to begin in your toes but can move to your feet, legs, hands, and arms. Symptoms range from mild to severe. Some of the more common symptoms are:

  • tingling or pins-and-needles sensation
  • sharp, stabbing pain
  • burning or shock-like sensations
  • loss of sensation or complete numbness
  • trouble with small motor skills such as writing, texting, and buttoning
  • gripping problems (dropping things)
  • clumsiness
  • weakness

You might also experience:

  • oversensitivity to touch
  • balance and coordination problems, which can lead to stumbling or falling when walking
  • differences in your sensitivity to temperature, making it harder to gauge heat and cold
  • reduced reflexes
  • swallowing difficulties
  • jaw pain
  • hearing loss
  • constipation
  • trouble urinating

Severe peripheral neuropathy can lead to serious health problems such as:

  • changes to blood pressure
  • changes to heart rate
  • breathing difficulties
  • injury due to falling
  • paralysis
  • organ failure
What causes CIPN?

Chemotherapy drugs are systemic treatments — that is, they affect your entire body. These powerful medications can take a toll, and some can damage your peripheral nervous system.

It’s hard to say exactly what causes CIPN since each chemotherapy drug is different, as is each person who receives treatment.

Some of the chemotherapy drugs associated with CIPN are:

  • nanoparticle albumin bound-paclitaxel (Abraxane)
  • bortezomib (Velcade)
  • cabazitaxel (Jevtana)
  • carboplatin (Paraplatin)
  • carfilzomib (Kyprolis)
  • cisplatin (Platinol)
  • docetaxel (Taxotere)
  • eribulin (Halaven)
  • etoposide (VP-16)
  • ixabepilone (Ixempra)
  • lenalidomide (Revlimid)
  • oxaliplatin (Eloxatin)
  • paclitaxel (Taxol)
  • pomalidomide (Pomalyst)
  • thalidomide (Thalomid)
  • vinblastine (Velban)
  • vincristine (Oncovin, Vincasar PFS)
  • vinorelbine (Navelbine)

Besides chemotherapy, peripheral neuropathy can be due to the cancer itself, such as when a tumor presses on a peripheral nerve.

Other cancer treatments such as surgery and radiation therapy can also lead to peripheral neuropathy. Even if you’re receiving chemotherapy, the neuropathy can be caused or aggravated by other conditions such as:

  • alcohol use disorder
  • autoimmune disorders
  • diabetes mellitus
  • HIV
  • infections that lead to nerve damage
  • poor peripheral blood circulation
  • shingles
  • spinal cord injury
  • vitamin B deficiency
How long does it last?

Symptoms can appear as soon as chemotherapy begins. Symptoms tend to get worse as the chemotherapy regimen progresses.

It’s a temporary problem for some, lasting only a few days or weeks.

For others, it can last for months or years and can even become a lifelong problem. This may be more likely if you have other medical conditions that cause neuropathy or take other prescription drugs that cause it.

How is CIPN treated?

Once your oncologist (a doctor who specializes in cancer treatment) determines that your peripheral neuropathy is caused by chemotherapy, they will monitor your treatment to see if symptoms are worsening. In the meantime, symptoms can be treated with:

  • steroids to reduce inflammation
  • topical numbing medicines
  • antiseizure medications, which can help relieve nerve pain
  • prescription-strength pain relievers such as narcotics (opioids)
  • antidepressants
  • electrical nerve stimulation
  • occupational and physical therapy

If symptoms continue, your doctor may decide to:

  • lower the dose of your chemotherapy drug
  • switch to a different chemotherapy drug
  • delay chemotherapy until symptoms improve
  • stop chemotherapy
Managing symptoms

It’s very important to work with your doctor to prevent neuropathy from getting worse. In addition, there are a few other things you can do, such as:

  • relaxation therapy, guided imagery, or breathing exercises
  • massage therapy
  • acupuncture
  • biofeedback

Pain, numbness, or strange sensations can make it difficult to work with your hands, so you should be extra careful with sharp objects. Wear gloves for yardwork or when working with tools.

If symptoms involve your feet or legs, walk slowly and carefully. Use handrails and grab bars when available and put no-slip mats in your shower or tub. Remove loose area rugs, electrical cords, and other tripping hazards in your home.

Wear shoes indoors and out to protect your feet. And if you have severe numbness in your feet, be sure to inspect them every day for cuts, injuries, and infection that you can’t feel.

Temperature sensitivity can also be a problem.

Make sure your water heater is set to a safe level, and check the temperature of the water before getting in the shower or bath.

Check the air temperature before going outside in winter. Even though you might not feel the cold, gloves and warm socks can help protect your feet and hands from frostbite.

If you find it helps to relieve your peripheral neuropathy symptoms, you can apply an ice pack on your hands or feet, but only for less than 10 minutes at a time with at least 10 minutes of breaktime between each repeat application.

Here are a few additional tips:

  • Don’t wear tight clothes or shoes that interfere with circulation.
  • Avoid alcoholic beverages.
  • Take all your medications as directed.
  • Get plenty of rest while in treatment.
  • Follow your doctor’s recommendations for diet and exercise.
  • Keep your oncologist informed about new or worsening symptoms.

Currently, there’s no scientifically proven way to prevent neuropathy caused by chemotherapy. And there’s no way to know in advance who’ll develop it and who won’t.

Some research, such as this 2015 studyTrusted Source and this 2017 studyTrusted Source, suggests that taking glutathione, calcium, magnesium, or certain antidepressant or antiseizure drugs might help mitigate the risk for certain people. However, the research is limited, weak, or shows mixed results at best.

Before starting chemotherapy, tell your oncologist about other health conditions, such as diabetes mellitus, that could lead to peripheral neuropathy. This can help them choose the best chemotherapy drug for you.

