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Exercise for treating people with diseases of their peripheral nerves (peripheral neuropathy)

Peripheral neuropathies are a wide range of diseases (both genetic and acquired) affecting the peripheral nerves. Symptoms can include pain, altered sensation such as tingling or numbness, muscle weakness and fatigue. Exercise therapy, with a view to improving strength and stamina, forms part of many rehabilitation programmes after a peripheral neuropathy. This review found inadequate evidence from randomised controlled trials to evaluate the effect of exercise in disability in peripheral neuropathy. There was evidence that strengthening exercises moderately improve muscle strength in people with a peripheral neuropathy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Chinese herbal medicine for treatment of diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. It is characterised by a progressive loss of nerve fibres that predisposes the person to painful or insensitive extremities, ulceration and amputation, and results in a large disease burden in terms of incapacity for work, quality of life and use of healthcare resources. This systematic review identified a total of 49 trials that included 3639 participants with DPN. Ten of the trials were new at this first update of the review. We evaluated the effects of various herbal formulations (including single herbs, Chinese proprietary medicines and mixtures of different herbs) for treating people with DPN. All the identified clinical trials were performed and published in China. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. The positive results described from the 49 studies of low quality are of questionable significance. There was inadequate reporting on adverse events in the included trials. Most of the trials did not mention whether they monitored for adverse effects. Only two trials reported adverse events but an adverse event occurred in the control group in one trial and it was unclear in which group they occurred in the other trial. Conclusions about the safety of herbal medicines cannot therefore be drawn from this review due to inadequate reporting. Most of the trials were of very low methodological quality and the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating DPN should be made with caution. Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for DPN. No well‐designed, randomised placebo controlled trial with objective outcome measures has been conducted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Immune treatments for peripheral neuropathy caused by an IgM paraprotein antibody, which may bind to MAG, a protein on the myelin sheath of nerves

IgM anti‐myelin‐associated glycoprotein paraprotein‐associated peripheral neuropathy is a condition affecting more men than women, most commonly over the age of 60 years. An IgM paraprotein (a cloned antibody of one type) in the blood may be an antibody that reacts against myelin‐associated glycoprotein (MAG), a molecule on the insulating myelin sheath of nerves. The antibody probably results in damage to the nerve fibres to which it is bound and thus causes a specific type of peripheral neuropathy. Treatments that act on the immune system such as plasma exchange (which removes circulating antibodies and replaces blood plasma with a clean plasma substitute), intravenous immunoglobulin (antibodies that have been purified from donated blood), rituximab (which kills some of the cells that produce the antibody), corticosteroids or chemotherapeutic drugs might be expected to reduce levels of these antibodies and slow or prevent progression of the disease. Many of these therapies have been tried in non‐randomised studies but we found only seven small randomised controlled trials, involving 182 participants, that were of adequate quality to be included in this review. Two trials with 33 participants (20 with antibodies against myelin‐associated glycoprotein) suggest that intravenous immunoglobulin may sometimes produce short‐term benefit and is relatively safe. No severe adverse effects related to intravenous immunoglobulin were reported in these trials. A trial of cyclophosphamide and steroids showed some mild benefit. A trial of rituximab was of very low quality with a high risk of bias and a further, larger study is awaited. The other trials did not allow conclusions to be drawn about the efficacy of other agents. Large, well designed randomised trials are needed to assess the efficacy of the existing and novel therapies, and better ways are needed for doctors and researchers to detect changes that patients report in response to treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatments that suppress the immune system for neuropathy caused by non‐systemic vasculitis (inflammation of blood vessels limited to those supplying the peripheral nerves)

Non‐systemic vasculitic neuropathy ('isolated vasculitic neuropathy') is a rare disease causing progressive, disabling, painful loss of sensation with muscle weakness in arms and legs that is often asymmetrical. The diagnosis is made through the finding of inflammation of blood vessels confined to nerve or muscle tissue, or both, and by excluding other conditions that could be the cause, such as systemic vasculitis (inflammation of blood vessels affecting multiple organs in the body), rheumatic diseases, or any other cause for the neuropathy. This is an updated review. No randomised controlled clinical trials have been performed on which to base immunosuppressive treatment for non‐systemic vasculitic neuropathy. Blinded randomised trials of adding other immunosuppressive agents to corticosteroids are needed. Such trials will need sufficiently long follow‐up periods to evaluate treatment efficacy with disability outcome measures designed and validated for assessing change in immune‐mediated inflammatory neuropathies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment for Charcot‐Marie‐Tooth disease (hereditary motor and sensory neuropathy)

Charcot‐Marie‐Tooth disease is a broad spectrum of different types of inherited peripheral neuropathy. The most common types affect motor and sensory nerves and cause muscle wasting and sensory loss. There have been few trials of treatment for Charcot‐Marie Tooth disease. One very small trial of the nerve growth promoting factor, neurotrophin‐3, showed possible benefit but needs to be replicated. Trials of exercise, orthosis, creatine and ganglioside injections have been done but did not show significant benefit. These were all too small to identify moderate benefit or harm. Trials of vitamin C for the commonest type of Charcot‐Marie Tooth disease are in progress.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Lower limb surgery to release trapped nerves in diabetic neuropathy

