Peripheral Neuropathy Part 2 – Managing Pain…Naturally

In the November issue, the first part of this article included an overview of peripheral neuropathy, its symptoms, risk factors and how it can be diagnosed. This article will focus primarily on natural ways to manage pain related to nerve damage, with particular emphasis on diabetic neuropathy, since it is the most common cause of nerve damage in the United States.

There is no medical cure for PN. Medications are used to try to control the nerve pain, but none of them treat the actual nerve damage. When the drugs are stopped, the pain returns because the underlying problem is still there. Unfortunately, side effects from some of these medications include drowsiness, fatigue and poor thinking ability.

Fortunately, there are some very effective natural ways to manage diabetic neuropathy pain and discomfort. I say manage, rather than cure, because even though the pain can be treated and sensation can oftentimes be greatly improved, when the day is done the patient is still a diabetic and will always be predisposed to neuropathy. By far, the single most important thing a diabetic can do to delay neuropathy is maintain strict control of their blood sugar. Elevated blood sugar damages nerves. The recommendations that follow will do little good if this is not taken into account.

Unfortunately, using artificial sweeteners may not be a safe sugar alternative for diabetics trying to control their blood sugar. Something to consider the next time you read the label on a can of diet soda or chewing gum. Aspartame can convert to methanol (the alcohol added to gasoline), a neurotoxin that can accumulate within the body relatively fast. Methanol can break down into formaldehyde (cadaver preservative) and formic acid (bee and ant sting poison). Another very common food additive, monosodium glutamate (MSG), has also been implicated as a neurotoxin. For a scary awakening regarding how prevalent MSG is in processed foods, as well as the other names used to disguise it, try typing in “hidden MSG” on Google sometime. It’s enough to make you first in line at the local farmers market!

While it should be obvious that everyone should avoid these food additives, diabetics and people with other forms of nerve damage should be especially careful.

The combination of poor wound healing and decreased sensation can be very dangerous for a diabetic. Patients with diminished sensation may not realize they have a blister after walking all day at the Big E. The blister then gets infected and if the infection can’t be controlled they may end up requiring amputation. As mentioned previously, 75,000 lower limb amputations are performed on diabetics each year. All diabetics should check their feet daily for cuts, scrapes and calluses. It would be well worth seeing a podiatrist for routine nail trimming, orthotics or special shoes if needed.

It is a bit paradoxical, but quite often the patients who complain of painful burning and cold sensations in their feet are actually unable to feel pain, hot or cold sensations when they are tested! This is because the brain tries to compensate for the lost sensation from nerve damage by “filling in” what it thinks should be there, similar to the mechanism involved with phantom limb pain. We have found that as neuropathy patients respond to a combination of nutritional supplementation and certain therapies; their sensation actually improves when tested. As their ability to perceive pain and temperature sensation improves, not only does their spontaneous pain decrease, but they regain some of the protective sensation needed to detect cuts and scrapes that otherwise might go unnoticed.

Some nutritional supplements have been shown to be very helpful in treating different aspects of neuropathy. As always, consult with a licensed practitioner before beginning any supplement, especially if you are also taking medication as some supplements can interfere with some medications. For this reason, the following guidelines do not contain specific dosage amounts, as these can vary among individuals.

Alpha Lipoic Acid, a strong antioxidant, has been demonstrated to improve pain, tingling and burning sensations in some patients however it has been reported that high doses may cause allergic skin reactions. In one study, Vitamin E was shown to improve some nerve conduction testing parameters compared to placebo. Good sources of vitamin E include vegetable oils, wheat germ, nuts and green leafy vegetables. Magnesium levels are generally lower in diabetics. While its role in neuropathy is unclear, one study found that oral supplementation resulted in decreased pain in diabetic rats.

As their name implies, it is “essential” to take essential fatty acids to promote nerve health and other functions. The problem with many diabetics is that even if they eat a good diet, they often lack one or two of the enzymes that are needed to convert the good fats from their diet into a substance called gamma-linolenic acid (GLA), which the body then turns into other chemicals that protect blood vessels, red blood cells and reduce inflammation. Since they tend to have problems making their own GLA, diabetics can take GLA as a supplement via Evening Primrose Oil (EPO) or borage oil. There is some evidence that GLA taken along with vitamin C and Alpha Lipoic Acid at certain ratios can even be more effective than taking any of them in isolation.

Certain therapies have been shown to reduce painful feelings in the hands and feet. In one study, 77% of patients reported significant pain reduction following acupuncture treatment. Some patients respond to surgical decompression of the nerves in the knees, ankles and feet, however, a more natural approach worth trying first would be manipulation of the involved joints to restore proper movement and free up restricted nerves in these areas. Light therapy has been shown to significantly decrease nerve pain without side effects. A proposed mechanism is that infrared light increases local circulation, which improves oxygen delivery to the affected nerves.

One small controlled study showed very slight improvement in nerve conduction among yoga participants while the control group continued to deteriorate. The mechanism for these findings is unclear however regular exercise can have a dramatic impact on blood sugar levels. It is amazing how many beneficial effects can be obtained from regular exercise, plus it’s free! Too bad you can’t put exercise in a pill.