Your oncologist may try to lessen the risk by prescribing lower doses of chemotherapy drugs over a longer period of time. If symptoms start, it may be appropriate to stop chemotherapy and restart when symptoms improve. It’s something that must be decided on a case-by-case basis.

While mild symptoms may resolve within a short time frame, more severe cases can linger for months or years. It can even become permanent. That’s why it’s so important to keep your oncologist informed about all your symptoms and side effects.

Addressing CIPN early may help ease symptoms and prevent it from getting worse.

Last medically reviewed on January 24, 2019

 

Article Provided By: healthline
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

 

 

 

0

Does Neuropathy from Chemo Go Away?

Does Neuropathy from Chemo Go Away?

What is peripheral neuropathy?
Peripheral neuropathy is a blanket term for pain and discomfort and other symptoms that result from damage to peripheral nerves, which are the nerves that extend away from the brain and spinal cord.
The peripheral nervous system carries signals from the brain and spinal cord to the rest of your body, and then returns nerve signals from the periphery to be received by the spinal cord and brain. Any problems along the way can affect the skin, muscles, and joints of your hands, feet, and other parts of the body.
Many things can cause neuropathy, including certain chemotherapy drugs. Damage to peripheral nerves by these drugs is called chemotherapy-induced peripheral neuropathy, abbreviated as CIPN.
CIPN isn’t uncommon. Of people with cancer who are treated with chemotherapy, about 30 to 40 percent develop CIPN. It’s one of the reasons that some stop cancer treatment early.

What are the symptoms of CIPN?
CIPN generally affects both sides of your body the same way. Symptoms are likely to begin in your toes but can move to your feet, legs, hands, and arms. Symptoms range from mild to severe. Some of the more common symptoms are:
tingling or pins-and-needles sensation
sharp, stabbing pain
burning or shock-like sensations
loss of sensation or complete numbness
trouble with small motor skills such as writing, texting, and buttoning
gripping problems (dropping things)
clumsiness
weakness
You might also experience:
oversensitivity to touch
balance and coordination problems, which can lead to stumbling or falling when walking
differences in your sensitivity to temperature, making it harder to gauge heat and cold
reduced reflexes
swallowing difficulties
jaw pain
hearing loss
constipation
trouble urinating
Severe peripheral neuropathy can lead to serious health problems such as:
changes to blood pressure
changes to heart rate
breathing difficulties
injury due to falling
paralysis
organ failure
What causes CIPN?
Chemotherapy drugs are systemic treatments — that is, they affect your entire body. These powerful medications can take a toll, and some can damage your peripheral nervous system.
It’s hard to say exactly what causes CIPN since each chemotherapy drug is different, as is each person who receives treatment.
Some of the chemotherapy drugs associated with CIPN are:
nanoparticle albumin bound-paclitaxel (Abraxane)
bortezomib (Velcade)
cabazitaxel (Jevtana)
carboplatin (Paraplatin)
carfilzomib (Kyprolis)
cisplatin (Platinol)
docetaxel (Taxotere)
eribulin (Halaven)
etoposide (VP-16)
ixabepilone (Ixempra)
lenalidomide (Revlimid)
oxaliplatin (Eloxatin)
paclitaxel (Taxol)
pomalidomide (Pomalyst)
thalidomide (Thalomid)
vinblastine (Velban)
vincristine (Oncovin, Vincasar PFS)
vinorelbine (Navelbine)
Besides chemotherapy, peripheral neuropathy can be due to the cancer itself, such as when a tumor presses on a peripheral nerve.
Other cancer treatments such as surgery and radiation therapy can also lead to peripheral neuropathy. Even if you’re receiving chemotherapy, the neuropathy can be caused or aggravated by other conditions such as:
alcohol use disorder
autoimmune disorders
diabetes mellitus
HIV
infections that lead to nerve damage
poor peripheral blood circulation
shingles
spinal cord injury
vitamin B deficiency

 

How long does it last?
Symptoms can appear as soon as chemotherapy begins. Symptoms tend to get worse as the chemotherapy regimen progresses.
It’s a temporary problem for some, lasting only a few days or weeks.
For others, it can last for months or years and can even become a lifelong problem. This may be more likely if you have other medical conditions that cause neuropathy or take other prescription drugs that cause it.

How is CIPN treated?
Once your oncologist (a doctor who specializes in cancer treatment) determines that your peripheral neuropathy is caused by chemotherapy, they will monitor your treatment to see if symptoms are worsening. In the meantime, symptoms can be treated with:
steroids to reduce inflammation
topical numbing medicines
antiseizure medications, which can help relieve nerve pain
prescription-strength pain relievers such as narcotics (opioids)
antidepressants
electrical nerve stimulation
occupational and physical therapy
If symptoms continue, your doctor may decide to:
lower the dose of your chemotherapy drug
switch to a different chemotherapy drug
delay chemotherapy until symptoms improve
stop chemotherapy

Managing symptoms
It’s very important to work with your doctor to prevent neuropathy from getting worse. In addition, there are a few other things you can do, such as:
relaxation therapy, guided imagery, or breathing exercises
massage therapy
acupuncture
biofeedback
Be sure to ask your doctor about complementary therapies before you start.
Pain, numbness, or strange sensations can make it difficult to work with your hands, so you should be extra careful with sharp objects. Wear gloves for yardwork or when working with tools.
If symptoms involve your feet or legs, walk slowly and carefully. Use handrails and grab bars when available and put no-slip mats in your shower or tub. Remove loose area rugs, electrical cords, and other tripping hazards in your home.
Wear shoes indoors and out to protect your feet. And if you have severe numbness in your feet, be sure to inspect them every day for cuts, injuries, and infection that you can’t feel.
Temperature sensitivity can also be a problem.
Make sure your water heater is set to a safe level, and check the temperature of the water before getting in the shower or bath.
Check the air temperature before going outside in winter. Even though you might not feel the cold, gloves and warm socks can help protect your feet and hands from frostbite.
If you find it helps to relieve your peripheral neuropathy symptoms, you can apply an ice pack on your hands or feet, but only for less than 10 minutes at a time with at least 10 minutes of breaktime between each repeat application.
Here are a few additional tips:
Don’t wear tight clothes or shoes that interfere with circulation.
Avoid alcoholic beverages.
Take all your medications as directed.
Get plenty of rest while in treatment.
Follow your doctor’s recommendations for diet and exercise.
Keep your oncologist informed about new or worsening symptoms.

