WHAT IS NEUROPATHY?
Any nerve can lose nerve tissue by compression, trauma, scarring from surgery, chemotherapy, and a lack of blood flow, or a number of medical issues (most importantly diabetes). Early on, if you can maintain the best health possible, neuropathy symptoms can slow or reverse. If you smoke, quitting can also result in less neuropathy pain.
WHAT ARE NEUROPATHY TYPES AND THEIR SYMPTOMS?
Neuropathy causes numbness, which progresses to pain. It is more common in the feet than hands, because the feet are farther from the spinal cord than the hands. It can involve one nerve (like carpal tunnel), or many nerves (like peripheral neuropathy). Most symptoms are sensory (i.e. numbness), but secondarily weakness and loss of strength or muscle mass may occur.
HOW IS NEUROPATHY DIAGNOSED?
Other than just by symptoms, neuropathy is diagnosed by placing needles in muscles to check nerve function, or to check the speed impulses travel within the nerve (electromyogram and nerve conduction respectively). Another method is to perform a small biopsy and look at the number of nerve fibers within. A lower number of nerve fibers parallel a loss of nerve function.
WHAT IS THE INITIAL TREATMENT FOR NEUROPATHY?
The first treatment for neuropathy is nerve medications. These include ointments and creams, as well as seizure medications and antidepressants, which both improve nerve pain OPIOIDS ARE TO BE AVOIDED! Remember… often neuropathy improves by better management of the medical condition causing it.
SO… WHAT IF MEDICATIONS FOR NEUROPATHY DON’T WORK?
Until recently few options existed to treat neuropathy pain other than medications. In the case of a focal neuropathy (such as carpal tunnel nerve compression at the wrist), surgically decompressing the nerve is often successful. But what if that did not work or something went wrong? Operating again is a consideration, but generally the chance for relief is much less with each subsequent surgery.
Nerve blocks can help, but generally don’t last. Neurostimulation involves a small wire implant energizing the nerves with electrical current. The current generated from a source either implanted within the body (generator), or from impulses transmitted to the implanted wire (radiofrequency). The wire can be located within the spine (epidural stimulation), next to the dorsal root ganglion (a relay point for nerve transmission, within the foramen or openings for nerve roots), or next to nerve itself (peripheral nerve stimulation). Not everyone is a candidate for neurostimulation, which requires certain prerequisites including no long-term relief with medications, injections, or other treatments, and possibly a desire to eliminate opioid use.
Discuss your options with your TriState Pain provider. Certain steps must be taken to determine if you are a candidate, including confirming a diagnosis of neuropathy. This may involve blocks or interventions, imaging and x-rays, and trials of medications. If there is a desire to proceed, select a system that is right for you. Some insurance plans require a short visit with a psychologist before approval to proceed. A office procedure at TriState Pain followed by a 3 – 5 day trial implant is done to assure that neurostimulation is right for you. Only then will a permanent implant be done.
THE TRISTATE PAIN INSTITUTE