Neuropathy is a disease that affects the nervous system in the peripheries. There are four main types of nerve damage: polyneuropathy (more than one site), mononeuropathy (just one site), autonomic neuropathy (your autonomic nervous system), and mononeuritis multiplex. The most common type is peripheral polyneuropathy of which the most common cause by far is diabetes. In diabetic neuropathy, the high sugar levels in the blood damage the nerves over time & causes symptoms of pins & needles, numbness and even severe pain mainly in the feet and legs. It's important to understand that having some neuropathy does not necessary mean that it will lead to a serious problem. However, the exact cause should be investigated and treated where possible as the cause of neuropathy is usually more serious than the neuropathy itself. The treatments for neuropathy depends on the type of neuropathy, but it usually includes strong opoid pain medications and medications that affect the nervous system such as antidepressants and anticonvulsants Besides diabetes, other common causes of neuropathy are herpes zoster infection (shingles), chronic or acute trauma (including surgery), and various neurotoxins. Neuropathy pain is common in cancer as a direct result of the cancer on peripheral nerves (e.G., compression by a tumor), as a side effect of many chemotherapy drugs, and as a result of electrical injury. Neuropathy, when it does occur, varies widely in severity, symptoms, and duration, from person to person. Factors that may influence the development of neuropathy include a patient's: • Poor liver and kidney function leads to build up of uraemia causing neuropathy • Existing nerve conditions, such as prior never damage like carpal tunnel syndrome, pinched nerves, prior neuropathy from diabetes • Types and high doses of chemotherapy may contribute to neuropathy Neuropathy often results in numbness, abnormal sensations called paraesthesia that occur either by itself or in reaction to external stimuli, and a classical form of pain, called neuropathic pain or neuralgia, which is different from the normal pain one might experience from stubbing a toe or banging your finger with a hammer. People may describe their neuropathy pain as any combination of a steady burning feeling, "pins and needles", "electric shock" sensations and numbness. The site of neuropathy pain is usually very hard to pin-point. The difference is due to the fact that "ordinary" pain stimulates only pain nerves, while neuropathy pain often results in the firing of both pain and non-pain (touch, warm, cool) sensory nerves in the same area, producing signals that the spinal cord and brain do not normally expect to receive Neuropathic pain can be very difficult to treat even with strong opioid analgesics. Opoid analgesics are to be considered only as a tertiary treatment of neuropathy. Several classes of medications not normally thought of as analgesics are often effective, alone or in combination with opioids and other treatments in neuropathy. These include tricyclic antidepressants such as amitriptyline (Elavil®), anticonvulsants such as gabapentin (Neurontin®) and pregabalin (Lyrica®) and serotonin norepinephrine reuptake inhibitors (SSNRI such as duloxetine (Cymbalta®)). Antidepressants usually reduce neuropathy pain more quickly and with smaller doses than they relieve depression. The newer anticonvulsants gabapentin and pregabalin appear to work in neuropathy by blocking ion channels in damaged peripheral neurons. The anticonvulsants carbamazepine (Tegretol®) and oxcarbazepine (Trileptal®) are especially effective on trigeminal neuralgia neuropathy. In neuropathy in general, the antidepressants seem to be most effective on continuous burning pain, while the anticonvulsants seem to work best on sudden, lancinating, "shock-like" pains that appear to involve large numbers of peripheral nerves improperly firing together. In some forms of neuropathy, especially post-herpes shingles neuralgia, the topical application of local anesthetics such as lidocaine can provide relief. Neurontin 100mg/G PLO gel is also effective for treating peripheral neuropathy, including Carpal Tunnel Syndrome.
