From the Guidelines
Peripheral neuropathy is caused by damage to peripheral nerves from multiple conditions including diabetes, alcoholism, vitamin deficiencies (particularly B12), autoimmune disorders, infections, certain medications (chemotherapy drugs, antiretrovirals), toxin exposure, and hereditary disorders, and management involves treating the underlying cause when possible and controlling symptoms, with the most recent guidelines recommending optimization of glucose management to prevent or delay the development of neuropathy in people with type 1 diabetes and to slow the progression of neuropathy in people with type 2 diabetes 1.
Causes of Peripheral Neuropathy
The causes of peripheral neuropathy are diverse and include:
- Diabetes
- Alcoholism
- Vitamin deficiencies (particularly B12)
- Autoimmune disorders
- Infections
- Certain medications (chemotherapy drugs, antiretrovirals)
- Toxin exposure
- Hereditary disorders As noted in the most recent guidelines, optimizing blood pressure and serum lipid control can also reduce the risk or slow the progression of diabetic neuropathy 1.
Management of Peripheral Neuropathy
Management of peripheral neuropathy involves:
- Treating the underlying cause when possible
- Controlling symptoms
- For pain, medications include:
- Anticonvulsants (gabapentin 300-1200mg three times daily or pregabalin 75-300mg twice daily)
- Antidepressants (duloxetine 30-60mg daily or amitriptyline 10-75mg at bedtime)
- Topical treatments (lidocaine patches or capsaicin cream) Non-pharmacological approaches include:
- Physical therapy to maintain strength
- Occupational therapy for adaptive techniques
- Transcutaneous electrical nerve stimulation (TENS)
- Lifestyle modifications such as regular exercise and blood sugar control for diabetics Proper foot care is essential, particularly for those with diabetes, including daily inspection, moisture control, and appropriate footwear, as emphasized in the guidelines for standards of care in diabetes-2023 1.
Pain Management
Pain management may require a multimodal approach, often combining different medication classes at lower doses to minimize side effects while maximizing pain relief, and regular monitoring is important as peripheral neuropathy is often progressive, requiring adjustment of treatment strategies over time, with the most recent guidelines recommending assessment and treatment of pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy to improve quality of life 1.
From the FDA Drug Label
Management of neuropathic pain associated with diabetic peripheral neuropathy Management of postherpetic neuralgia Management of neuropathic pain associated with spinal cord injury
The causes of peripheral neuropathy are not directly stated in the provided drug labels. However, the labels mention diabetic peripheral neuropathy, postherpetic neuralgia, and spinal cord injury as conditions associated with neuropathic pain that can be managed with pregabalin.
- Diabetic peripheral neuropathy is a type of peripheral neuropathy caused by diabetes.
- Postherpetic neuralgia is a type of peripheral neuropathy caused by shingles.
- Spinal cord injury can also cause peripheral neuropathy. The management of peripheral neuropathy includes treatment with medications such as pregabalin to alleviate neuropathic pain. 2 2
From the Research
Causes of Peripheral Neuropathy
- Vitamin deficiency is a risk factor in the development of peripheral neuropathy, which can lead to complex and severe diseases 3
- Deficiencies of almost all vitamins are associated with diabetic neuropathy, and vitamin supplementation may serve as an effective therapeutic strategy 3
- Peripheral neuropathy is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine 4
- Diabetes is a common cause of peripheral neuropathy and is associated with both mono- and polyneuropathies 5
- Other causes of generalized peripheral neuropathy include diseases with tissue deposits, autoimmunity, infections, malignancy, and metabolic diseases 6
Management of Peripheral Neuropathy
- Vitamin B supplementation may be used to treat diabetic peripheral neuropathy, but the evidence is mixed 4, 7
- Treatment with B1 was associated with a significant improvement in symptoms of peripheral neuropathy 4
- Well-designed studies are needed to establish optimal treatment strategies for vitamins in peripheral neuropathy 3, 4
- Diagnosis of peripheral neuropathy demands complicated examinations, and knowledge about simultaneous occurrence of different types of neuropathy can lead to faster recognition and diagnosis 6
Types of Peripheral Neuropathy
- Mononeuropathies, multifocal neuropathies, and polyneuropathies are types of peripheral neuropathies, with polyneuropathies being divided into axonal and demyelinating forms 5
- Carpal tunnel syndrome is the most common mononeuropathy, while chronic polyneuropathy has a prevalence of 1% and increases to 7% in persons over 65 years of age 5
- Immune-mediated polyneuropathies like Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy are rare diseases 5