Outlook and prevention
Currently, there’s no scientifically proven way to prevent neuropathy caused by chemotherapy. And there’s no way to know in advance who’ll develop it and who won’t.
Some research, such as this 2015 study
Trusted Source
and this 2017 study
Trusted Source
, suggests that taking glutathione, calcium, magnesium, or certain antidepressant or antiseizure drugs might help mitigate the risk for certain people. However, the research is limited, weak, or shows mixed results at best.
Before starting chemotherapy, tell your oncologist about other health conditions, such as diabetes mellitus, that could lead to peripheral neuropathy. This can help them choose the best chemotherapy drug for you.
Your oncologist may try to lessen the risk by prescribing lower doses of chemotherapy drugs over a longer period of time. If symptoms start, it may be appropriate to stop chemotherapy and restart when symptoms improve. It’s something that must be decided on a case-by-case basis.
While mild symptoms may resolve within a short time frame, more severe cases can linger for months or years. It can even become permanent. That’s why it’s so important to keep your oncologist informed about all your symptoms and side effects.
Addressing CIPN early may help ease symptoms and prevent it from getting worse.

Article Provided By: healthline
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

 

 

 

 

0

Why Is Neuropathy Worse at Night?

January 3, 2020 / Brain & Spine
Why Is Neuropathy Worse at Night?
Reasons why nerve pain is more painful at night
Peripheral neuropathy is when a nerve or group of nerves outside of the brain and spinal cord is injured or dysfunctions. It could be because of an injury to a single nerve, like carpal tunnel syndrome, or because a group of nerves have become defective, like with peripheral neuropathy of the feet.
“Across the board we know that neuropathy can cause pain depending on what type of nerves are involved,” says neurologist Benjamin Claytor, MD. “When people describe worsening symptoms at night they’re describing discomfort – pins and needles, tingling and burning pain.”
Here Dr. Claytor discusses what might be causing this nightly pain and how to find relief.
Distraction
Our attention level can influence how we perceive pain. So during the day when we’re at work or taking care of the kids – we’re distracted and busy. Although there hasn’t been much research around it, the idea is that we aren’t focusing on the pain during the day because we’re busy, we pay less attention to it and perceive less pain.
“Many patients will tell me that after they get home from work, have dinner and sit down to watch TV for the night that their pain flares up,” says Dr. Claytor. “This could be because the daytime distractions are now gone and you’re starting to unwind for the night.”
Temperature and sleep
Another thought behind nightly neuropathy has to do with temperature. At night our body temperature fluctuates and goes down a bit. Most people tend to sleep in a cooler room as well. The thought is that damaged nerves might interpret the temperature change as pain or tingling, which can heighten the sense of neuropathy.
Also consider poor sleep quality. If you’re not sleeping very well to begin with, either due to poor sleep habits or sleep related disorders, this could lead to increased pain perception.
Emotions and stress
Our emotional state can also influence how we perceive pain. Stress and anxiety can feed in to and amplify pain signaling. Living in a chronic state of stress wreaks havoc on your physical and mental health.
Medication
Sometimes medication dosing and timing might need to be adjusted, which could be particularly true for some short acting medications used for neuropathy pain.
How to stop neuropathy pain at night
“There are options we can explore if your neuropathy pain seems to be worsening at night,” explains Dr. Claytor. “There might be oral or topical medications we can prescribe, or maybe it’s getting your stress under control and being more mindful.”
Cognitive behavioral therapy, physical therapy and meditation may be complementary tools to reduce pain as well.
Dr. Claytor stresses the importance of talking to your doctor sooner rather than later. Often time’s people will wait so long to see their physician that there’s permanent nerve damage that might have been avoided.
“I think one of the most important things I can discuss with a patient who comes in with neuropathy pain at night is getting to the root cause of what is actually driving it,” says Dr. Claytor. “Depending on what the underlying cause is, treating that first and foremost can usually help reduce the pain overall – especially at night.”

 

Article Provided By: health.clevelandclinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

 

 

 

 

0

Peripheral Neuropathy

Neuropathy (Peripheral Neuropathy)

Diabetes is a leading cause of neuropathy in the United States, although there are many other causes too. Some cases of neuropathy can be easily treated and sometimes cured. If neuropathy can’t be cured, treatment is aimed at controlling and managing symptoms and preventing further nerve damage.

Your peripheral nervous system is made up of the nerves outside your central nervous system. Sensory nerves carry messages to your brain. Motor nerves carry messages to your muscles.
What is neuropathy?
Neuropathy is damage or dysfunction of one or more nerves that typically results in numbness, tingling, muscle weakness and pain in the affected area. Neuropathies frequently start in your hands and feet, but other parts of your body can be affected too.
Neuropathy, often called peripheral neuropathy, indicates a problem within the peripheral nervous system. Your peripheral nervous system is the network of nerves outside your brain and spinal cord. Your brain and spinal cord make up your central nervous system. Think of the two systems working together this way: Your central nervous system is the central station. It is the control center, the hub from which all trains come and go. Your peripheral nervous system are the tracks that connect to the central station. The tracks (the network of nerves) allow the trains (information signals) to travel to and from the central station (your brain and spinal cord).
Neuropathy results when nerve cells, called neurons, are damaged or destroyed. This disrupts the way the neurons communicate with each other and with the brain. Neuropathy can affect one nerve (mononeuropathy) or nerve type, a combination of nerves in a limited area (multifocal neuropathy) or many peripheral nerves throughout the body (polyneuropathy).

