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

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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

18

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