Doctors take many different paths after graduation. Just as an MD degree may lead one toward radiology, pathology or cardiac surgery, DC’s may focus on sports medicine, low back pain, or, more recently, neuropathy. Neuropathy is diagnosed when patients complain of pain, tingling, trouble sleeping, loss of sensation to heat or cold or pressure, or numbness.
Clearly all neuropathy is not the same. To help a patient with neuropathy, one needs to know what causes his or her neuropathy.
It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes. And there are more than 20 million diabetics in this country. Restoring sensation and balance leads to fewer falls, which should translate into fewer fractures; restoration of sensation and balance allows patients to engage in exercise programs recommended by healthcare groups such as the American Diabetes Association. Restoring sensation also limits the catastrophic effects of unappreciated wounds that become infected or necrotic, often leading to amputations. Interventions by physicians along with standard physical therapies in such patients saves healthcare dollars and improves activities of daily living (ADL) and quality of life (QOL).
About 20% of neuropathy cases are considered idiopathic, which means they are of unknown cause. Another 50% of neuropathies are due to diabetes. In fact, about 70% of people with diabetes will develop some type of neuropathy. The remaining cases of neuropathy, called acquired neuropathies, have several possible causes, including:
· Trauma or pressure on nerves, often from a cast or crutch or repetitive motion such as typing on a keyboard
· Nutritional problems and vitamin deficiencies, often from a lack of B vitamins
· Alcoholism, often through poor dietary habits and vitamin deficiencies
· Other diseases and infections, such as kidney disease, liver disease, Lyme disease & HIV/AIDS
· Poison exposure, from toxins such as heavy metals, and certain medications and cancer treatment drugs
Chemotherapy can and does cause neuropathy! Cancer patients who have been treated with chemotherapy are another group who might well seek out therapists to help resolve their neuropathy.
How is neuropathy treated?
There are a variety of treatments available for peripheral neuropathy. They range from traditional pills and creams to special diets and therapies that stimulate the nervous system.
Antidepressants are a favored treatment for neuropathies. They will relieve neuropathic pain in non-depressed persons. Another class of medicines commonly prescribed for neuropathy is that of anticonvulsants such as Lyrica and gabapentin. These medicines block calcium channels on neurons to limit pain. Opioid narcotic treatments for neuropathy are used as well to treat the condition, but are less favored because of the risk of dependency.
Alternative therapies for peripheral neuropathy include cannabinoids (an class of chemicals found in marijuana), Botulinum Toxin Type A (better known as Botox), NMDA antagonists (such as ketamine), dietary supplements (such as alpha lipoic and benfotiamine), chiropractic massages, yoga, meditation, cognitive therapy, and acupuncture.
As you probably know, diabetes has a significant effect on blood flow. Vessels get smaller in diameter or close off completely. The skin becomes cooler than normal, it loses its pink color, and sophisticated devices like vascular ultrasound or scanning laser Doppler can demonstrate the reduction in blood flow.
Some scientists and healthcare professionals have begun to focus on how to improve blood flow to the limbs of patients with neuropathy; an added benefit of that approach is improved blood flow to nerves themselves within those limbs. Why is that important? Because any of the pharmaceutical or nutritional interventions mentioned above will be delivered more effectively to the limbs and their nerves, if one increases blood flow.
Drug-free approaches:Red and infrared diodes (LEDs) emit wavelengths that have been shown to increase blood flow at the site of treatment. This means that a DC, a therapist, a physician,
nurse or the patient can treat the symptoms of neuropathy, in the office or the home and,
by increasing blood flow, reverse or eliminate the pain, tingling, sensory loss as well as the
gait and balance problems that are classic signs of neuropathy. Acute treatment with LEDs for 30 min. or less causes an immediate, sustained (for a few hours) increase in blood flow by dilating existing blood vessels. Subsequent treatments appear to cause angiogenesis (the growth of new blood vessels) so that eventually blood flow to all areas of a treated limb (or site) return toward normal rates.