What types of peripheral nerves are there and what do they do?
The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.
Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.
Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.
Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body’s temperature from rising too high.
The type of symptoms you feel depend on the type of nerve that is damaged.
What does neuropathy feel like?
If you have neuropathy, the most commonly described feelings are sensations of numbness, tingling (“pins and needles”), and weakness in the area of the body affected. Other sensations include sharp, lightening-like pain; or a burning, throbbing or stabbing pain.
How common is neuropathy? Who gets neuropathy?
Neuropathy is very common. It is estimated that about 25% to 30% of Americans will be affected by neuropathy. The condition affects people of all ages; however, older people are at increased risk. About 8% of adults over 65 years of age report some degree of neuropathy. Other than age, in the United States some of the more common risk factors for neuropathy include diabetes, metabolic syndrome (high blood pressure, high cholesterol, obesity, diabetes), and heavy alcohol use. People in certain professions, such as those that require repetitive motions, have a greater chance of developing mononeuropathies from trauma or compression of nerves.
Among other commonly cited statistics, neuropathy is present in:
60% to 70% of people with diabetes.
30% to 40% of people who receive chemotherapy to treat cancer.
30% of people who have human immunodeficiency virus (HIV).
How quickly does neuropathy develop?
Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.

There are many causes of neuropathy. Diabetes is the number one cause in the United States. Other common causes include trauma, chemotherapy, alcoholism and autoimmune diseases.
What causes neuropathy?
Neuropathy is not caused by a single disease. Many conditions and events that impact health can cause neuropathy, including:
Diabetes: This is a leading cause of neuropathy in the United States. Some 60% to 70% of people with diabetes experience neuropathy. Diabetes is the most common cause of small fiber neuropathy, a condition that causes painful burning sensations in the hands and feet.
Trauma: Injuries from falls, car accidents, fractures or sports activities can result in neuropathy. Compression of the nerves due to repetitive stress or narrowing of the space through which nerves run are other causes.
Autoimmune disorders and infections: Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjogren’s syndrome and chronic inflammatory demyelinating polyneuropathy are autoimmune disorders that can cause neuropathy. Infections including chickenpox, shingles, human immunodeficiency virus (HIV), herpes, syphilis, Lyme disease, leprosy, West Nile virus, Epstein-Barr virus and hepatitis C can also cause neuropathy.
Other health conditions: Neuropathy can result from kidney disorders, liver disorders, hypothyroidism, tumors (cancer-causing or benign) that press on nerves or invade their space, myeloma, lymphoma and monoclonal gammopathy.
Medications and poisons: Some antibiotics, some anti-seizures medications and some HIV medications among others can cause neuropathy. Some treatments, including cancer chemotherapy and radiation, can damage peripheral nerves. Exposure to toxic substances such as heavy metals (including lead and mercury) and industrial chemicals, especially solvents, can also affect nerve function.
Vascular disorders: Neuropathy can occur when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.
Abnormal vitamin levels and alcoholism: Proper levels of vitamins E, B1, B6, B12, and niacin are important for healthy nerve function. Chronic alcoholism, which typically results in lack of a well-rounded diet, robs the body of thiamine and other essential nutrients needed for nerve function. Alcohol may also be directly toxic to peripheral nerves.
Inherited disorders: Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy. CMT causes weakness in the foot and lower leg muscles and can also affect the muscles in the hands. Familial amyloidosis, Fabry disease and metachromatic leukodystrophy are other examples of inherited disorders that can cause neuropathy.
No known cause: Some cases of neuropathy have no known cause.
What are the symptoms of neuropathy?
Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can appear suddenly, which is called acute neuropathy, or develop slowly over time, called chronic neuropathy.
Common signs and symptoms of neuropathy include:
Tingling (“pins and needles”) or numbness, especially in the hands and feet. Sensations can spread to the arms and legs.
Sharp, burning, throbbing, stabbing or electric-like pain.
Changes in sensation. Severe pain, especially at night. Inability to feel pain, pressure, temperature or touch. Extreme sensitivity to touch.
Falling, loss of coordination.
Not being able to feel things in your feet and hands – feeling like you’re wearing socks or gloves when you’re not.
Muscle weakness, difficulty walking or moving your arms or legs.
Muscle twitching, cramps and/or spasms.
Inability to move a part of the body (paralysis). Loss of muscle control, loss of muscle tone or dropping things out of your hand.
Low blood pressure or abnormal heart rate, which causes dizziness when standing up, fainting or lightheadedness.
Sweating too much or not enough in relation to the temperature or degree or exertion.
Problems with bladder (urination), digestion (including bloating, nausea/vomiting) and bowels (including diarrhea, constipation).
Sexual function problems.
Weight loss (unintentional).

Neuropathy (Peripheral Neuropathy): Diagnosis and Tests

Common symptoms of neuropathy include numbness and tingling, frequent falls, muscle weakness and difficulty walking, and low blood pressure.
How is neuropathy diagnosed?
History and physical exam: First, your doctor will conduct a thorough history and physical exam. You doctor will review your symptoms and ask questions including your current and past medications, exposure to toxic substances, your history of trauma, your line of work or social habits (looking for repetitive motions), family history of diseases of the nervous system, your diet and alcohol use.

