Managing patients with peripheral neuropathy involves providing both supportive care as well as symptomatic management.1 Although pharmacologic therapy can slow the progression of neuropathy, chronic residual symptoms typically persist in most patients. Supportive care includes routine foot care and surveillance of wounds for patients with sensory loss in their feet, orthotic devices for patients with weakness, and balance training and/or exercises when a patient’s gait is affected.
First-line treatment options for the management of neuropathic pain are listed in Table 3.1 An agent should be chosen based on the patient’s comorbidities, concomitant medications, as well as medication cost. An agent should be increased to the goal dose prior to concluding therapeutic failure. If a medication fails or is not tolerated, initiating another agent from a different medication class is the next step. In addition, combination therapy has been shown to be more effective compared to monotherapy, therefore should be attempted prior to initiating a second-line agent.
Peripheral neuropathy is a common neurologic disorder with diverse presentations.1 A recent review by Doughty and Sadjadi discussed the importance of utilizing a standardized approach to evaluate, diagnose, and manage a patient with suspected neuropathy. Treatment of peripheral neuropathy includes both supportive care as well as symptomatic treatment.
1. Doughty CT, Sadjadi R. Approach to Peripheral Neuropathy for the Primary Care Clinician. Am. J. Med. 2018; DOI: https://doi.org/10.1016/j.amjmed.2017.12.042.
|Type||Comments||Signs & Symptoms|
|Sensory|| • Typically observed first
• Include large diameter fibers (mediate vibratory sensation, proprioception) and small diameter fibers (mediate sensations of pain, temperature)
| • Numbness
• Loss of coordination/falls
• Ataxia, sensory ataxia
• Decreased/loss of vibratory, pain, and temperature sensations
|Motor||• Typically observed later|| • Weakness
|Autonomic||• Typically observed later
• May be only or most prominent sign/symptom (rare)
| • Dizziness
• Dry eyes, mouth, or skin
• Blurry vision
• Hair loss
• Changes in the skin
• Early satiety
• Coldness, flushing
• Bladder dysfunction
• Orthostatic hypotension
• Cold, pale feet