Nerve damages or Neuropathy

Neuropathy is a long-term complication which affects the nerves endings.

Nerves carry messages between the brain and every part of our bodies: making it possible to see, hear, feel and move. Nerves carry signals to the heart and lungs: dictating the rate at which it beats and at which we breathe. Damage to the nerves can cause numerous problems in various parts of the body.

There are three different types of neuropathy: sensory, autonomic and motor.

Diabetes can cause neuropathy. High blood glucose levels can damage the small blood vessels which supply the nerves (polyneuropathy). Damage to blood vessels can prevent essential nutrients reaching the nerves which in turn damages or kills the nerve fibres.

Peripheral neuropathy can result from physical injury to the nerves, from viral infection (such as shingles).

Neuropathy can be caused by drinking too much alcohol. It can also result from low levels of vitamin B12 or other vitamins.

It might also result as side effect of certain medications (eg. metronidazole or nitrofurantoin, phenytoin, amiodarone and thalidomide) in some people: 

Guillain-Barre Syndrome is a rare condition that causes rapid onset of paralysis.

Amyloidosis is the name for a group of rare, serious conditions caused by a build-up of an abnormal amyloid protein in tissues and organs in the body. The build-up of amyloid proteins (deposits) can make it difficult for the organs and tissues to work properly. These conditions are caused by overactivity of the immune system by diseases such as rheumatoid arthritis, lupus, Sjogren's syndrome or even an undiagnosed underactive thyroid gland (hypothyroidism)

Medication               

Anti-convulsant and anti-depressant drugs are often the first line of treatment. 

Some neuropathic pain studies suggest the use of non-steroidal anti-inflammatory drugs (NSAIDs). These medications will be stopped if someone is diagnosed with stroke! It is very important to note that, unlike most other types of pain, neuropathic pain does not usually respond to common painkillers (such as paracetamol or ibuprofen) and so other medications are required. 

As the condition progresses stronger and stronger painkillers are required.

If another condition, such as diabetes, is involved, better management of that disorder may alleviate the pain. Effective management of the condition can also help prevent further nerve damage.

In cases that are difficult to treat, a pain specialist may use an invasive or implantable device to manage the pain. Electrical stimulation of the nerves involved in neuropathic pain may significantly control the pain symptoms.

The main medications recommended for neuropathic pain include:

Amitriptyline – treats migraine and depression;

Duloxetine – treats of bladder problems and depression;

Pregabalin and Gabapentin – treats epileptic seizures, headaches and anxiety;

Capsaicin cream stopping the nerves sending pain messages to the brain;

Tramadol related to morphine that can be used to treat neuropathic pain.

Other kinds of treatments might include: physical therapy, working with a counsellor, relaxation therapy, massage therapy or acupuncture as well as powerful corticosteroids or anti-inflammatories and possibly B12 injections or tablets (in cases of B12 deficiency).

Peripheral neuropathy could lead to other medical problems, such as foot ulcers, heart rhythm changes, and blood circulation problems. 

 Diabetic Foot Ulcer

If nerves in the foot become damaged the reduction in sensation can make it more likely for blisters (or cuts) to develop unknowingly. A reduced pain sensation may mean that such an injury goes unnoticed and then develop into an ulcer. High blood sugar can damage your blood vessels, causing the blood supply to the skin of the foot to become restricted, lowering the number of infection-fighting cells and leading to a longer time to heal or complications such gangrene.

Gangrene

In cases of peripheral neuropathy, there's a greater risk that an infected wound can lead to the death of part of the skin or underlying tissues (ie. Gangrene). If gangrene develops then a course of antibiotics to treat any underlying infection might be required in tandem with surgery to remove the damaged tissue (known as debridement). In severe cases a toe or foot may need to be amputated.

Cardiovascular autonomic neuropathy (CAN)

Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem that's common in people with diabetic polyneuropathy.

CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat.

The two main noticeable symptoms of CAN are:

an inability to exercise for more than a very short period

and low blood pressure that can make you feel dizzy or faint when you stand up (called Orthostatic hypotension).

Carbon dioxide is colour and odourless gas that is heavier than air. When bathing (to chest height) in a “dry carbon dioxide” the gas is absorbed through the hair follicles and skin into the capillaries and connective tissues. This (vasodilation) expands the blood vessel’s diameter which improves blood flow and the removal of waste products as well as increasing the transport of oxygen, nutrients and glucose to the tissues.

Effects:

Within the first couple of minutes a client experiences pleasant heat and perspiration.

Blood pressure is decreased typically by 15-20mmHg Systolic and 10-15mmHg Diastolic.

Benefits last up to six months:

Helps to alleviate Stroke/Diabetes related Neuropathic pain

Better blood flow increases energy levels alleviates fatigue and improves mood

Cognition may improve

Eyesight may improve

Alleviates wheezing

Helps to improve independence and improves quality of life

Helps improve lymphatic fluid drainage (gravitational oedema) - meaning shoes fit properly

Gradually walking distance will improve

Important:

Home Exercise Programmes that has been given by your NHS therapist to be practised daily and additional Stretching and Strengthening exercises at the clinic strongly recommended