Jenny L. F. Andrus, MD
In the past few articles, I have addressed that polyneuropathy can be caused by a variety of underlying conditions or for idiopathic (unknown) reasons. For that reason, I typically will work in concert with the patient, other physicians, including the Primary Care physician, and perhaps other specialists, depending on the condition, to tailor a specific treatment plan for the individual patient.
For example, a patient with a life-threatening cancer will need to be under the care of an oncologist/hematologist, with support from a primary care physician and perhaps others, including myself, because the cancer treatment is the most important. A diabetic patient will have their diabetes managed by their PCP; however, they will need my expertise with their chronic pain and nerve dysfunction. A patient who abuses alcohol may need to go into inpatient rehab before a long-term treatment plan for their polyneuropathy can be implemented by me. I think you get the picture of how different medical disciplines work together to best help the patient.
As many of my patients are already on multiple medications when they come to see me, it is very important that I fully understand everything they are taking, at what dose and how often, BEFORE I prescribe them another medication for their polyneuropathy. Drugs can and do interact and I take every precaution to keep that from happening.
Just a few years ago, some patients who had severe nerve pain were given high doses of opioids to counteract their symptoms. In a best-case scenario, the patients were drugged out and sleepy, and had difficulty working or functioning well. The worst case was drug abuse, addiction and death. Ethical pain management does not happen in this way anymore.
Today, we typically don’t prescribe opioids. Instead, we use a multi-modal approach to pharmaceutical therapy, which tends to work much more effectively at reducing pain and gives the patient a much greater quality of life without worrying about the possibility of addiction. The medication(s) I prescribe affects different brain receptors that separately address pain, inflammation, sensitivity, depression and nerve function. Antidepressants, anti-seizure medications, non-narcotic pain medications, nerve calming agents (such as gabapentin and pregabalin) may be given alone or in any combination to achieve the best pain relief.
Inflamed or irritated nerves often respond well to steroids, which can be given orally to work systemically or can be injected near the nerve root itself by epidural, facet or nerve block injection. Sometimes, the steroids will provide inflammation and pain relief for months or even longer and their use may be an alternative to surgery for some patients.
Some patients have severe nerve damage that doesn’t respond well to medication or even surgery. For those patients, we can try Radio Frequency Ablation (RFA), a procedure during which the myelin sheath is burned off the damaged nerve, stopping it from transmitting pain signals to the brain. The myelin sheath will grow back after six months, but many times, the pain won’t return or will return greatly diminished. RFA can be repeated as often as necessary.
For patients who still cannot find relief, we can trial a Spinal Cord Stimulator, or Spinal Neuromodulation. This device allows a current to run in the patient’s epidural space, blocking pain signals on their way to the brain, and replaces them with a sensation of gentle tapping, bubbles, high frequency or a hum. The brain is given another sensation to think about and pain is greatly reduced or eliminated. The patient is allowed to try this for a week to see if it really works for them. They can turn it off and on, adjust it up and down, etc. with a remote. If it works well and they experience a significant reduction in pain, they can move forward with permanent implantation. If not, no permanent implantation needs to be done. I have had great success with many of my polyneuropathy patients who have tried Neuromodulation when other treatments failed.
OSC also has a Pain Psychologist on staff for our chronic pain patients, as well as for any individual who needs mental health care. Andrew Martin, PsyD, provides emotional and behavioral support for and specializes in the treatment of persons with chronic pain, stress, and trauma issues. He uses evidence-based, focused, short-term therapies to give patients the tools they can use on their own to successfully deal with pain for a better quality of life.
I also am a big believer in self-care of all types. Gentle exercise, such as walking, swimming, biking or yoga, is greatly encouraged, as is eating whole and nutritious foods, that do not interfere with any underlying medical condition. Getting enough restful sleep can be difficult with nerve pain but is extremely important to healing the body. Some of my patients will also ask if they can try acupuncture, massage, water therapy or other alternative therapies to ease their pain. I simply ask that you talk to me first before trying something new. I’m open to anything that will help you to feel better, within reason.