Peripheral Neuropathy Treatment

[Pain Applicant1]

Does anyone do epidurals for treatment for peripheral neuropathy somewhere between meds and stim? If so, why would it provide relief?

Also, anyone do peripheral nerve blocks (sural, saphenous) for treatment?

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[lobelsteve]

THERE IS NO ROLE FOR SCS OR ESI FOR PERIPHERAL NEUROPATHY.

The folks using SCS off label to treat may get good early results, but if the data (from industry no less) reports 17 cases of SCS for DM PN. 70% success.

If you can make it work, publish your 2 year data and demonstrate clinically and functionally relevant endpoints. Didn't think so. I have a dozen batteries in my drawer that say otherwise for SCS in PN.

 

[NorthernDoc]

never heard of epidurals for diabetic neuropathy.

Ive read recently, ( and more articles are being published on this topic...led by Doohee lee), that tarsal tunnel syndrome may be responsible for most of the symptoms of peripheral diabetic neuropathy, and that surgical decompression may be the way to go.

Since reviewing the litterature on this possible paradigm shift, ive added in my treatment algorithm , for patients that fail to get relief from neuropathic agents ( ill try various types first) , an ultrasound exploration for any signs of entrapment neuropathy , followed by a diagnostic and therapeutic xylocaine-cortisone injection. If they respond well, but it doesnt last, i send them off to a neurosurgeon for exploration and nerve release.

 

[SSdoc33]

never heard of epidurals for diabetic neuropathy.

Ive read recently, ( and more articles are being published on this topic...led by Doohee lee), that tarsal tunnel syndrome may be responsible for most of the symptoms of peripheral diabetic neuropathy, and that surgical decompression may be the way to go.

Since reviewing the litterature on this possible paradigm shift, ive added in my treatment algorithm , for patients that fail to get relief from neuropathic agents ( ill try various types first) , an ultrasound exploration for any signs of entrapment neuropathy , followed by a diagnostic and therapeutic xylocaine-cortisone injection. If they respond well, but it doesnt last, i send them off to a neurosurgeon for exploration and nerve release.

if you are concerned about tarsal tunnel syndrome, get an EMG - rather than ultrasound. more highly validated and objective -- rather than just looking at a flattened nerve o a fuzzy black and white screen.

 

[PMR 4 MSK]

TTS is, by itself, a controversial diagnoses, as there are no standardized criteria for it's diagnosis. To then make the leap that a controversial Dx is responsible for most of the pain in DM PPN makes me very skeptical of this claim.

Since release of the carpal ligament in CTS superimposed on PPN often results in no improvement in symptoms, I would be even less optimistic about releasing the TT.

As a last, or near-last resort, I can see trying it, but not front line therapy.

 

[SSdoc33]

TTS is, by itself, a controversial diagnoses, as there are no standardized criteria for it's diagnosis. To then make the leap that a controversial Dx is responsible for most of the pain in DM PPN makes me very skeptical of this claim.

Since release of the carpal ligament in CTS superimposed on PPN often results in no improvement in symptoms, I would be even less optimistic about releasing the TT.

As a last, or near-last resort, I can see trying it, but not front line therapy.

i think the theory is that since diabetics are more prone to compression neruopathies (CTS is more common in diabetics), therefore tarsal tunnel may also play a role in foot pain, rather than just peripheral neuropathy.

 

[Doctodd]

i use a compounded cream with gabapentin, an NSAID, a 'caine, some capsaicin, and some other stuff.

 

[bedrock]

i use a compounded cream with gabapentin, an NSAID, a 'caine, some capsaicin, and some other stuff.

I use a similar cream, which can be helpful.

THERE IS NO ROLE FOR SCS FOR PERIPHERAL NEUROPATHY.

The folks using SCS off label to treat may get good early results, but if the data (from industry no less) reports 17 cases of SCS for DM PN. 70% success.

Steve's being a bit dogmatic again I fear. I completely agree that SCS doesn't work most of the time for PN. I would never use it for someone with only numbness or pins/needles. SCS isn't going to help those symptoms, but if someone has significant burning pain from PN, non responsive to multiple oral and topical neuropathic meds, then yeah I'm going to do an SCS trial, and on the rare occasions that I've done this, they've had worthwhile relief.

 

[lobelsteve]

I use a similar cream, which can be helpful.




Steve's being a bit dogmatic again I fear. I completely agree that SCS doesn't work most of the time for PN. I would never use it for someone with only numbness or pins/needles. SCS isn't going to help those symptoms, but if someone has significant burning pain from PN, non responsive to multiple oral and topical neuropathic meds, then yeah I'm going to do an SCS trial, and on the rare occasions that I've done this, they've had worthwhile relief.

So publish this. If lost to follow up I can mail you an ipg. 😉