A very common problem seen in primary care physician's office is Peripheral Neuropathy. The patient complains about neuropathic problems of the feet and lower legs. These symptoms can be mild or severe depending on the length of time and cause of the pathology. In many cases, the symptoms are annoying with the patient complaining of numbness and parestesia. However, in other cases the symptoms may be quite debilitating with complaints of severe and chronic neuropathic pain. 

 

How serious is this problem and how does one go about treating it?

 

First, differentiate the type of symptoms they present with. If the patient presents with numbness, this can be a serious problem as the ramifications of possible limb loss can occur. Most causes of numbness are diabetes, but not all of the time. Even though a patient does not have pain doesn't mean that the problem should not be treated. The risk of potential limb loss from this type of neuropathy in diabetes is 17 times greater than the general public. It usually doesn't take an extensive exam to figure this problem out (nerve conduction studies are not necessary) because the symptoms speak for themselves. 

 

Medical management of this problem does not reverse the pathology. Better diabetic control may help in some cases, but treatment with an assortment of medications such as Neurontin, Lyrica, and Cymbalta do not reverse the symptoms. In fact most patients would rather live with the problem rather than take medication because of the potential side effects of the somnolence and the sedation associated with them. However, another option to treating this component of peripheral neuropathy is electrostimulation which I will discuss later in this article.

 

The second type of peripheral neuropathy seen is the hyperesthesia component in which the patients complains of considerable burning and tingling in the extremities. This type can present with almost intolerable symptoms making it difficult to function in daily life. After the medical workup is completed and etiology determined, there are many medical options available for treatment. This type of neuropathy does respond in many cases to medication. Electrostimulation can be utilized for treatment. However, I would continue with the medication and titrate the dose down based on the response to treatment with electrostimulation.

 

The causes of peripheral neuropathy are numerous. The most obvious cause would be diabetes. But don't be fooled because in many cases the symptoms may predate the diagnosis of diabetes so you have to determine whether the symptoms are due to another cause or the initiating symptoms of actual diabetes. If you determine that the neuropathy is due to diabetes, then the most important treatment is diabetic control. In some cases, neuropathy does get worse with the initiation of insulin to the treatment regimen. Also it is important to think about nutritional status because in many case a thiamine deficiency can accentuate the symptoms and appropriate supplementation is needed.

 

The second most common cause is Idiopathic Neuropathy. This is a diagnosis of exclusion, as the diagnosis is made after all appropriate medical testing is inconclusive for a potential cause. After Idiopathic neuropathy, the most common causes are hypothyroidism, alcoholic, pernicious anemia, and chemotherapy induced. This list is quite short as I don't want to elaborate on the hundreds of causes but rather to point out how complicated it may be to determine an etiology. The only reason an etiology is pursued is because if found it can be treated and improvement noted. However, in many cases, even if the cause is determined, it is too late to reverse the presenting symptoms. Electrostimulation, in many cases, can reverse these symptoms. 

 

The VST Myodynamic Device has emerged for the treatment of peripheral neuropathy. This new modality uses a pure, alternating, biphasic, sinusoidal waveform. The treatment involves a series of stimulation treatments over an 8 to 12 week period. The treatment takes approximately 60 minutes and is performed 2-3 times weekly. Recent studies retrospectively indicated an 83% reduction in pain and an overall symptom improvement of 86%. This is not to say everyone will be cured but the bottom line is we now have an alternative treatment to reverse the numbness associated with neuropathy and also to decrease the neuropathic pain without any oral medications and therefore prevent potential side effects. 

 

If you have any questions about electrostimulation treatment, please call Healthcare America in Bradenton, Florida at 941-752-2860 ask for Brent Rubin, DPM.