Peripheral neuropathy
March 2008 View PDF En
español
How do you treat it?
Treating PN is usually focused on treating the underlying cause(s)
and controlling the symptoms with the right medicines. Currently,
there are few treatments for PN itself and none of them are highly
effective, though new research shows promise. For some, dealing
with their chronic pain may contribute to depression. So treating
PN may also need to include treating depression.
There are several
ways to ease or treat PN: making lifestyle changes, taking pain
relievers, changing or stopping the medicines that cause PN, and
taking medicines that control PN. You may need to use more than
one of these to treat your PN. It also may take some time for your
symptoms to improve.
Much of the research on treating PN has occurred
in HIV-negative people, a good deal of it in people with diabetes.
Though this information is useful, it may not address the specific
health needs of people with HIV. Seeking the advice of an HIV experienced
neurologist can greatly improve your outcome.
LIFESTYLE
You can
do many things yourself that may relieve your PN. Some people find
that one approach is enough while others use several ways to ease
their discomfort.
- Wear proper shoes. Tight or ill-fitting shoes
can cause pain even in people without PN. So consider wearing
shoes that give the proper support for your feet while still
being flexible for comfort. Consult a foot doctor (podiatrist) or
experienced salesperson for the best choice for you.
- Keep your feet cool. Many people with PN report
that soaking their feet and hands in cold water helps reduce
the pain. Consider keeping your feet and hands free of bed covers
at night. Many report more pain in the evening, especially when
getting them wrapped up in their covers.
- Improve your diet. Getting enough vitamins
B12 and E in your diet is important. Foods high in B12 include
liver, snapper, salmon, beef, poultry, milk, eggs, shellfish,
tofu and yeast. Foods with E include green leafy vegetables,
carrots, nuts, oils (olive, corn, canola, safflower, sunflower),
wheat germ, whole grains, and margarines made from plant oils.
Consider taking supplements that provide the recommended daily
amounts.
- Get a massage. Massaging your feet and hands
increases blood flow, which can ease pain. A massage therapist,
friend or even you can gently massage those areas that have pain.
- Avoid strain. Ease foot and leg pain by not
walking great distances or standing for long periods. Also, avoid
repetitive tasks with your hands and fingers. On the other hand,
when able, moderate walking or other activity can help improve
blood flow to the feet and reduce symptoms.
- Try to relax. There are many different relaxation
techniques and exercises. Find the ones that suit you and consider
doing them more than once a day.
- Use support tools. Pain in the hands may prevent
you from doing daily tasks, like opening jars of food or pulling
up a zipper. Kitchen tools are available with easy grips as well
as reachers for items on shelves. Dressing aids are also available,
from long-handled shoehorns and brushes to zipper pulls and elastic
shoestrings. Many of these aids that help older adults with their
mobility concerns can be found in stores and online. Your doctor
may have listings for where to buy these products.
STOP THE OFFENDING DRUG(S)
If you take a medicine that’s
known to cause PN, your doctor may recommend stopping it, adjusting
its dose, or switching it to something else. Do not stop a drug
without your doctor’s knowledge. Be aware that stopping an
offending drug may actually make your PN worse for a short time.
This occurs in about 1 of 4 people.
PAIN RELIEVERS
Over-the-counter
medicines, like ibuprofen, aspirin and acetaminophen, can help
ease mild-to-moderate pain due to PN. Your health provider may
recommend prescription versions for you.
STRONGER PAIN RELIEVERS
For moderate-to-severe pain, your doctor
may prescribe narcotics for short-term use. Many are available
for various levels of pain, so if you have difficulty taking one
then another may be better. Common side effects include nausea,
vomiting, constipation, tiredness and sleepiness. For those with
a history of drug addiction, taking a short-term course of these
drugs should be safe, but discuss this with your doctor should
you have concerns. Also, these drugs may interact with the HIV
drugs you take.
TRICYCLIC ANTIDEPRESSANTS
(TCAs)
These drugs were among the first anti-depressants. They
are thought to work by adjusting the balance of certain chemicals
in the brain. They also inhibit certain cell receptors, which cause
their many possible side effects. You and your health provider
may need to try different drugs before finding the one that works
best.
TCAs are usually used to treat mild-to-moderate pain, and
are sometimes taken with pain relievers. Though some report that
these drugs improve their symptoms, studies actually show that
they’re
not clinically effective. The more commonly prescribed TCAs for
PN include Elavil (amitriptyline), Aventyl (nortriptyline), Norpramin
(desipramine) and Tofranil (imipramine). Some protease inhibitors
and NNRTIs can interact with TCAs and change their blood levels.
Your doctor may need to adjust the dose given the HIV meds you
take.
TCAs are normally prescribed in small increasing doses to
avoid side effects. This gives the body a chance to adapt to the
new drug. Common side effects include dry mouth and nose, blurred
vision, drowsiness, difficult urination and constipation. Other
side effects may include restlessness, anxiety, nausea, memory
problems, weight gain and sexual problems, among others.
ANTICONVULSANTS
These drugs are normally used to prevent and treat
seizures due to epilepsy. They work by controlling the nerve activity
in the brain. Anticonvulsants are being used more often to treat
other conditions like PN, and studies show some success in controlling
its pain.
Several drugs are used for PN: Lyrica (pregabalin), Neurontin
(gabapentin), Dilantin (phenytoin), Tegretol (carbamazepine) and
Lamictal (lamotrigine), among others. You and your health provider
may need to try different drugs before finding the one that works
best for you.
Anticonvulsants
are usually prescribed in small increasing doses to avoid side
effects, giving the body a chance to adapt to the new drug. Common
side effects include drowsiness, dizziness, nausea, vomiting and
constipation. Other side effects may include restlessness, sleep
problems, memory problems, sore joints or muscles, among many others.
MEDICAL
MARIJUANA
A 2007 study report showed that smoking medical marijuana
reduced chronic pain by one-third due to PN in just over half of
the participants. All smoked three marijuana cigarettes a day.
Side effects included dizziness, anxiety, confusion and sedation.
Medical marijuana may not be available to you as a treatment for
PN since it’s classified as a controlled substance.
TOPICAL
MEDICINES
Some patches and gels that are applied to the skin may
be able to treat some symptoms of PN. See Research
on peripheral neuropathy for more information.
SUPPLEMENTS
Two supplements are now being studied to treat PN.
More information about both is found in Research
on peripheral neuropathy .
ACUPUNCTURE
Some people report that acupuncture
helps them managing their pain. Research has not proven this effective,
including a US study that compared it to placebo. However, a person’s
belief in the process may be enough for her or him to get relief.
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