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Neuropathy

A nerve problem that causes pain, numbness, tingling, swelling, or muscle weakness in different parts of the body. It usually begins in the hands or feet and gets worse over time. Neuropathy may be caused by physical injury, infection, toxic substances, disease (such as cancer, diabetes, kidney failure, or malnutrition), or drugs, including anticancer drugs. NIH - National Cancer Institute

What works? Research summarized

Evidence reviews

[Opioids in the management of pain in diabetic neuropathy]

Bibliographic details: Moreno CB, Gutierrez-Alvarez AM.  [Opioids in the management of pain in diabetic neuropathy]. [Opioides en el manejo del dolor en la neuropatia diabetica.] Archivos de Neurociencias 2010; 15(1): 31-34

Effects of methylcobalamin on diabetic peripheral neuropathy: a systematic review

Bibliographic details: Jia H Y, Tian H M, Wei D.  Effects of methylcobalamin on diabetic peripheral neuropathy: a systematic review. Chinese Journal of Evidence-Based Medicine 2005; 5(8): 609-617

Autologous transplantation of stem cells for diabetic peripheral neuropathy: a systematic review

Bibliographic details: Wang F, Gao W, Ran XW.  Autologous transplantation of stem cells for diabetic peripheral neuropathy: a systematic review. Chinese Journal of Evidence-Based Medicine 2013; 13(9): 1090-1095 Available from: http://www.cjebm.org.cn/oa/DArticle.aspx?type=view&id=20130911

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Summaries for consumers

Treatments that suppress or modify the immune system for multifocal motor neuropathy

Multifocal motor neuropathy is a rare condition causing progressive weakness of the limbs, especially the hands and arms. This disorder is believed to be driven by an immune‐based process. The usual treatment is infusion of immunoglobulin (antibodies purified from the blood) into a vein. This is expensive, needs to be repeated every few weeks and is not always completely effective. Immunosuppressive drugs (drugs that suppress immune responses) such as cyclophosphamide, azathioprine, ciclosporin, interferon beta‐1a, mycophenolate mofetil and rituximab have been tried as initial or add‐on treatments. This updated review looked for evidence of the benefits and harms which they produce. Only one randomised controlled trial, of a drug called mycophenolate mofetil, was found. This medication, when used with immunoglobulin, did not reduce the requirement for immunoglobulin or improve muscle strength of trial participants with multifocal motor neuropathy. No serious side‐effects were observed. Bias is low in this study. New randomised controlled trials of other immunosuppressive drugs are needed to identify beneficial treatments for multifocal motor neuropathy.

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.

Surgery for the treatment of traumatic optic neuropathy

The optic nerve transmits visual information from the eye to the brain and traumatic optic neuropathy (TON) refers to any injury to the optic nerve secondary to trauma. After the optic nerve has been injured, it becomes more swollen and this can lead to further damage. Traumatic optic neuropathy often results in severe visual loss and the vast majority of affected patients are young males in their thirties. Surgery has been used in TON to try and reduce this abnormal swelling or remove bone fragments. There are currently no good quality studies that show greater visual improvement following surgery compared to no treatment. Surgery carries a definite risk of complications which must be considered.

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