Neurologic exam: During a neurologic exam, your doctor will check your reflexes, your coordination and balance, your muscle strength and tone, and your ability to feel sensations (such as light touch or cold).
Blood work and imaging tests: Your doctor may also order blood work and imaging tests. Blood work can reveal vitamin and mineral imbalances, electrolyte imbalances (indicator of kidney problems, diabetes, other health issues), thyroid problems, toxic substances, antibodies to certain viruses or autoimmune diseases. Magnetic resonance imaging (MRI) can detect tumors, pinched nerves and nerve compression.
Genetic testing: A genetic test may be ordered if your doctor suspects a genetic condition is causing your neuropathy.
Electrodiagnostic assessment (EDX): Your doctor might send you to a nerve specialist for an EDX to find the location and degree of nerve damage. EDX includes two tests:
Nerve conduction study (NCS): During this test, small patches – called electrodes – are placed on the skin over nerves and muscles on different parts of your body, usually your arms or legs. A brief pulse of electricity is applied to the patch over a nerve to be studied. The test measures the size of the response and how quickly the nerve is carrying the electrical signal. Both motor and sensory nerves can be studied in this way.
Needle electromyography (EMG): An EMG can determine the health of a muscle, and determine if there is any disconnection between the nerve and muscle by measuring the electrical activity within the muscle while it is in use. During an EMG, a very thin needle electrode is inserted through the skin into the muscle. The muscle is then used for a specific movement and the electrical activity of the muscle is recorded on a graph called an electromyogram.
Tissue biopsies: In some cases, a nerve, muscle or skin biopsy is needed to confirm the diagnosis. During a biopsy, a small sample of your tissue is removed for examination under a microscope.
Other tests: Other tests include a test to measure your body’s ability to sweat (called a QSART test) and other tests to check the sensitivity of your senses (touch, heat/cold, pain, vibration).

Neuropathy (Peripheral Neuropathy): Management and Treatment

How is neuropathy treated?
Treatment begins by identifying and treating any underlying medical problem, such as diabetes or infections.

Some cases of neuropathy can be easily treated and sometimes cured. Not all neuropathies can be cured, however. In these cases, treatment is aimed at controlling and managing symptoms and preventing further nerve damage. Treatment options include the following:
Medicines can be used to control pain. A number of different medications contain chemicals that help control pain by adjusting pain signaling pathways within the central and peripheral nervous system. These medications include:
Antidepressants such as duloxetine or nortripyline.
Antiseizure medicines such as gabapentin (Neurontin®, Gralise®) and pregabalin (Lyrica®).
Topical (on the skin) patches and creams containing lidocaine (Lidoderm®, Xylocaine®) or capsaicin (Capsin®, Zostrix®).
Narcotic medications are not usually used for neuropathy pain due to limited evidence that they are helpful for this condition.
Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
Occupational therapy can help you cope with the pain and loss of function, and teach you skills to make up for that loss.
Surgery is available for patients with compression-related neuropathy caused by such things as herniated disc in back or neck, tumors, infections, or nerve entrapment disorders, such as carpal tunnel syndrome.
Mechanical aids, such as braces and specially designed shoes, casts and splints can help reduce pain by providing support or keeping the affected nerves in proper alignment.
Proper nutrition involves eating a healthier diet and making sure to get the right balance of vitamins and other nutrients.
Adopting healthy living habits, including exercising to improve muscle strength, quitting smoking, maintaining a healthy weight, and limiting alcohol intake.
Other treatments
Transcutaneous electrical nerve stimulation (TENS): This treatment involves placing electrodes on the skin at or near the nerves causing your pain. A gentle, low-level electrical current is delivered through the electrodes to your skin. Treatment schedule (how many minutes and how often) is determined by your therapist. The goal of TENS therapy is to disrupt pain signals so they don’t reach the brain
Immune suppressing or immune modulating treatments: Various treatments are used for individuals whose neuropathy is due to an autoimmune disease. These include oral medications, IV infusion treatments, or even procedures like plasmapheresis where antibodies and other immune system cells are removed from your blood and the blood is then returned to your body. The goal of these therapies is to stop the immune system from attacking the nerves.
Complementary treatments: Acupuncture, massage, alpha-lipoic acid, herbal products, meditation/yoga, behavioral therapy and psychotherapy are other methods that could be tried to help relieve neuropathic pain. Ask your doctor if any of these therapies might be helpful for treating the cause of your neuropathy.

Neuropathy (Peripheral Neuropathy): Prevention

Can neuropathy be prevented?
You can reduce your risk of neuropathy by treating existing medical problems and adopting healthy living habits. Here are some tips:
Manage your diabetes: If you have diabetes, keep your blood glucose level within the range recommended by your doctor.
Take care of your feet: If you have diabetes or poor blood flow, it’s important to check your feet every day. Look for sores, blisters, redness, calluses, or dry or cracking skin. Keep your toenails clipped (clip straight across the nail); apply lotion to clean, dry feet; and wear closed-toe, well-fitting shoes. Protect your feet from heat and cold. Don’t walk barefoot.
Declutter your floors. Keep your floors free of items that could cause you to trip and fall. Make sure all electrical cords are tucked away along the baseboards of walls and rooms are well lit.
Stop smoking: Smoking constricts blood vessels that supply nutrients to nerves. Without proper nutrition, neuropathy symptoms can worsen.
Maintain a healthy lifestyle: Eat a balanced diet, stay within your ideal weight range, exercise several times a week and keep alcoholic drinks to a minimum. These healthy living tips keep your muscles strong and supply your nerves with the oxygen and nutrients they need to remain healthy.
Review your medications: Talk with your doctor or pharmacist about all the medications and over-the-counter products you take. Ask if any are known to cause or worsen neuropathy. If so, ask if a different medication can be tried.

Neuropathy (Peripheral Neuropathy): Outlook / Prognosis

Can neuropathy be stopped?
Your long-term outcome depends on what is causing your neuropathy. If your neuropathy is caused by a treatable condition, managing the condition might result in stopping the neuropathy or preventing it from getting worse. If the underlying cause of the neuropathy can’t be treated, then the goal is to manage the symptoms of neuropathy and improve your quality of life.
Neuropathy rarely leads to death if the cause is determined and controlled. The sooner the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or repaired. Recovery, if it’s possible, usually takes a very long time — from months to even years. Some people live with a degree of neuropathy for the rest of their lives.

