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Peripheral neuropathy

MagazineApril 2009 (Vol. 20 Issue 1)Peripheral neuropathy

Q) Case 1: My brother-in-law has been diagnosed with neuropathy

Q) Case 1: My brother-in-law has been diagnosed with neuropathy. He is losing the feelings in his legs because the nerve endings are supposedly dying. Do you know of any natural remedy? His doctors are not helping him at all.-R.W., St Louis, Missouri

Case 2: My husband has been suffering from burning of the feet for the past few months and the doctor doesn't seem to know what causes it. He also had a neurological exam which did not show diabetes or any nerve damage. Do you have any suggestions?-B.K., via e-mail

A) There are three tell-tale clues to indicate when medicine doesn't have an answer for a particular condition. First, doctors talk a lot about 'coping skills'; next, they dish out generalized health advice and, finally, they do a survey of how many patients with the condition seek the help of alternative medicine. This is the case here. The condition is called 'peripheral neuropathy' (PN), and both of the cases here are sufferers. It's a problem of the nerves going to the hands or feet, causing numbness, tingling, burning sensations and pain. In descending order, the causes are diabetes, drug side-effects, environmental toxins, vitamin deficiencies, herpes, AIDS, alcoholism and coeliac disease. Yet, half of all PN cases are called 'idiopathic'-doctor-speak for 'we haven't a clue'.

Eat healthy meals, take regular exercise and quit smoking is the advice offered by the world-famous Mayo Clinic to PN sufferers, followed by "have someone massage your feet", "get out of the house" and "talk to a counsellor".

With medicine offering so little, it's little wonder that nearly one in two PN patients has tried complementary medicine, and more than a quarter of those found it beneficial (J Neurol Sci, 2004; 218: 59-66).

It's easy to check for drug side-effects. Although the most frequent culprits are the anti-AIDS and anti-cancer drugs, other, more common drugs such as thalidomide, leflunomide and statins can also cause neuropathy (Curr Opin Neurol, 2005; 18: 574-80). It's also easy to check for diabetes, as in Case 2. Diabetic neuropathy is thought to be due to the long-term effect of high levels of glucose on the nerves, which may explain why it usually takes years to show up.

Check out your environment, too. Moulds and spores often occur in damp or so-called 'sick buildings' and can cause PN, as can chemical toxins-solvents and heavy metals such as mercury, lead and arsenic are particular culprits. There are anecdotal reports that mercury fillings may trigger PN. A study found that one PN symptom ('continuous vibrotactile sensation') may be linked to fillings, but the association was not strong enough to be conclusive (Neurotoxicology, 2005; 26: 241-55).

Conventional treatments are generally reckoned to be ineffective. Some antidepressants can help, but painkillers often don't work-hence, conventional medicine's shoulder-shrugging 'coping' recommendations.

However, one non-toxic conventional treatment that seems promising uses infrared light at a wavelength of 890 nm. This is claimed to stimulate nitric oxide, which relaxes blood vessels and improves circulation. A review of the medical records of more than 2200 PN patients showed that the treatment cured both pain and numbness in over half (J Diabetes Complications, 2006; 20: 81-7). The review's methodol-ogy, however, has come under criticism.

Happily, there are a number of effective alternatives. Alpha-lipoic acid (ALA), a natural-food supplement, can ease diabetic neuropathy. Oral tablets (600 mg/day) may work, but intravenous (parenteral) doses are better (Diabetes Educ, 2007; 33: 111-7).

Supplementing with the amino-acid acetyl-l-carnitine (1000 mg three times a day) can also improve pain, nerve regeneration and 'vibratory perception' (Diabetes Care, 2005; 28: 89-94). It increases the speed of neural conduction.

As PN can be caused by nutritional deficiency-many sufferers are deficient in B1, B6, B12 and folic acid-vitamins can help, especially B-complex. Some studies show that B supplements may only work in cases of B deficiency, so this needs to be checked first (through laboratories such as Biolab Medical Unit, tel: +44 20 7636 5959/5905).

With or without a B deficiency, three studies have shown that vitamin B12 supplements successfully treated both pain and numbness (Acta Neurol Taiwan, 2005; 14: 48-54). Other studies have shown that 400 mg/day of benfotiamine, a fat-soluble form of B1, can reduce the pain of PN (Int J Clin Pharmacol Ther, 2005; 43: 71-7).

Another effective alternative is capsaicin cream, made from the hot-pepper plant Capsicum officinalis. In one clinical, controlled trial of 252 patients, eight weeks of treatment improved pain by 69.5 per cent (Arch Intern Med, 1991; 151: 2225-9).

Not surprisingly, acupuncture has proved to be helpful in cases of PN-it is, after all, traditional Chinese medicine's standard painkiller and is now widely used in Europe. German doctors recently tested it in PN sufferers, and found that about three in four patients enjoy benefit (Eur J Neurol, 2007; 14: 276-81). And this is just the latest in a long line of clinical trials showing the value of acupuncture in PN.

An unusual therapy that shows promise is electro-magnetism. Tests have been carried out using pulsed magnetic fields (20 gauss at 30 Hz, for you techies) directed at the legs of people with PN. After nine one-hour-a-day treatments, pain levels were almost halved (Neurorehabil Neural Repair, 2004; 18: 42-6).

Using 450-Gauss static magnetic shoe insoles can also reduce PN pain (Arch Phys Med Rehabil, 2003; 84: 736-46).

Finally, try smoking cannabis. In one San Francisco study, smoking three joints a day for five days reduced pain by 34 per cent (Neurology, 2007; 68: 515-21).


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