Post on 08-Jul-2020
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Peripheral NeuropathyBryan Skulpoonkitti, DO
Balcones Pain Consultants
Buda, Cedat Par( and Lockhart
Oblectives
' - '- - -'' I(now the definition of petipheral neuopadry
' Know the common causes of peripheral neuropathy
' Know how peripheral neuropathy is diagnosed
' Know how to prevent peripheral neurop a.crry or stop the progression
I l{now what are available tteatment options
Definition of P.t pheral Neuropatbry
' - ' ' -'1\ disease ordegenerative state'of the-periphetal nerves in which motor, '
serrsory, or vasomotor nerve fibers m^y be affected and which is marked by
weakness and auoph;r, paifl, and numbness."
Causes of Peripheral Neuropathy
' Physical traun:a
e Automobile accidents
. Falls
' Sports reiated iniuries
' SurgerY
t Repetitive stress
o
Causes of Peripheral Neuropathy
' Diseases and disorders. Diabetes
' Hypothyroidism
' Ovelproduction of grolvth hormone
' Sma-llvesseldiseases
' Autoimmune diseases
' Chronic renal failure
' Cancer
' Neuroma
Causes of Peripheral Neuropathy
o Exposure to toxins
' Medication
' Hepatitis C antiviral medications
' HlV antMral rnedications
. Chemotherapy
t Enrrironmentai
' Alcohoi
Comrnon Diagnoses
' Diabetic peripheral neuropathy
o Medication induced penpheral neuropathy
' Complex regional pain syndrome
o Idiopathic penpheral neuropathy
' Carpal tunnel syndrome
. Cubital funnel syndtome
arcxlrunnel-syndiome - - -- --
Cub ttalT[nnel SYndrome
Side view of elbow
Normal ouhital tunnel Utnar nerve comPressedin the cubital tunnel
FIow to Diagnose Peripheral Neuropathy
o llistorya
a
Physical exam
Labs
' Blood glucose levels
' Kidney function labs
' Livcr cflzymcs
' \zitamio levels
' AntibodY labs
. EIVIG/NCT
. Nen e aod skin biopsy
Imaging
' CT, NIRI, and x-rays
Prevention of P*ttpheral l{europathy
Repetitive Stress
' Ergonomicrvorkstation
Disordets and diseases
' Regular follorv-up with primary care physician
' Diabetes
' l)iet and daily exercrse
' Blood glucose cootrol
' r\1c < 7Yo
' Avoid daily use of alcohol
' Decrcases B vitamin lcvcls lcadingto peripheral ncuropadrl,
. ,{void 566king
Ergonornic \K4crks tation
DOCUI,{ENTHOLQER
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ADJUSTASLE FOR
llElcl lT l"oBYr:IT,I.IHAL ANO
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Diagmm rrom "Ergonomics and VDT Use." llyer prepored bv the Liblsnr
ot ciongress corections Sarvices vor Ergonomica- s9lg1tt?1-199]-!3
What l)oes A1C rnean?
. A1C
' Teils how much glucose is attached to hemoglobin
' Hemoglobin carries oxFgen in red blood cells
' Red blood cell average life is 3 months
' Indicative of blood glucose levels over the past 3 months
' AtC levels < 7 o is ideal
Trcatrnent Options
' Nofl-steroidalanti-infl'ammatories
' Ibuprofm (Advil)
. Nlelosicrm (n'lobic)
' NaProsYn (r\Jcvc)
' Ncuropathic pain mcdications
' Gabapcntin(I"lcurontin)
' Avcragc dosc for pain reliefis 1800 mg/day
. Nlatioum dose is 3600 og/day
. Commoo side cffcct is sedation
' Pregabalin Pyrica)
' Recommcnd startingdose is 75 mg nvice a day
' Doscs above 450 mg/dry do oot harrc much bcne6t
' Common side cffcct is scdrtion
' Tolemncc to sidc cffccts dcvclops aftcr approxinatc\'4 rvceks
Trcatrnent Options
" r\nGdeprcssaotmedications
' Duloxetine (Cymbdta)
. Scrotooin-NorcpinephrioeReuptakciqhibitor
. 30 to 120 og/day
' Doses aborr 60 mg/day ue oot as effective for ncuropathic paio
' Nortdptlline(Pamelor)
. Inhibirs oorcpinephrinc md scrotonin rcuptalic
. 10 mg at night
' Less side cffccts thrc amitripq'line
. Comon sidc cffcct is scdatioo
' r\mitripq.line(Elav$
. Inhibitsoorcpinqrhrincandserotoninrcuptalie
' 25 mgat oight
' Comon sidc cffcct is scdation
Treatment Options
. Topical Pain Creams
o lidq6aine g7o
' Diclofeaac gel3o/o
' Compoundedcombinati.on
' Opiates and opioids
' Ch-tonic opiate/opioid therapy adverse effects' ".:::::ffffH:"."'
"":'il;:lo.i,;on,o bonc rncnrcs
' Decrcased thyroid hormoncs, testosterooc and esuogcn
. Weight gain and dccrcascd energl'
Treatment Options
' Peripheral nerve blocks
' Sympathetic netve blocks
. Stellate ganglion
' Lumbar sympathetic
' Radiofrequency ablation
' Spinal cord stimulators
Peripheral Nerve Blocks
G Median nerve block for carpal tunnel syndrome
I lolt$rroi lo !3Rr! t{!L$ TBr HfL
x
P.t pheral NerYe Blocks
' Posterior tibial nerve block for tarsal tunnel syndrome
..4-'* 1---..r SEA..*--* - - *aL
^GP ..a. n4.0 12.0
posterior tibial. nerve
ljlrrar nerve bl
P.ttpheral Nerve Blocks
1:OcK t()t cuDtfar turlfret
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Sy*pathetic Nerve Blocks
o Lumbar sympathetic nerve block for lower extremity neurop^thy
Sy*pathetic Nerve Blocks
Stellate ganglion nerve block for upper extremiry neck, and head neuropathy