Can neuropathy be reversed?
If the underlying cause of the neuropathy can be treated and cured (such as neuropathy caused by a vitamin deficiency), it’s possible that the neuropathy can be reversed too. However, frequently by the time individuals are diagnosed with a neuropathy, there is some degree of permanent damage that can’t be fixed.
Even though this is the general belief of today, it’s not the hope of tomorrow. Nerve damage may be reversible someday. Researchers are already seeing positive results – the regrowth of nerve fibers – in a drug study in mice with diabetes. Ongoing research combined with living a healthy lifestyle so the body can repair itself will likely be needed. Stay tuned.

Neuropathy (Peripheral Neuropathy): Living With

Can neuropathy lead to amputation?
Yes, neuropathy – especially diabetic neuropathy – can lead to limb amputation. Each year about 86,000 Americans with diabetes lose a limb. The sequence of events leading up to amputation is typically this: the high glucose levels seen in diabetes cause nerve damage. The nerve damage reduces sensation in the limbs (usually the feet), which can lead to unnoticed injuries turning into skin ulcers or infections. Reduced blood flow to the feet, another effect of diabetes, prevents the wound from healing properly. The wounds cause the tissue in the foot or leg to break down, requiring amputation.
You can, however, reduce your chance of an amputation by keeping your diabetes under control and carefully caring for your skin and feet.

What should I do if I think I have neuropathy?
See your healthcare provider immediately as soon as you notice symptoms. Neuropathy can also be a symptom of a serious disorder. If left untreated, peripheral neuropathy can lead to permanent nerve damage.

Article Provided By: ClevelandClinic
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Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-Induced Peripheral Neuropathy
Timothy J Brown, MD; Ramy Sedhom, MD; Arjun Gupta, MD
Article Information
JAMA Oncol. 2019;5(5):750. doi:10.1001/jamaoncol.2018.6771

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN?
Certain chemotherapy drugs are more likely to cause neuropathy. These include: platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.
Other chemotherapy drugs can also cause neuropathy. The risk of developing CIPN is higher with higher doses, multiple courses, and combination chemotherapy. Patients are more likely to develop CIPN if they are older or have diabetes, vitamin deficiencies, or preexisting peripheral neuropathy.
How Can I Reduce My Risk of Developing CIPN?
No medication or supplement has been shown to definitively prevent CIPN. Regular exercise, reducing alcohol use, and treating preexisting medical conditions (vitamin B12 deficiency) may reduce the risk of CIPN.
What Are the Symptoms and Complications of CIPN?
Depending on the nerves affected, symptoms include:

Tingling (“pins and needles”)
Pain, which may be severe and constant, may come and go, or may feel like burning
Decreased sensation (“legs feel like jelly”)
Increased sensitivity to touch, temperature, pressure, pain
Muscle weakness

Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time. Commonly, symptoms occur weeks to months after chemotherapy. They can get worse with additional cycles of chemotherapy.
What Should I Do If I Develop Symptoms?
You should notify your care team. Symptoms are likely to worsen if not addressed. Your oncologist can diagnose CIPN based on symptoms and by examining you. Specialized testing is rarely needed.
I Have CIPN—What Now?
One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the kitchen to avoid burns. Your oncologist may choose to discontinue or reduce the dose of a chemotherapy drug. Your oncologist may recommend over-the-counter pain medications, lidocaine patches, menthol creams, or a medication called duloxetine. Physical therapy, occupational therapy, and rehabilitation may be helpful to regain function. Studies are researching how novel therapies (biofeedback or scrambler therapy) can help. Improvements in function may be gradual. In some cases, nerve damage may be permanent.

Article Provided By: JAMA

 

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Neuropathic Pain Management

Neuropathic Pain Management

Neuropathic pain is often described as a shooting or burning pain. It can go away on its own but is often chronic. Sometimes it is unrelenting and severe, and sometimes it comes and goes. It often is the result of nerve damage or a malfunctioning nervous system. The impact of nerve damage is a change in nerve function both at the site of the injury and areas around it.
One example of neuropathic pain is called phantom limb syndrome. This rare condition occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.
Causes of Neuropathic Pain
Neuropathic pain often seems to have no obvious cause. But some common causes of neuropathic pain include:
Alcoholism
Amputation
Chemotherapy
Diabetes
Facial nerve problems
HIV infection or AIDS
Multiple myeloma
Multiple sclerosis
Nerve or spinal cord compression from herniated discs or from arthritis in the spine
Shingles
Spine surgery
Syphilis
Thyroid problems
Symptoms of Neuropathic Pain
Neuropathic pain symptoms may include:

Shooting and burning pain
Tingling and numbness

Diagnosing Neuropathic Pain
To diagnose neuropathic pain, a doctor will conduct an interview and physical exam. He or she may ask questions about how you would describe your pain, when the pain occurs, or whether anything specific triggers the pain. The doctor will also ask about your risk factors for neuropathic pain and may also request both blood and nerve tests.
Neuropathic Pain Treatment
Anticonvulsant and antidepressant drugs are often the first line of treatment. Some neuropathic pain studies suggest the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve or Motrin, may ease pain. Some people may require a stronger painkiller. Be sure to discuss the pros and cons of the medicine you take with your doctor.

If another condition, such as diabetes, is involved, better management of that disorder may alleviate the pain. Effective management of the condition can also help prevent further nerve damage.
In cases that are difficult to treat, a pain specialist may use an invasive or implantable device to effectively manage the pain. Electrical stimulation of the nerves involved in neuropathic pain may significantly control the pain symptoms.
Other kinds of treatments can also help with neuropathic pain. Some of these include:
Physical therapy
Working with a counselor
Relaxation therapy
Massage therapy
Acupuncture
Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. For some people, it can lead to serious disability. A multidisciplinary approach that combines therapies, however, can be a very effective way to provide relief from neuropathic pain.

