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Massage Today
April, 2012, Vol. 12, Issue 04

Treatment Decisions for Peripheral Neuropathy

By Rita Woods, LMT

My last two articles on peripheral neuropathy (in the October 2011 and February 2012 issues of Massage Today) prompted several positive comments and treatment questions.

The focus was diabetic-induced peripheral neuropathy and chemotherapy-induced peripheral neuropathy for which I included a massage therapy protocol for treatment from the book, Step By Step Massage Therapy Protocols for Common Conditions. Here, I will broaden the list of conditions and causes of other peripheral neuropathies so you can better understand your clients condition and create a treatment plan accordingly.

First, the physiology and chain of events involved in a glucose-related neuropathy, as with diabetes, is more clearly understood than in some other neuropathies. This makes it easy to see how and why the protocol can be effective. Second, we know from experience that chemotherapy-induced peripheral neuropathy responds well to the massage protocol and is used today in some oncology massage clinics. Both of these conditions require that the underlying cause be eliminated for complete recovery. The glucose levels must be stable to prevent further damage and the chemotherapy must be completed or changed to achieve optimal results. Our work is to return the tissue back to normal (as much as is possible) through increased circulation and the condition will improve or go away. Peripheral neuropathies (PN) come with a variety of causes and in some cases, the cause is not known. Let's take a look at some of them.

Peripheral Neuropathy - Copyright – Stock Photo / Register Mark About 30% of all PNs are a direct result of diabetes. Another 30% are considered idiopathic, meaning the cause is unknown. The rest fall into several groups and are either acquired (most of them are) or inherited. Presently, there are more than 100 known causes of peripheral neuropathy. The Mayo Clinic provides this list of known causes:

  • Exposure to poisons. These may include some toxic substances, such as heavy metals, and certain medications — especially those used to treat cancer (chemotherapy).
  • Infections. Certain viral or bacterial infections can cause peripheral neuropathy, including Lyme disease, shingles (varicella-zoster), Epstein-Barr, hepatitis C and HIV/AIDS.
  • Inherited disorders. Examples include Charcot-Marie-Tooth disease and amyloid polyneuropathy.
  • Trauma or pressure on the nerve. Traumas, such as motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from using a cast or crutches, spending a long time in an unnatural position or repeating a motion many times — such as typing.
  • Tumors. Growths can form directly on the nerves themselves, or tumors can exert pressure on surrounding nerves. Both cancerous (malignant) and noncancerous (benign) tumors can contribute to peripheral neuropathy.
  • Vitamin deficiencies. B vitamins — B-1, B-6 and B-12 — are particularly important to nerve health. Vitamin E and niacin also are crucial to nerve health.
  • Other diseases. Kidney disease, liver disease and an underactive thyroid (hypothyroidism) also can cause peripheral neuropathy.

What I found missing from this list was that some medications are known to cause PN in some patients. In particular are the statins – cholesterol lowering drugs. This prompts me to remind you to get a complete medical history that includes a list of medication. Drugs are easy to look up online in order to identify possible side effects. (Please review two articles on this subject, "Chasing the Pain" from the October 2010 and February 2011 issues of Massage Today). To see how this happens, let's remember that a nerve is surrounded by a myelin sheath. Myelin is an insulating layer that forms around nerves and is made up of protein and fatty substances including cholesterol. The purpose of the myelin sheath is to allow impulses to transmit quickly and efficiently along the nerve cells. If myelin is damaged, for whatever reason, the impulses slow down or send imperfect signals that can be interrupted as pain. Stain drugs are developed to reduce cholesterol and in some patients, it prevents the myelin sheath from repairing itself. This reduces its ability to protect the nerve resulting in pain, tingling and numbness of the nerves. This can also affect nerves to internal organs. Do you see how our ability to help that client may be limited because the neuropathy is caused by nerve damage and is not the result of blocked or impaired circulation?

The neuropathies caused by physical trauma or pressure on nerves is really our area of expertise and an area in which can have a positive impact on the client. Repetitive stress often leads to entrapment neuropathies, a special category of compression injury. Cumulative damage can result from repetitive, forceful, awkward activities that require flexing of any group of joints for prolonged periods. The resulting irritation may cause ligaments, tendons and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass. Carpal tunnel syndrome is a good example of this kind of neuropathy. Remember to think it through. If the underlying cause falls within our scope of practice, then you may be able to have a positive outcome. If not, give what supportive care you can but be careful not to give false hope to the client. Help them to understand their condition and develop a treatment plan that you will both be happy with.

Click here for previous articles by Rita Woods, LMT.


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