Will compression help with neuropathy?

Compression Therapy for Neuropathy

Compression therapy may be beneficial for specific types of neuropathy, particularly chemotherapy-induced peripheral neuropathy (CIPN), but is not recommended as a standard treatment for most forms of neuropathy. 1

Evidence for Compression Therapy in Different Types of Neuropathy

Chemotherapy-Induced Peripheral Neuropathy

• Compression therapy shows promise for preventing CIPN during chemotherapy administration:
  • One randomized trial using tight surgical gloves during taxane chemotherapy found significantly lower rates of grade ≥2 sensory neuropathies in gloved hands (21%) compared to ungloved hands (76%) 1
  • A small trial (38 patients) comparing compression therapy to cryotherapy found similar results with both approaches 1
  • A proof-of-concept study combining compression with cryotherapy (cryo-compression at 16°C with cyclic pressure of 5-15 mm Hg) showed preservation of motor nerve function compared to baseline 1

Lymphedema-Related Neuropathy

• For patients with lymphedema who may experience associated neuropathic symptoms:
  • Manual lymphatic drainage and compression bandaging are considered equivalent treatment options (Grade C evidence) 1
  • Compression garments that are at least thigh-high and preferably include the abdomen can improve orthostatic symptoms in patients with orthostatic hypotension 1

Other Types of Neuropathy

• No strong evidence supports compression therapy for:
  • Diabetic neuropathy
  • Entrapment neuropathies (beyond standard medical management)
  • Inflammatory neuropathies

Clinical Application of Compression Therapy

When to Consider Compression Therapy

• During administration of neurotoxic chemotherapy (particularly taxanes) to prevent CIPN
• For patients with lymphedema who have associated neuropathic symptoms
• As part of a comprehensive management approach for orthostatic hypotension with neurogenic origin

Practical Implementation

• For chemotherapy-related prevention:
  • Apply compression gloves/garments during chemotherapy infusion
  • Consider combining with cryotherapy for potentially enhanced effect
  • Ensure proper fit to avoid excessive pressure that could worsen symptoms

Limitations and Caveats

• Most evidence is limited to prevention rather than treatment of established neuropathy
• Compression therapy alone is unlikely to provide complete relief for established neuropathy
• Risk of excessive pressure causing further nerve damage if not properly fitted
• Limited evidence for long-term benefits beyond the chemotherapy administration period

Alternative and Complementary Approaches

Pharmacological Options

• Duloxetine is the only medication with strong evidence for treating established CIPN 2
• For other neuropathies, treatment depends on underlying cause:
  • Membrane stabilizing agents for ectopic discharges on damaged neural membranes
  • Drugs enhancing dorsal horn inhibition for augmenting biogenic amine or GABAergic mechanisms 3

Non-Pharmacological Options

• Exercise may help reduce CIPN symptoms 1
• Physical therapy focusing on neural gliding techniques may benefit compression neuropathies 4
• Acupuncture and scrambler therapy may be considered for CIPN despite limited evidence 2

Conclusion

Compression therapy shows promise primarily for preventing CIPN during chemotherapy administration but has limited evidence supporting its use for established neuropathy of various etiologies. For established neuropathy, evidence-based pharmacological approaches like duloxetine should be considered first-line treatment, with compression therapy potentially serving as an adjunctive approach in specific situations.