WebMD Medical Reference Reviewed by Tyler Wheeler, MD on August 11, 2019

Article Provided By: Webmd

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Peripheral Neuropathy

Peripheral Neuropathy

There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis.
Peripheral neuropathy has many different causes. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.
The most common type of peripheral neuropathy is diabetic neuropathy, caused by a high sugar level and resulting in nerve fiber damage in your legs and feet.
Symptoms can range from tingling or numbness in a certain body part to more serious effects, such as burning pain or paralysis.

Peripheral neuropathy is a type of damage to the nervous system. Specifically, it is a problem with your peripheral nervous system. This is the network of nerves that sends information from your brain and spinal cord (central nervous system) to the rest of your body.
Peripheral Neuropathy Causes
Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents. Others develop it because of an injury or another disorder.
In many cases, a different type of problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.
Peripheral Neuropathy Types
There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. To help doctors classify them, they are often broken down into the following categories:
Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.
Sensory neuropathy. Sensory nerves control what you feel, such as pain, temperature or a light touch. Sensory neuropathy affects these groups of nerves.
Autonomic nerve neuropathy. Autonomic nerves control functions that you are not conscious of, such as breathing and heartbeat. Damage to these nerves can be serious.
Combination neuropathies. You may have a mix of 2 or 3 of these other types of neuropathies, such as a sensory-motor neuropathy.
Peripheral Neuropathy Symptoms
The symptoms of peripheral neuropathy vary based on the type that you have and what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis.
Muscle weakness
Cramps
Muscle twitching
Loss of muscle and bone
Changes in skin, hair, or nails
Numbness
Loss of sensation or feeling in body parts
Loss of balance or other functions as a side effect of the loss of feeling in the legs, arms, or other body parts
Emotional disturbances
Sleep disruptions
Loss of pain or sensation that can put you at risk, such as not feeling an impending heart attack or limb pain
Inability to sweat properly, leading to heat intolerance
Loss of bladder control, leading to infection or incontinence
Dizziness, lightheadedness, or fainting because of a loss of control over blood pressure
Diarrhea, constipation, or incontinence related to nerve damage in the intestines or digestive tract
Trouble eating or swallowing
Life-threatening symptoms, such as difficulty breathing or irregular heartbeat
The symptoms of peripheral neuropathy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
Peripheral Neuropathy Diagnosis
The symptoms and body parts affected by peripheral neuropathy are so varied that it may be hard to make a diagnosis. If your healthcare provider suspects nerve damage, he or she will take an extensive medical history and do a number of neurological tests to determine the location and extent of your nerve damage. These may include:
Blood tests
Spinal fluid tests
Muscle strength tests
Tests of the ability to detect vibrations
Depending on what basic tests reveal, your healthcare provider may want to do more in-depth scanning and other tests to get a better look at your nerve damage. Tests may include:
CT scan
MRI scan
Electromyography (EMG) and nerve conduction studies
Nerve and skin biopsy
Peripheral Neuropathy Treatment
Usually a peripheral neuropathy can’t be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.
In some cases, over-the-counter pain relievers can help. Other times, prescription medicines are needed. Some of these medicines include mexiletine, a medicine developed to correct irregular heart rhythms; antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.
Lidocaine injections and patches may help with pain in other instances. And in extreme cases, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.
Peripheral Neuropathy Prevention
Lifestyle choices can play a role in preventing peripheral neuropathy. You can lessen your risk for many of these conditions by avoiding alcohol, correcting vitamin deficiencies, eating a healthy diet, losing weight, avoiding toxins, and exercising regularly. If you have kidney disease, diabetes, or other chronic health condition, it is important to work with your healthcare provider to control your condition, which may prevent or delay the onset of peripheral neuropathy.
Peripheral Neuropathy Management
Even if you already have some form of peripheral neuropathy, healthy lifestyle steps can help you feel your best and reduce the pain and symptoms related to the disorder. You’ll also want to quit smoking, not let injuries go untreated, and be meticulous about caring for your feet and treating wounds to avoid complications, such as the loss of a limb.
In some cases, non-prescription hand and foot braces can help you make up for muscle weakness. Orthotics can help you walk better. Relaxation techniques, such as yoga, may help ease emotional as well as physical symptoms.

 

Article Provided By: hopkinsmedicine

 

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Nerve Pain Treatment, Pain Relief, Chronic Pain, Chronic Pain Therapy, Pain Therpy, Neuropathic Pain Therapy, Greenville SC

Managing Peripheral Neuropathy

There is no sure way to prevent chemo-induced peripheral neuropathy (CIPN), but there are things you can do to manage your symptoms. During treatment, your cancer care team will ask you about your symptoms and watch you to see if the CIPN is getting worse. Your team may need to delay your treatment, use smaller doses of the chemo drugs, or stop treatment with the drug that is causing the CIPN until your symptoms get better. These actions must be started right away to prevent long-term damage that won’t get better.

Can CIPN be treated?

Treatment can often help ease some of the symptoms of CIPN. Sometimes these symptoms go away a short time after treatment is done. But sometimes they last much longer and need long-term treatment. Severe CIPN may never go away.

Treatment is mostly given to relieve the pain that can come with CIPN. Some of the drugs used include:

  • Steroids for a short time until a long-term treatment plan is in place
  • Patches or creams of numbing medicine that can be put right on the painful area (for example, lidocaine patches or capsaicin cream)
  • Antidepressant medicines, often in smaller doses than are used to treat depression
  • Anti-seizure medicines, which are used to help many types of nerve pain
  • Opioids or narcotics, for when pain is severe

Researchers are looking at which drugs work best to relieve this kind of pain. It may take more than one try to find out what works best for you.

