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13 Articles in Volume 18, Issue #6
Advice for the Advanced Practice Provider
Authorities’ Use of Big Data May Harm—or Help—Your Chances of Investigation
Considering Comorbidities When Selecting Medications (Part 2)
Gaps in the Pharmacist’s Pain Management Role
How can cyproheptadine manage complicated chronic pain cases?
Letters to the Editor: Trackable Pills; Buprenorphine; CRPS Diagnosis
Managing Opioid Use Disorder
Mobile Trackers and Digital Therapeutics
New Insights in Understanding Chronic, Central Pain
Nocebo Effects: How to Prevent them in Patients
Polarizing Topics in Chronic Pain
The Fight to End Peripheral Neuropathy
Urine Drug Monitoring

The Fight to End Peripheral Neuropathy

The Foundation for Peripheral Neuropathy’s Executive Director shares her hopes for new treatment options for this painful disorder.

The first time many people hear of peripheral neuropathy is when they or a loved one is first diagnosed with the condition. It is a very common condition, with an estimated 30 million Americans affected; however, there are remarkably low levels of public awareness on peripheral neuropathy, or PN, given the number of patients who have the disorder.

Often difficult to diagnose, PN is a non-life threatening secondary disorder—and one of the many chronic pain conditions that is invisible to the naked eye. It occurs when nerves are damaged or destroyed and can no longer send messages from the brain and spinal cord to the muscles, skin, and other parts of the body. Symptoms usually start with numbness, prickling, or tingling in the toes or fingers, and may spread to the feet or hands, causing sensations of burning, freezing, throbbing and/or shooting pain that is often worse at night. The pain may be constant or periodic, and is typically felt equally on both sides of the body (eg, both hands or both feet). Some types of PN develop suddenly, while others progress slowly over many years.

For those living with PN, obtaining answers is not always easy. In most cases, patients are frustrated with not knowing the cause of their neuropathy and their neurologists do not always know how to improve their symptoms. Research is paramount to these patients’ mental, physical, and emotional states, as it may provide hope that a cure is on the horizon.

This past summer, The Foundation for Peripheral Neuropathy (FPN) surveyed a segment of its membership base (all patients), of which 230 members responded, to learn more about how the condition affects quality of life. Unsurprisingly, pain was a significant factor, with the average respondent reporting moderate pain (via a 1-to-10 scale) on a daily basis. A majority also reported that PN affects their day-to-day activities, mobility, and overall sense of well being in a moderate to significant way. On a positive note, those surveyed shared that PN had little impact on their ability to live independently, including their ability to drive.

New treatment options that may work for many PN patients are in development. For example, therapies that target pain-specific ion channels and advances in neuromodulation using electrical stimulation are being studied. Additionally, initial strategies for preventing chemotherapy-induced neuropathy, and for preventing PN in diabetics, are proving more beneficial.

But until these projects emerge from the pipeline, patients are left to manage symptoms with medication and lifestyle adjustments. According to FPN’s surveyed members, gabapentin is by far the most used medication among PN patients (83.6% reported trying it) and it seemed to be fairly effective at managing chronic pain due to neuropathy. Patients reported exploring other medications as well, such as: capsaicin cream, lidocaine, amitriptyline, duloxetine, pregabalin, mexiletine, nortriptyline, carbamazepine, tramadol, and medical cannabis, as well as devices such as TENS units and other wearables. However, patients tended to change these other regimens over time due to unwanted side effects, lack of efficacy, or cost concerns.

Approximately 90% of surveyed patients ticked “diet and exercise” as one of their alternative treatments of choice, with a majority of them finding it to be effective in helping them cope with PN symptoms. Others pointed to acupuncture and yoga.

The challenges that remain for patients with PN is that no single treatment seems to work for everyone, and when a patient does find success with a particular treatment plan, it often requires modifications as efficacy wanes or side effects grow. Additionally, insurance providers may not cover certain medications or may alter coverage to reflect legislative changes (eg, around opioids), leaving some patients without access to potentially helpful treatments.

FPN is optimistic that pending treatment options will help improve the lives of those living with peripheral neuropathy. In the meantime, the Foundation encourages healthcare providers to run complete neurological and physical examinations and refer patients to a PN specialist when necessary.

Educational materials and clinical trial opportunities are listed at: www.foundationforpn.org.

Last updated on: September 5, 2018
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Relief of Symptoms Associated with Peripheral Neuropathy
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