In the November issue, the first part of this article included an overview of peripheral neuropathy, its symptoms, risk factors and how it can be diagnosed. This article will focus primarily on natural ways to manage pain related to nerve damage, with particular emphasis on diabetic neuropathy, since it is the most common cause of nerve damage in the United States.

There is no medical cure for PN. Medications are used to try to control the nerve pain, but none of them treat the actual nerve damage. When the drugs are stopped, the pain returns because the underlying problem is still there. Unfortunately, side effects from some of these medications include drowsiness, fatigue and poor thinking ability.

Fortunately, there are some very effective natural ways to manage diabetic neuropathy pain and discomfort. I say manage, rather than cure, because even though the pain can be treated and sensation can oftentimes be greatly improved, when the day is done the patient is still a diabetic and will always be predisposed to neuropathy. By far, the single most important thing a diabetic can do to delay neuropathy is maintain strict control of their blood sugar. Elevated blood sugar damages nerves. The recommendations that follow will do little good if this is not taken into account.
Unfortunately, using artificial sweeteners may not be a safe sugar alternative for diabetics trying to control their blood sugar. Something to consider the next time you read the label on a can of diet soda or chewing gum. Aspartame can convert to methanol (the alcohol added to gasoline), a neurotoxin that can accumulate within the body relatively fast. Methanol can break down into formaldehyde (cadaver preservative) and formic acid (bee and ant sting poison). Another very common food additive, monosodium glutamate (MSG), has also been implicated as a neurotoxin. For a scary awakening regarding how prevalent MSG is in processed foods, as well as the other names used to disguise it, try typing in “hidden MSG” on Google sometime. It’s enough to make you first in line at the local farmers market! While it should be obvious that everyone should avoid these food additives, diabetics and people with other forms of nerve damage should be especially careful.

The combination of poor wound healing and decreased sensation can be very dangerous for a diabetic. Patients with diminished sensation may not realize they have a blister after walking all day at the Big E. The blister then gets infected and if the infection can’t be controlled they may end up requiring amputation. As mentioned previously, 75,000 lower limb amputations are performed on diabetics each year. All diabetics should check their feet daily for cuts, scrapes and calluses. It would be well worth seeing a podiatrist for routine nail trimming, orthotics or special shoes if needed.
It is a bit paradoxical, but quite often the patients who complain of painful burning and cold sensations in their feet are actually unable to feel pain, hot or cold sensations when they are tested! This is because the brain tries to compensate for the lost sensation from nerve damage by “filling in” what it thinks should be there, similar to the mechanism involved with phantom limb pain. We have found that as neuropathy patients respond to a combination of nutritional supplementation and certain therapies; their sensation actually improves when tested. As their ability to perceive pain and temperature sensation improves, not only does their spontaneous pain decrease, but they regain some of the protective sensation needed to detect cuts and scrapes that otherwise might go unnoticed.

Some nutritional supplements have been shown to be very helpful in treating different aspects of neuropathy. As always, consult with a licensed practitioner before beginning any supplement, especially if you are also taking medication as some supplements can interfere with some medications. For this reason, the following guidelines do not contain specific dosage amounts, as these can vary among individuals.

Alpha Lipoic Acid, a strong antioxidant, has been demonstrated to improve pain, tingling and burning sensations in some patients however it has been reported that high doses may cause allergic skin reactions. In one study, Vitamin E was shown to improve some nerve conduction testing parameters compared to placebo. Good sources of vitamin E include vegetable oils, wheat germ, nuts and green leafy vegetables. Magnesium levels are generally lower in diabetics. While its role in neuropathy is unclear, one study found that oral supplementation resulted in decreased pain in diabetic rats.
As their name implies, it is “essential” to take essential fatty acids to promote nerve health and other functions. The problem with many diabetics is that even if they eat a good diet, they often lack one or two of the enzymes that are needed to convert the good fats from their diet into a substance called gamma-linolenic acid (GLA), which the body then turns into other chemicals that protect blood vessels, red blood cells and reduce inflammation. Since they tend to have problems making their own GLA, diabetics can take GLA as a supplement via Evening Primrose Oil (EPO) or borage oil. There is some evidence that GLA taken along with vitamin C and Alpha Lipoic Acid at certain ratios can even be more effective than taking any of them in isolation.

Certain therapies have been shown to reduce painful feelings in the hands and feet. In one study, 77% of patients reported significant pain reduction following acupuncture treatment. Some patients respond to surgical decompression of the nerves in the knees, ankles and feet, however, a more natural approach worth trying first would be manipulation of the involved joints to restore proper movement and free up restricted nerves in these areas. Light therapy has been shown to significantly decrease nerve pain without side effects. A proposed mechanism is that infrared light increases local circulation, which improves oxygen delivery to the affected nerves.

One small controlled study showed very slight improvement in nerve conduction among yoga participants while the control group continued to deteriorate. The mechanism for these findings is unclear however regular exercise can have a dramatic impact on blood sugar levels. It is amazing how many beneficial effects can be obtained from regular exercise, plus it’s free! Too bad you can’t put exercise in a pill.

About Andrew Gregory

Dr. Andrew Gregory is a board certified chiropractic neurologist who sees neuropathy patients daily in his practice. He is a Diplomate of the American Chiropractic Neurology Board, a Fellow of the American College of Functional Neurology, a Fellow of the American Board of Electrodiagnostic Specialties and a Registered Nerve Conduction Technologist.
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