Utilizing laser, LED therapy, and electroanalgesics has been shown to have a tremendous success rate
From the moment I graduated I have treated neuropathology. I have discovered, however, that many patients do not know chiropractors treat neuropathy. Only a small percentage of people truly understand what chiropractors do and that we treat more than back pain. Our goal is to educate the public that treating conditions such as degenerative disc disease and idiopathic peripheral neuropathy are the essence of what we do.
To treat idiopathic peripheral neuropathy doctors must understand its symptoms, which include numbness or altered sensations, such as feeling like a bunched sock is under the toes. Idiopathic (the underlying cause of nerve damage is unknown) peripheral neuropathy (damage to the nerves in the legs and arms) typically begins in the longest nerves first, usually in the toes and feet. These can be debilitating to the patient.
This condition can have significant symptoms, yet some patients notice no symptoms at all. The Cleveland Clinic estimates that 25 to 30 percent of Americans will be affected by peripheral neuropathy. They estimate 30 to 40 percent of peripheral neuropathy cases are idiopathic in nature.
Utilizing laser, LED therapy, and electroanalgesics has been shown to have a tremendous success rate—some studies show up to a 90 percent success rate, especially when you supplement the patients with nitric oxide.
The basics of peripheral neuropathy
Symptoms of peripheral neuropathy can include numbness, tingling, pain, and oversensitivity to touch. Strange altered sensations may be present. Patients describe the feeling they have as a sock bunched under their toes even though they are not wearing a sock.
Others report it feels as if they are walking on leather or rocks or have something wrapped around their feet. Sometimes a stimulus that normally is not painful is perceived as painful, such as a sheet touching a foot.
Some people do not notice any symptoms at all. These patients do not realize they have lost sensation in their feet as the loss has been so gradual that it seems normal. They have no abnormal or strange sensations in their feet, but may lose balance gradually or develop a painless sore on their foot that normally would be expected to be painful.
Peripheral neuropathy can lead to loss of balance, weakness, hammer toes, and foot deformity, which may require the use of a cane, walker, or foot braces, if severe. The condition typically worsens as a person ages.
Loss of sensation in the feet can be serious. A person can develop a foot sore they do not feel, even if it becomes severely infected. This can lead to amputation of toes or legs and, in rare cases, death.
The loss of balance associated with peripheral neuropathy also is very serious, as it puts a person at higher risk of falls. Falls can have catastrophic consequences. This is why diagnosis and treatment protocols are so important.
Falls are the most common cause of injury in elderly adults (age 65 and older). As many as one third of elderly adults fall each year and the risk of falling triples if you have a neurologic disorder such as peripheral neuropathy.
Twenty to 30 percent of older people who fall suffer moderate to severe injuries, such as hip fractures and head traumas. These injuries can be life-altering and even deadly. According to the Centers for Disease Control and Prevention, falls kill more than 18,000 older adults each year.
Why we fall
Balance is the ability to maintain the body’s center of mass over its base of support. A properly functioning balance system allows humans to see clearly while moving, identify orientation with respect to gravity, determine direction and speed of movement, and make automatic postural adjustments to maintain posture and stability in various conditions and activities.
Balance depends on the coordination of input from multiple sensory systems:
Visual: Provides information on the verticality of the body and spatial location relative to objects.
Proprioception: Provides information from skin (touch) and joints (pressure and vibratory senses).
Vestibular: Our sense organs that provide information on direction, motion, equilibrium, and spatial orientation.
Our bodies need to integrate this sensory input and translate that into motor output to the eye and body muscles. Maintaining balance depends on information received by the brain from three peripheral sources: eyes, muscles and joints, and vestibular organs. All three of these sources send information to the brain in the form of nerve impulses from special nerve endings called sensory receptors.
Peripheral neuropathy is a disorder of the motor, sensory, and autonomic nerves. So, in addition to aging, peripheral neuropathy patients are at a greater risk of falling because numbness, decreased sensitivity to touch, and muscle weakness can have significant adverse effects on their balance.
Evaluation and diagnosis
To diagnose a peripheral neuropathy as idiopathic, you must first evaluate for treatable causes of peripheral neuropathy:
An electromyography (EMG) test can evaluate for a demyelinating peripheral neuropathy.
Blood work that includes hemoglobin A1C to evaluate for pre-diabetes; a vitamin B12 blood test (with the goal being a number greater than 400); a thyroid-stimulating hormone (TSH) test to rule out hypothyroidism; and a serum protein electrophoresis test are all advised.
If the peripheral neuropathy is idiopathic, all of these lab tests will be normal.
Excessive alcohol use, based on patient history, also can determine peripheral neuropathy.
Monitor feet for any sores or cuts, and give care vigilantly if a wound is discovered.
Treatment options
Here are several suggestions to prevent and treat peripheral neuropathy:
Use medications to help neuropathic pain. These include Neurontin (Gabapentin), Lyrica (Pregabalin) and Cymbalta (Duloxetine). These medications only help with pain; they do not correct numbness or balance problems and do not slow the progression of neuropathy as we age. They also carry the risk of dizziness, which can increase fall risk even further.
- Shun excess vitamin B6. Doses greater than 100 mg per day are toxic to the nerves and actually cause nerve damage.
- Avoid falls—eliminate throw rugs, have a night light, or use a cane or walker for safety. Most falls occur inside the home.
- Don’t smoke; limit alcohol intake.
- Apply laser treatment, which may help temporarily with pain, but does not fix numbness or cure neuropathy.
- Take available supplements, such as alpha lipoic acid, although they are uncertain to be of benefit.
- Exercise is a must! Regular exercise, such as walking, improves circulation, helps control weight, and helps maintain balance. Strengthening exercises for the back, legs, and core improve balance.
A 2012 study of balance disorders in diabetic peripheral neuropathy patients showed that patients could achieve better balance and stability through progressive balance training. The study recommended that training be gradual and persistent so as to have long-term effects on the patient. Clinical studies also have shown that Tai Chi helps stabilize gait, improve balance, and reduce falls among people with peripheral neuropathy.
Idiopathic peripheral neuropathy is very frustrating when it is found in a patient who is otherwise healthy. Knowledge about the condition is important. Ruling out treatable causes of peripheral neuropathy is imperative. Knowing that peripheral neuropathy increases the risk of falls can lead a person to be more careful and help prevent a fall. Medication treatment can help with neuropathic pain symptoms, but as chiropractors we know treating the symptoms alone will not be a cure.
We must detect the regions of kinesiopathology subluxations, while treating these pathophysiologies with chiropractic care to remove the nerve interference, with laser to assist in stimulating the cells and with electroanalgesics to reduce symptoms while healing nerves and increasing circulation. This, combined with proper nutrition and supplementation, actually positions chiropractors and the chiropractic profession to be the leaders in both disc and neuropathy treatment.
Eric Kaplan, DC, FIAMA, is the lead instructor of the Chiropractic Peripheral Neuropathy Certificate Program at Parker University. He can be contacted at parker.edu.