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Integrative Medicine Rakel > Ch 14: Peripheral Neuropathy > Flashcards

Ch 14: Peripheral Neuropathy Flashcards

1
Q

In what percentage of cases of peripheral neuropathy is the underlying cause found?

A

Only 50% of cases!

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2
Q

Additional sign seen in peripheral neuropathy from Acrylamide

A

truncal ataxia

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3
Q

Additional sign seen in peripheral neuropathy from Dimethylaminopropionitrile

A

urinary complaints

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4
Q

Additional sign seen in peripheral neuropathy from Biologic toxin in diphtheritic neuropathy

A

pharyngeal neuropathy

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5
Q

From what can you get peripheral neuropathy from hexacarbon (n-hexane) toxicity

A

Glue-sniffing, solvents, glue thinner

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6
Q

Additional sign seen in peripheral neuropathy from lead

A

wrist drop, abdominal colic

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7
Q

Additional sign seen in peripheral neuropathy from Lucel-7

A

cataracts

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8
Q

Additional sign seen in peripheral neuropathy from organophosphates

A

cholinergic symptoms
delayed onset neuropathy

triorthocresyl phosphate, leptophos, mipafox, trichlorphon

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9
Q

Additional sign seen in peripheral neuropathy from Thallium

A

pain, alopecia, Mees lines (white horizontal lines on nails)

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10
Q

Additional sign seen in peripheral neuropathy from trichloroethylene

A

trigeminal neuralgia

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11
Q

Mechanisms of chemo-induced neuronal damage

A
  1. microtubule disruption
  2. oxidative stress & mitochondrial damage
  3. Altered ion channel activity
  4. Myeline sheath damage
  5. DNA damage
  6. Neuroinflammation

Overall leads to A-delta and C-fiber damage –> peripheral sensitization of nociceptors –> peripheral neuropathy

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12
Q

Which exercise is the best for neuropathy

A

Balance training

Strength and endurance/strength combo do have some benefit though

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13
Q

what is the benefit or movement therapies like yoga and tai chi

A

Gentler and less strenuous so may have better compliance

Have benefits outside of the neuropathy symptoms - QOL in Tai Chi; stress reduction, cancer side effects, sleep improvement

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14
Q

How does biofeedback benefit neuropathy

A
  • It actually imrpoves A1c directly!
  • It improves blood flow to extremities!

Can improve pain, mental health, stress, sensorimotor function, dexterity. May work as well as pharmacotherapies

Minimum of six 1-hour sessions approx 1 week apart.

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15
Q

What is pulsed electromagnetic frequency (PEMF) and amplitude (PEMA)

A
  • the new waveform of pulsed-electromagnetic therapy devices
  • Caution: all the research comes from the marketer of the devices BEMER
  • When it is applied by a mat, improved microcirculation occurs - directly improves tissue and pain.
  • By improving blood flow, it may increase the efficacy of medications used!
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16
Q

how does acupuncture work to treat neuropathy

A

may stimulate production of endorphins in CNS

Some studies show it is more effective than conventional treatments

Electroacupuncture may also be beneficial

Neuroacupuncutre (ie Chinese scalp acupuncture) has remarkable effects for CNS disorders. You can use electrical stimulation for enhanced response

17
Q

Curcumin

A
  • 3% or 5% concentration in turmeric
  • beneficial in diabetes and in diabetic neuropathy
  • multiple anti-inflammatory mechanisms, reducing many markers of inflammation (CRP, COX-2, TNF=alpha)
  • improves endothelial function: reduces vascular inflammation
  • Downregulates adipokines like resistin, leptin, and monocytoe chemotactic protein 1
  • minimizes osmotic stress by regulating the polyol pathway
  • Also helps with liver disorders and pancreatic B-ilet cell dysfunction
  • antinocioceptive activity
  • also improes depression adn anxiety in patients with peripheral neuropathy
  • Dosage: 1g two to three times daily. Combine with black pepper to enhance absorption.
  • Caution: synthetic forms and contaminants like lead, solvents exist!C3 complex standardized with curcumin, bidemethyoxycurcumin and demethoyxycurcumin, is widely studied and likely safe
18
Q

Cannabinoids

A
  • CBD reduces neuropathic pain in diabetes and chemo-induced
  • CBD Enhances arterial relaxation by enhancing COX-1/2
  • Is antiinflammatory and lowers inflammation in oxidative stress
  • May potentiate prescription pain medications and mood medications
  • May potentiate glucocorticoid use
  • Chronic CBD may downregulate the glucocorticoid response
  • tincture of CBD oil 2-25mg three or four times per day sublingually. Can use topically as well. Avoid in pregnancy and breast feeding
19
Q

Geranium Oil

A
  • Neuragen PN: proprietary blend of essential oils and homeopathic agents. Significant reduction in neuropathic pain; lasting up to 8 hours
  • Geranium oil by itself can provide significant relief in minutes and last up to 8 hours
  • Apply 1-2 rops neuragen PRN to affected area and rub in up to 5x/day. If larger skin areas or sensitive skin, dilute 4-5 drops in 1 tablespoon of carrier. Relief available in 30 min.
20
Q