This review analyzed the role of decompressive surgery of lower limb nerves for symmetrical diabetic peripheral neuropathy. Peripheral neuropathy is one of the most common complications of diabetes. Pain and numbness in the feet are common features. Pain may impair the quality of life and lack of feeling puts the diabetic foot at increased risk of ulceration. Strict glucose control may reduce the risk of developing diabetic neuropathy but once developed, neuropathy is irreversible and slowly progressive. New treatment strategies are needed to treat diabetic neuropathy. In this review, the role of surgical decompression of "entrapped" peripheral nerves as an alternative approach to treatment for diabetic neuropathy was analyzed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Treatment for IgG and IgA paraproteinaemic neuropathy

Paraproteinaemic neuropathy refers to those neuropathies associated with a paraprotein (an abnormal antibody or immunoglobulin present in relative excess in the blood). If the paraprotein is present without underlying evidence of disease, this is known as a monoclonal gammopathy of uncertain significance. This review looked at the treatments for neuropathy associated with and possibly caused by IgG and IgA paraproteins. The optimal treatment is not known. Treatments that act on the immune system such as plasma exchange, corticosteroids or intravenous immunoglobulin have been examined in non‐randomised studies of people with IgG and IgA paraproteinaemic neuropathy. We identified only one randomised controlled trial of 18 participants treated with plasma exchange. The trial demonstrated a modest benefit over a short follow‐up period. The long‐term benefit is unclear. Further randomised controlled trials of this and other treatments with larger numbers of participants are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia

Duloxetine is a drug used to treat depression and urinary urge incontinence (leakage of urine) and it can be also be useful for certain types of pain. Pain can arise spontaneously when there is damage to nerves that carry pain information to the brain (neuropathic pain). When this damage is to nerves outside the spinal cord it is called a peripheral neuropathy. Another type of pain, nociceptive pain, occurs when the nerves sense damage to another tissue (for example, a pinprick in the skin). Some pain is of unclear origin and occurs without apparent nerve or tissue damage. This sort of pain happens, for example, in fibromyalgia. The objective of this review was to assess the benefits and harms of duloxetine for treating painful neuropathy and chronic pain of all sorts.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Vitamin B for treating disorders of the peripheral nerves

Peripheral neuropathy is a disorder of the peripheral nerves resulting from different causes, such as diabetes mellitus and alcoholism, leading to pain, numbness or weakness of the limbs and other problems. Vitamin B is commonly used to treat peripheral neuropathy but it is not clear if it helps. This review of 13 trials on diabetic and alcoholic peripheral neuropathy with a total of 741 participants showed only one study that suggested possible short‐term benefit from eight‐week treatment with benfotiamine (a derivative of vitamin B1) with slightly greater improvement in vibration perception threshold compared to placebo. Vitamin B complex when given in a higher dose administered for four weeks was more efficacious than a lower dose in reducing pain and other clinical problems based on another study. Two to eight weeks of treatment with vitamin B was less efficacious than alpha‐lipoic acid, cilostazol or cytidine triphosphate in short‐term improvement of clinical and nerve test findings. All these findings require confirmation in larger studies before they can be accepted as definite. Vitamin B is generally well‐tolerated with only a few reports of mild side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Lacosamide for neuropathic pain and fibromyalgia in adults

Antiepileptic drugs like lacosamide are commonly used for treating neuropathic pain, usually defined as pain due to damage to nerves. This would include postherpetic neuralgia (persistent pain experienced in an area previously affected by shingles), painful diabetic neuropathy, nerve injury pain, phantom limb pain and trigeminal neuralgia; fibromyalgia also responds to some antiepileptic drugs. This type of pain can be severe and long‐lasting, is associated with lack of sleep, fatigue, depression and a reduced quality of life. This review included five studies in painful diabetic neuropathy (1863 participants) and one in fibromyalgia (159 participants). In people with painful diabetic neuropathy, lacosamide had only a modest effect, with a specific effect due to its use in 1 person in 10. This is a minor effect and may be an over‐estimate due to use of the last observation carried forward method for analysis. There was insufficient information in fibromyalgia to draw any conclusions about the effect of lacosamide. There was no significant difference between lacosamide and placebo for participants with any, or a serious, adverse event, but there were significantly more adverse event withdrawals with lacosamide. Regulatory authorities have not licensed lacosamide for treating pain based on evidence presently available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Oxcarbazepine for neuropathic pain

