Neuropathy Therapy at NYU Langone Medical Center
A multipronged approach to neuropathy therapy treatment often produces the best results. NYU Langone doctors first address the root cause of the nerve pain by prescribing medications to treat underlying conditions like diabetes or high blood pressure.
Medications to alleviate pain might include over-the-counter pain relievers, or prescription opioids and antidepressants. They may also recommend immunosuppressive treatments like azathioprine and prednisone, or plasmapheresis to remove antibodies from the body.
There are many over-the-counter and doctor prescribed medications that can ease nerve pain. Some are neuropathic pain relievers that specifically target a specific type of nerve (neuropathic pain). Other medicines can treat an underlying condition causing neuropathy, such as regulating blood sugar levels in diabetics or treating liver or kidney disease.
Your health care professional will do a physical exam and order blood tests to detect diabetes, vitamin deficiencies, herniated discs, autoimmune disorders or other problems that might cause neuropathy. Other tests, such as electromyography (EMG), help doctors find the cause of nerve damage.
Some medications reduce chronic painful neuropathies by calming excess signaling of nerve cells. Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, ease inflammation and swelling, and also fight general pain. Other medications that help reduce neuropathic pain include the anticonvulsants gabapentin and pregabalin, tricyclic antidepressants and duloxetine, low potency opioids and capsaicin cream or patches.
Peripheral neuropathy often causes pain, numbness and weakness. It is caused by damage to the nerves outside of your brain and spinal cord (peripheral nervous system). Your peripheral nerves send motor signals that allow you to move and control your muscles.
The symptoms vary depending on the type of damage and your health history. For example, some conditions that increase your risk of developing neuropathy include diabetes, high blood pressure, thyroid issues and autoimmune disorders.
Physical therapy is one of the most commonly recommended treatments for neuropathy. This treatment involves using select exercises, stretches and equipment to improve your mobility and reduce your pain. Physical therapists who specialize in neuropathy can provide you with specific modalities that may help reduce your pain and symptoms, such as TENS therapy. TENS therapy uses an electrical current to decrease neuropathic pain by blocking the nerves’ ability to send pain signals to your brain. It also increases blood flow and decreases vasoconstriction to alleviate pain and discomfort.
Acupuncture helps to reduce neuropathic pain and improve function by increasing blood flow to the nerves. Many patients are able to stop or significantly reduce their medications after receiving acupuncture treatments for neuropathy. The reduction in symptoms allows them to become more active which improves their overall health and also decreases their depression that often accompanies neuropathy.
A randomized controlled trial of acupuncture for diabetic neuropathy (including Bell’s palsy, carpal tunnel syndrome, and human immunodeficiency virus-related neuropathies) reported that compared with the waitlist control group, acupuncture resulted in a greater improvement in neuropathic symptoms. In addition, the trial also showed that acupuncture can improve nerve conduction study results.
Acupuncture can also help to relieve other symptom of neuropathy such as fatigue and poor sleep, and increase energy levels. The most common home remedies for neuropathy include regular exercise, which can help to increase circulation and strengthen muscles, a healthy diet that limits sugar and alcohol intake, and stress management.
TENS (transcutaneous electrical nerve stimulation) is a small, battery-operated device that delivers mild electric impulses that you wear on or near the area of pain. The impulses interrupt the cycle of pain signals going to your brain and can cause your body to release natural painkillers called endorphins.
TENS has been used to manage pain from cancer-related peripheral neuropathy (CIPN), and it is especially effective in reducing the symptoms of chemotherapy-induced CIPN. Research also suggests that TENS may reduce pain from rheumatoid arthritis and migraine headaches, and ease neuropathic pain due to diabetes or spinal cord injury.
Placement of electrodes on the painful areas is important for maximizing relief. Your Physical Therapist will guide you through a trial-and-error process to find the best location and unit settings for your pain. Some people experience a pleasant, soothing sensation, and others feel a slight buzzing or prickling that may be uncomfortable at first. Do not use a TENS unit if you have epilepsy or have a pacemaker as it can interfere with the electrical signals.