neuropathy Nerve in need itch By Susanne Poth / permanent and tingling toes and legs, as if an ant colony darüberkrabbelt. This nightmare scenario many people must endure with neuropathy daily. What causes this insidious disease, which treatment options are there, and what recommendations can PTA or pharmacist Pronounce? display When neuropathy is a disease of the central or peripheral nervous. Unlike the classic pain with an injury, inflammation or irritation of the healthy tissue has an important function as a warning signal, when the neuropathy pain-conducting system itself is damaged. By hyperexcitability of damaged nerves leads to the described irritation phenomena. In the industrialized nations, the number of people affected should be 2 to 4 percent and increases with age up to 8 percent. It seems regardless of gender, to be racial and socio-economic status. Many neuropathy patients suffer from itching and tingling of the legs and feet. To prevent damages, especially diabetics should inspect their feet daily for changes.
Photo: Lilly Pharma Holding GmbH Many sufferers suffer from constant itching or tingling of the legs and feet, sometimes with burning the soles, also called “burning feet”. In addition, irritation of touch, and motor functions, reduction in reflection, for example, paralysis of the eye muscles, muscle cramps and a decreased touch, temperature and pain. Typical of some neuropathic pain syndromes like trigeminal neuralgia or zoster neuralgia are spontaneous stabbing pain attacks. The nerve pain usually take in the disease process continuously and spread gradually throughout the nervous system (polyneuropathy). High risk for diabetics The most common cause of neuropathy is diabetes mellitus. Both type 1 and type 2 diabetes, it occurs as a result of sustained high blood sugar levels, because this damage in addition to the blood vessels and nerves. So about half of people with diabetes is affected by this disease, which can affect both the peripheral nerves and the autonomic nervous system. Later in this autonomic neuropathy organs damaged: So come incontinence, gastroparesis, or erectile dysfunction, and cardiac arrhythmias in the risk of cardiac arrest. Another cause of the damage to the nerves of chronic alcohol abuse or neurotoxins are eligible. Moreover neuropathies are often accompanying symptom of infections such as shingles, HIV or Lyme disease. Also permanent pressure on a nerve can cause malfunctions, such as the herniated disc or carpal tunnel syndrome.
If the nerve damage, an atypical activity and sensitization of afferent pain-sensitive nerve fibers is usually the result. Thus, the function of ion channels and pro-inflammatory substances changes are propagated released. Difficult diagnosis Asking the diagnosis of neuropathy, is difficult and requires a thorough history of the doctor expected. It is based on specific questionnaires, a neurological examination and sensitivity tests of vibration, shock and temperature perception. When indicated, the physician performs cardiovascular examinations and tests the function of the autonomic nervous system. As further diagnostics measuring the nerve conduction and electromyography come by the neurologist into consideration. Depending verdächtigtem trigger examine physicians whether a tumor or toxins cause discomfort. Causes of neuropathy Metabolic diseases such as diabetes Viral diseases such as shingles (herpes zoster), HIV infection Mechanical nerve injuries caused by trauma, herniated disc, carpal tunnel syndrome Taking neurotoxic substances or poisons such as cytostatics, heavy metals or alcohol abuse
Inflammatory changes in the blood vessels (vasculitis), or of the nervous system Degenerative diseases such as multiple sclerosis, Alzheimer’s, Parkinson’s or stroke Approximately 40 percent of all patients in pain clinics and pain clinics suffer from neuropathic pain. Standard analgesics not help most. By careful selection of the active ingredient and optionally a combination of various substances with other treatment options, however, can significantly alleviate by 30 to 50 percent of the pain. Therapeutic goal is to maintain or restore the sleep and quality of life and the working capacity of the patient. Symptoms of peripheral neuropathy light touch results in disproportionately severe pain (allodynia) Pain is perceived differently, such as tingling or pinprick (dysesthesia, paresthesia) pain sensitivity is either increased (hyperalgesia) or decreased (hypoalgesia) Pain remains after the releases consist (Hyperpathy) Is polyneuropathy result of another disease, such as diabetes mellitus, alcohol abuse or poisoning is the causal therapy in the first place, which means a good glycemic control and abstinence from alcohol or detoxification. The most common drug classes of symptomatic therapy include tricyclic antidepressants such as amitriptyline and imipramine, newer antidepressants from the group of serotonin-norepinephrine reuptake inhibitors such as duloxetine and venlafaxine and acting on neuronal calcium channels anticonvulsant pregabalin.