Neuropathic pain is pain that arises from damage to the part of the nervous system that carries sensory information to the brain. It is difficult to treat because of its severity, duration and resistance to simple painkillers. Some studies have suggested that oxcarbazepine, when given on its own, can relieve pain from nerve damage. To investigate the benefits and harms of oxcarbazepine in different forms of neuropathic pain, we performed a comprehensive search for randomised controlled trials and found four trials, involving 634 participants with painful diabetic neuropathy and 145 with neuropathic pain due to radiculopathy. All were funded by the manufacturer. The results showed that oxcarbazepine produced pain relief and an improved global impression of change in pain at 16 weeks for people with diabetic neuropathy. This evidence, which was of moderate quality, only included data from the single positive trial, and did not take into account negative results from other diabetic peripheral neuropathy trials that could not be included in our analysis. For painful radiculopathy, data from the only included trial showed no significant efficacy of oxcarbazepine. Although trial reports stated that most side effects were mild to moderate in severity, the number of any kind of event and those leading to participants' dropping out of the trials were both higher in the oxcarbazepine group than in the placebo group, and serious events were not uncommon. In the radiculopathy trial, numbers with serious adverse events were similar with oxcarbazepine and placebo, but with oxcarbazepine more people experienced adverse events that led them to stop treatment. We did not find studies of oxcarbazepine for other types of neuropathic pain that met our inclusion criteria. More well designed randomised controlled trials of oxcarbazepine for various types of neuropathic pain are needed, with large numbers of participants spread over different centres. Such studies should also compare the effect of different dosages on pain relief.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

When used with AZT, ddI and perhaps ddC, can delay HIV disease progression and death

Zidovudine (AZT) was the first antiretroviral drug used in HIV and AIDS. It is expensive and has several adverse effects including nausea, vomiting, blood problems (anaemia and neutropenia) and myopathy (muscle weakness). The next two drugs developed for HIV were didanosine (ddI) and zalcitabine (ddC). The adverse effects of ddI include nausea, vomiting, diarrhoea and problems with the pancreas (pancreatitis) and nerves in the arms and legs (peripheral neuropathy). Adverse effects of ddC are mouth ulcers and peripheral neuropathy. The review of trials found that both HIV disease progression and death are delayed by ddI, and perhaps also by ddC, at least when used with AZT.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Premenstrual syndrome: Can dietary supplements help?

Many women regularly experience mood swings, pain and breast tenderness on the days before their period. Some evidence suggests that pyridoxine (vitamin B6) can help relieve these symptoms. Calcium and chaste tree extracts (vitex agnus castus) also seem to help.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 19, 2013

Educating people with diabetes about foot care to help reduce foot ulcers and amputations

Foot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease (PVD)), or both. People with ulcers due to diabetes sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring. This review of high‐level studies found that educating people with diabetes about the need to look after their feet seems to improve people's foot care knowledge and behaviour in the short term. There is insufficient evidence that education alone, without any additional preventive measures, will effectively reduce the occurrence of ulcers and amputations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Combined strategies to avoid foot ulcers in patients with diabetes

Foot ulcers (open sores) are common in people with diabetes mellitus (type 1 and type 2), especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease) or both. People with ulcers due to diabetes will sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life, but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring, for example, by showing patients with diabetes how to look after their feet or by prompting doctors to check their patients' feet more often. The results of single prevention strategies alone have so far been disappointing, therefore in clinical practice, preventive interventions directed at patients, healthcare providers and/or the structure of health care are often combined. In this review of trials of complex, preventive interventions, we found insufficient evidence that these combined approaches can be effective in reducing foot problems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

There is no compelling evidence to support the use of the herbal medicines identified in this review for treatment of HIV infection and AIDS.

People with HIV infection or AIDS frequently seek alternative or 'complementary' therapies for their illness. Although many trials of these therapies exist, very few meet the scientific standards necessary to support the claims of beneficial effects in the therapies studied. This review identified nine randomized clinical trials, which tested eight different herbal medicines, compared with placebo, in HIV‐infected individuals or AIDS patients with diarrhoea. The results showed that a preparation called SPV30 may be helpful in delaying the progression of HIV disease in HIV‐infected people who do not have any symptoms of this infection. A Chinese herbal medicine, IGM‐1, seems to improve the quality of life in HIV‐infected people who do have symptoms. Another herbal compound ,SH, showed an increase of antiviral benefit when combined with antiretroviral agents. A South American herb preparation, SP‐303, may reduce the frequency of abnormal stools in AIDS patients with diarrhoea. Other herbs tested were no better than placebo; however, the beneficial effects need to be considered with caution because the number of patients in these trials was small and the size of the effects quite moderate. In one trial the use of medicinal herbs was related to adverse effects such as gastrointestinal discomfort. Conclusion: No compelling evidence exists to support the use of the herbal medicines identified in this review for treatment of HIV infection and AIDS. To ensure that evidence is reliable, there need to be larger and more rigorously‐designed trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Tramadol for neuropathic pain

Neuropathic pain is frequently caused by damage to the peripheral nerves. Symptoms may include burning or shooting sensations, and abnormal sensitivity to normally non‐painful stimuli. Neuropathic pain is difficult to treat. Anticonvulsants and antidepressants are frequently used but their use is limited by side effects. Tramadol is a unique pain killing drug with mild opiate properties.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Gastrointestinal Complications (PDQ®): Patient Version

Expert-reviewed information summary about constipation, impaction, bowel obstruction, and diarrhea as complications of cancer or its treatment. The management of these problems is discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 12, 2013

AIDS-Related Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of AIDS-Related Lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 2, 2014

Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood acute myeloid leukemia, myelodysplastic syndromes, and other myeloproliferative disorders.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 5, 2014

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