Evening Primrose Oil

A
  • Rich source of Omega-6 fatty acids (gamma-linoleic acid and linoleic acid)
  • Both essential components of neuronal cell membrane
  • GLA may be more effective than DHA in preventing neuropathy in diabetics
  • GLA supplements augment prodution of prostaglandin E1 > E2. E1 is the antiinflammatory / antiplatelet one.
  • 360mg daily of GLA fro m evening primrose oil. Should be refrigerated and stored in light-resistant containers
  • primrose oil may increase effectiveness of ceftazidime, chemo, and cyclosporine; interact with phenothiazines; increased seizure; avoid in antiplt/ anticoagulatns. NSAIDS may counteract effect of primrose oil.
21
Q

Acetyl-N-Carnitine

A
  • Amino acid responsible for mitochondrial fatty acid transport
  • More bioavailable than L-carnitine
  • Analgesic action by reducing glutamate concentration in synapses
  • Facilitates nerve regeneration, improves neuronal transport, amplifies nerve growth factor responsiveness
  • ALC specifically protective when given concomitantly and after treatment from chemo=induced neuropathy. Also good for diabetic neuropathy.
  • More effective in shorter durations of neuropathy (and in Type II vs Type I DN)
  • 500-1000mg BID-TID. May cause N/V/D/HA/bladder irritation, body odor, stuffy nose, rash, restlessness, insomnia.
22
Q

Alpha lipoic acid

A
  • also known as thioctic acid
  • approved for clinical use in Germany
  • A universal antioxidant
  • chelates transition metal ions; mitigates heavy metal poisonin toxicity
  • Increases activity of antioxidant enzymes catalase and superoxide dismutase in peripheral nerves and protects against lipid peroxidation.
  • Inhibits hexosamine and advanced glycation end-product pathways - improves neurla blood flow and conduction velocities
  • improves glycemic control and inflammatory parameters in DM
  • 600-1800 daily. Caution for hypoglycemia. CHelator - monitor for mineral deficiencies. GI upset. Rarely, rash.
23
Q

Benfotamine

A
  • lipid soluble derivative of thiamine (Vit B1)
  • much more absorbable than water-soluble form. Penetrates nerves more readily.
  • Reduces advanced glycocylation end products –> prevents endothelial dysfunction
  • improves neuropathy, HBA1c, pain
  • Well studied in Russia
  • may be helpful in preventing retinopathy!
  • 150-300 daily for diabetic peripharl neuropathy
24
Q

Methylcobalamin

A
  • Active form of Vit B12
  • improved somatic and autonomic symptoms of neuropathy
  • in addition to peripheral neuropathy, it improved heart rate variability (a marker of autonomic neuropathy!)
  • 500 TID or 1500 daily of methylcobalamin or 5-adenosylcobalamin (most generic vitamins contain cyanocobalamin)

A methyl b-complex vitamin may be helpful in peripheral neuropathy involved in deficiency syndromes (ie alcohol, pernicious anemia, malabsorption, isonaizid-induced pyridoxine deficiency) and chemo-induced PN. Caution for doses of B6 higher than 250mg daily which can result in reversible nerve damage! And B3 > 300 can cause headache, flushing, tingling, nausea.

25
Q

Fish Oil

A
  • Decreases pain and nerve function in DM
  • RCT sho protective against paclitaxel-induced PN
  • Beneficial in chemo and radiation, with none of the studies reporting worse outcomes
  • Also beneficial in diabetes
  • EPA 1000-2000 daily and DHA 500-1000 daily (so 2:1 EPA to DHA?) Natural triglyceride form better absorbed than ethyl ester forms. Algal oil vegan option available. Caution - possible blood thinning effect with higher doses
26
Q

Capsaicin

A
  • Chili pepper extract
  • Affects sensory fibers especially C fibers by depleting endogenous neurotransmitter stores associated with pain transmission (like substance P, VIP, cholecystokinin, somatostatin)
  • Doesnt actually change the neuropathy but reverses the pain that occurs from it
  • Initial burning sensation but with repeated applications there is a dose-dependent degeneration and desensitization of afferent fibers . If it is tolerable, patients should continue using it, for at least 4-6 weeks before the benefits are appreciated
  • dermal patch available (need anesthetic pretreatment, then application in clinic for 1 hour). May help for postherpetic neuralgia and HIV-associated distal sensory polyneuropathy
  • Must use it 3-4 times per day for improvement (daily, BID, or PRN likely no better than placebo)
27
Q

Most effective pharmaceticual analgesic for neuropathy?

A

TCAs

Followed by traditional anticonvulsants the nnewer generation anticonvulsants

28
Q

most serious concern with gabapentin

A

Leukopenia

Do not abruptly discontinue

29
Q

side effects of pregabalin

A

dizzy somnolence headache
dry mouth
peripheral edema
weight gain

30
Q

PENS

A

percutaneous electic nerve stimulation (like TENS = transcutaneous)
similar to electroacupuncture, dlivered by disposable needles however is delivered along peripheral nerves rather than along meridians
Alternating low and high frequency stimulation and 30-min intervals three times per week

31
Q

Nigella Sativa

A
  • black seed oil
  • many biologic effects (against cancer, diabetes, HTN, lipids, microbes, wound healing)
  • Thymoquinone is most important constituent
  • helps against myelin breakdwn in diabetic conditions and chemodincued neurotoxicity

Integrative Medicine Rakel (16 decks)

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