Pain Management Q&A by Dr. Helm
Peripheral neuropathy is when the peripheral nerves (as compared to the spinal cord or brain) become the source of pain. One way to look at pain is whether it is in response to an appropriate stimulus, such as someone stepping on your toe, or whether the pain occurs for no obvious reason; malfunctioning of the nerves themselves becomes the source of the pain. Peripheral neuropathy can occur for many reasons, including as a consequence of diabetes, following trauma, toxins, and in alcoholism, to name a few causes. Peripheral neuropathy can also occur for no obvious reason.
Treatment depends in part upon the cause of the neuropathy. In general, physicians prescribe drugs that alter the processing of pain information in the spinal cord. Examples would include antidepressants, anti-epilepsy drugs, certain alpha-2 agonists, and opioids. Capsaicin cream (containing the substance found in hot peppers) and lidocaine patches have also been used for some patients.
Peripheral neuropathies can be frustrating to treat. As a general rule, the drugs used have a number needed to treat of about three, meaning that you have to treat three people to get one who has a 50% reduction of pain. Much of this treatment is off label, meaning that the drugs are prescribed for a different use than one of their FDA-approved indications. However, two new medications which have received specific FDA approval for diabetic peripheral neuropathy are pregabalin (Lyrica) and duloxetine (Cymbalta).
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Last Editorial Review: 4/9/2012