Is there a machine that can reverse peripheral neuropathy?

From the Guidelines

Currently, there is no machine that can completely reverse neuropathy, and treatment focuses on managing symptoms and addressing underlying causes rather than reversing the nerve damage through a single device. The most recent and highest quality study, published in 2023 1, emphasizes the importance of assessing and managing diabetic peripheral neuropathy to improve quality of life. According to this study, specific treatment to reverse the underlying nerve damage is currently not available, and glycemic control can effectively prevent diabetic peripheral neuropathy and cardiac autonomic neuropathy in type 1 diabetes, but it does not reverse neuronal loss.

Treatment Approaches

• Proper blood sugar control (for diabetic neuropathy) is essential in managing neuropathy, as it can help prevent the progression of nerve damage 1.
• Medications like gabapentin (300-1200mg three times daily), pregabalin (75-300mg twice daily), or duloxetine (30-60mg daily) can be effective in managing neuropathic pain, as supported by studies published in 2011 1 and 2015 1.
• Physical therapy and lifestyle modifications, including regular exercise and a balanced diet, can also help improve symptoms and quality of life.
• Some patients may use TENS (Transcutaneous Electrical Nerve Stimulation) units or other devices like infrared light therapy boots or socks for symptom relief, but the scientific evidence supporting their effectiveness is limited.

Importance of Early Detection and Management

• Early recognition and appropriate management of neuropathy in people with diabetes is crucial, as emphasized in the 2023 study 1.
• Annual assessments, including careful history and assessment of temperature or pinprick sensation, vibration sensation, and 10-g monofilament testing, can help identify feet at risk for ulceration and amputation.
• Treatment decisions should consider each patient's presentation and comorbidities, and a tailored and stepwise pharmacological strategy with careful attention to relative symptom improvement, medication adherence, and medication side effects is recommended to achieve pain reduction and improve quality of life 1.

From the Research

Treatment Options for Peripheral Neuropathy

• There are various treatment options available for peripheral neuropathy, including pharmacological and non-pharmacological approaches 2, 3, 4, 5.
• First-line pharmacologic therapy for painful diabetic neuropathy includes gabapentinoids (pregabalin and gabapentin) and duloxetine 3, 4.
• Additional pharmacologic modalities that are approved by the Food and Drug Administration (FDA) but are considered second-line agents include tapentadol and 8% capsaicin patch 3.
• Non-pharmacological treatments such as exercise, spinal cord stimulation, and transcutaneous electrical nerve stimulation may also be effective in managing peripheral neuropathy 4, 5.

Reversal of Peripheral Neuropathy

• Currently, there is no single treatment that can reverse peripheral neuropathy 2, 6.
• Treatment of peripheral neuropathy is largely symptomatic, and available treatments offer only symptom relief 2, 6.
• Research is ongoing to understand the pathogenesis of peripheral neuropathy and to develop effective treatments that can halt or reverse the condition 6.

Machine-Based Treatments

• There is evidence to support the use of dorsal column spinal cord stimulation (SCS) for the treatment of painful diabetic neuropathy, delivering either a 10-kHz waveform or tonic waveform 3.
• Peripheral transcutaneous electrical nerve stimulation is also a well-tolerated and inexpensive treatment option, although benefits are modest 4.
• However, there is no evidence to suggest that a machine can reverse peripheral neuropathy 2, 3, 4, 5, 6.