Treatment of polyneuropathy: Drugs to relieve symptoms and progression

The main goal of treating polyneuropathy is to relieve the symptoms that polyneuropathy causes. However, there is as yet no specific drug for the effective treatment of polyneuropathy that will completely eliminate the damage and cure the disease.

It is a symptomatic, preventive treatment, one that alleviates problems that have already arisen and improves the patient's well-being.

If the cause of the symptoms and difficulties is not clear from the examination and laboratory tests, the doctor may recommend waiting and monitoring the condition to see if the neuropathy improves or progresses.

So far, there is no specific cure for polyneuropathy. The therapy is symptomatic, preventive. It relieves the already present problems and improves the patient's well-being.

The goals of treatment are as follows:

• to prevent further deterioration and nerve damage
• treatment of pain
• preserving the proper function of the organs

Preventing further deterioration and nerve damage

Important ways to slow or prevent the worsening of pre-existing neuropathy include maintaining normal glycaemia or blood sugar levels. This is especially true for people with a known diagnosis of diabetes. In addition, taking important vitamins, especially B vitamins, keeping blood pressure under control, taking care of weight and regular physical activity.

Pain management

Therapy for neuropathic pain in painful forms of polyneuropathy is neither effective nor satisfactory. Only about 50 % of patients experience pain relief.

Individualisation is the cornerstone of therapy. Each person responds differently to medication, has a different cause of neuropathy and may experience different side effects from treatment.

The first choice drugs are anticonvulsants, which are also used in the treatment of seizure disorders. The most commonly used agents with good effect are gabapentin and pregabalin.

Common side-effects include drowsiness, dizziness and oedema. Therefore, caution should be exercised in dosage when dealing with elderly people or those whose occupation requires increased attention, e.g. professional drivers or machine operators.

Other preparations are antidepressants, e.g. amitriptyline, duloxetine, etc. The most common side effects include dry mouth, drowsiness, decreased appetite and constipation.

Opioids, derivatives of opium, come into consideration for non-improving conditions as second choice drugs. They have a strong analgesic effect, but special care should be taken when using them. These drugs quickly become addictive.

Side effects include constipation, respiratory depression, euphoria, physical dependence and others.

Maintaining proper organ function

Impaired organ function requires examination by many other specialists. For example, urinary tract dysfunction requires examination by a urologist, digestive problems by a gastroenterologist, heart rhythm disorders by a cardiologist, and so on.

• Urinary and urinary tract problems are quite common in patients. It helps to establish a diary and a schedule for urination. Timed urination, i.e. voiding at the exact hour, can also be started. Patients may also find it helpful to apply pressure with a cold object, such as a spoon, to the lower abdomen where the bladder is located.

A common complication is the inability to empty the bladder completely, with residual urine remaining in the bladder. This condition predisposes to recurrent urinary tract infections.

In the case of a large volume of residual urine, bladder catheterisation is useful. A thin and flexible tube is inserted through the urethra into the bladder. This ensures a continuous outflow of urine.

• Indigestion manifests itself as gastroparesis. These are symptoms of frequent belching, upset stomach and vomiting. More frequent intake of non-irritating food in smaller portions can alleviate these symptoms.

Additional supportive treatment

Many dietary supplements are available on the market to help improve the patient's clinical condition.

The mechanisms by which they act are as follows:

• blood supply to the tissues
• improve blood circulation to the skin and muscles
• promote nerve regeneration
• reduce swelling

Consult your physician before taking any new dietary supplements to avoid unwanted drug interactions or side effects.

Topical capsaicin cream is popularly used topically on the skin. It is applied to the skin in areas where there is burning, tingling or pain, such as the soles of the feet.

Transient side effects include local skin irritation, redness and intolerance to burning heat.

Capsule preparations containing alpha lipoic acid, which is a powerful antioxidant, are used. It is also found naturally in some foods, e.g. potatoes and fruit.

Oxidative stress is a known factor in damage to blood vessels and subsequently nerves. Therefore, the use of all types of antioxidants is very effective in preventing neuropathy. Of the antioxidants, alpha lipoic acid is the most effective.

Acupuncture is a well-known method of Eastern medicine that helps with various types of chronic pain and is also effective in managing neuropathic pain.