Other treatments that can be tried to ease nerve pain and its effects on your life include:

  • Electrical nerve stimulation
  • Occupational therapy
  • Physical therapy
  • Relaxation therapy
  • Guided imagery
  • Distraction
  • Acupuncture
  • Biofeedback

What can I do to deal with CIPN?

There are some things you can do to better manage the symptoms of CIPN, such as:

  • Talk to your doctor or nurse about the problems you are having in daily life. They might be able to suggest ways to make you feel better or function better.
  • If you are taking pain medicines, use them as your doctor prescribes them. Most pain medicines work best if they are taken before the pain gets bad. See Cancer Pain to learn more about pain, how to talk about it, and how to manage it.
  • Avoid things that seem to make your CIPN worse, such as hot or cold temperatures, or snug clothes or shoes.
  • Give yourself extra time to do things. Ask friends for help with tasks you find hard to do.
  • Don’t drink alcohol. It can cause nerve damage on its own, and might make CIPN worse.
  • If you have diabetes, control your blood sugar. High blood sugar levels can damage nerves.
  • If constipation is a problem, follow your doctor’s recommendations about laxatives and exercise. Drink plenty of water and eat fruits, vegetables, and whole grains to get enough fiber.
  • If the neuropathy is in your feet, sit down as much as possible, even while brushing your teeth or cooking.
  • If your neuropathy is permanent, your doctor may refer you to an occupational therapist (OT). They are experts who help people lead more normal lives despite physical limits.

What should I do to avoid injury?

When your sense of feeling is affected by CIPN, you might be more likely to injure yourself by accident. Here are some things you can do to stay safe:

  • If you have neuropathy in your hands, be very careful when using knives, scissors, box cutters, and other sharp objects. Use them only when you can give your full attention to your task.
  • Protect your hands by wearing gloves when you clean, work outdoors, or do repairs.
  • Take care of your feet. Look at them once a day to see if you have any injuries or open sores.
  • Always wear shoes that cover your whole foot when walking, even at home. Talk to your doctor about shoes or special inserts that can help protect your feet.
  • Be sure that you have ways to support yourself if you have problems with stumbling while walking. Hand rails in hallways and bathrooms may help you keep your balance. A walker or cane can give you extra support.
  • Use night lights or flashlights when getting up in the dark.
  • Protect yourself from heat injuries. Set hot water heaters between 105° to 120°F to reduce scalding risk while washing your hands. Use oven gloves and hot pads when handling hot dishes, racks, or pans. Check bath water with a thermometer.
  • Keep your hands and feet warm and well covered in cold weather. For example, consider keeping a pair of gloves in your car. Avoid extreme temperatures.

What questions should I ask about CIPN?

Here are some questions you might want to ask your health care team:

  • Is the chemo I’m getting likely to cause CIPN?
  • Am I at high risk for CIPN?
  • What symptoms do I need to watch for and report to you?
  • Have you treated CIPN in other patients? How? Did it work?
  • If my CIPN gets bad and is very painful, will it change my treatment plan?
  • Is it likely that my CIPN will get better or go away after treatment is over?

Talk to your health care team

It’s important to work closely with your doctor or nurse to manage peripheral neuropathy caused by chemotherapy. Talk to your doctor about any changes in how you feel, and any trouble you have walking or holding things. Tell the doctor how your symptoms affect the things you do every day.

If you get medicines to help CIPN, be sure to keep your doctor posted on whether the drugs are helping and if new problems start up. You might also want to talk with your doctor about whether you can get into a clinical trial to help deal with your CIPN.

If you are concerned about how future treatment might affect your quality of life, talk with your doctor about what’s most important to you. Remember that only you can decide whether you want to get, or keep getting, a certain treatment.

Article Provided By: American Cancer Society

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CIPN, Peripheral Neuropathy, Pain Management, Pain Relief, Pain Therapy, Carolina Pain Scrambler Center, Greenville South Carolina

Chemo Induced Peripheral Neuropathy

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN?

Certain chemotherapy drugs are more likely to cause neuropathy. These include: platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.

Other chemotherapy drugs can also cause neuropathy. The risk of developing CIPN is higher with higher doses, multiple courses, and combination chemotherapy. Patients are more likely to develop CIPN if they are older or have diabetes, vitamin deficiencies, or preexisting peripheral neuropathy.

How Can I Reduce My Risk of Developing CIPN?

No medication or supplement has been shown to definitively prevent CIPN. Regular exercise, reducing alcohol use, and treating preexisting medical conditions (vitamin B12 deficiency) may reduce the risk of CIPN.

What Are the Symptoms and Complications of CIPN?

Depending on the nerves affected, symptoms include:

  • Tingling (“pins and needles”)

  • Pain, which may be severe and constant, may come and go, or may feel like burning

  • Decreased sensation (“legs feel like jelly”)

  • Increased sensitivity to touch, temperature, pressure, pain

  • Muscle weakness

Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time. Commonly, symptoms occur weeks to months after chemotherapy. They can get worse with additional cycles of chemotherapy.

What Should I Do If I Develop Symptoms?

You should notify your care team. Symptoms are likely to worsen if not addressed. Your oncologist can diagnose CIPN based on symptoms and by examining you. Specialized testing is rarely needed.

I Have CIPN—What Now?

One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the kitchen to avoid burns. Your oncologist may choose to discontinue or reduce the dose of a chemotherapy drug. Your oncologist may recommend over-the-counter pain medications, lidocaine patches, menthol creams, or a medication called duloxetine. Physical therapy, occupational therapy, and rehabilitation may be helpful to regain function. Studies are researching how novel therapies (biofeedback or scrambler therapy) can help. Improvements in function may be gradual. In some cases, nerve damage may be permanent.

Article Provided By: JAMA Network

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