Diabetics should be tested regularly served by a podiatric specialist in foot care. Photo: Super Image Some patients received tramadol as the drug does not only affect the opioid, but also to the serotonergic and noradrenergic receptors. Depending on the intensity of pain doctors combine a opioid with a psychotropic drug. Only mild pain they cause a temporary therapy experiment with painkillers such as paracetamol or metamizol. If the neuropathic pain syndrome associated with an inflammatory component, but not in diabetic polyneuropathy, the patient can also take NSAIDs (NSAIDs) in addition. Based on the findings of the molecular and biochemical mechanisms in neuropathies develop scientists currently taking medication with other mechanisms of action, for example in the direction of a blockade of sodium and calcium channels. In recent years came with active substance patches containing local anesthetics, new therapeutic options on the market. So a lidocaine patch (Versatis®) was developed for the relief of neuropathic pain after healing of herpes zoster infection. After the skin symptoms have healed, the patient should apply the patch about six weeks. In parallel, researchers observed that the active substance capsaicin on vanilloid receptor initially triggers a burning sensation, but after repeated use affects pain relieving effect. From this they developed a prescription high dose capsaicin patch (Qutenza®), which is on the market since of 2010. The patch is suitable for HIV-associated neuropathies and neuralgia after herpes zoster infection, always has the skin intact.
For painful diabetic polyneuropathy, but the two patches according to the treatment guidelines are not suitable. substitution controversial For other ways to support the drug therapy, there are no clearly documented evidence of efficacy. With proven vitamin deficiency but a substitution therapy is helpful, alcoholics lacks example most vitamin B1. Patients with sensory loss can help the intake of alpha-lipoic acid. The substance is not a vitamin, but a coenzyme. In vitro and animal studies indicate an antioxidant protective function of lipoic acid against oxidative nerve damage. Also be first placebo-controlled human studies suggest that alpha-lipoic acid at least temporarily improve symptoms and individual parameters of nerve functions. In the current guideline neuropathy in diabetes, the use of the substance is not recommended due to lack of available data. In the future, earlier diagnosis The damage to the nerve pathways to recognize even before the first symptoms, to take early therapeutic countermeasures, is the goal of a new diagnostic method. A working group of the University of Rostock succeeded using a special microscope method to detect changes in the nerve center of the cornea of the eye. From the image obtained is possible to draw conclusions on the extent of diabetic neuropathy.
Many patients turn to non-drug therapies, their action is not always clearly established. The effect depends on the type of neuropathic disease. For example, two-chamber baths stimulate circulation of the feet and thus contribute to pain relief. Physiotherapy and orthopedic aids that facilitate walking, and in particular the right shoes to reduce the risk of injury in patients with diabetic neuropathy. For the effectiveness of electrical nerve stimulation are effectiveness evidence justifying a therapeutic trial. These include transcutaneous electrical nerve stimulation (TENS), the frequency-modulated electromagnetic nerve stimulation (FREMS), a special form of TENS, and the high tone (nerve stimulation at higher frequencies). advice needed Complains a customer about sensory loss, numbness or canted pain, should recommend him to visit a doctor or neurologist PTA or pharmacist. This can clarify possible causes and prevent, for example, in infectious polyneuropathy through early causal therapy, the disease becomes chronic. Diabetics should be made aware of the increased risk of neuropathy and also noted that the optimum adjustment of blood glucose levels can slow the progression of the disease, especially in younger patients. Often, the nerves of the lower legs of the first affected, and it comes to diabetic foot ulcers. Patients complain of burning feet, drilling, stabbing or cramping pain that worsens at rest, be improved while running on the other hand. As a result of the discomfort of legs and feet sufferers often feel not when her feet were injured, for example by pressing shoes and pedicures.
Unnoticed infections are spreading, at the same time favoring existing circulatory problems yet. Not infrequently necrosis develop. According to the German Diabetes Center at the University of Dusseldorf in Germany lose therefore approximately 25,000 diabetics each year a foot or part of a leg. Maintain feet properly The advice to all diabetics is this: In order to prevent the development of diabetic neuropathy, they should – maintain their weight and blood pressure in the normal range, do not smoke and only drink alcohol excessively – besides the near normal control of blood sugar levels. Annually they should checked the neurological functions in their diabetologists. Particular attention is the feet. To prevent diabetic foot syndrome, the shoes should fit well and not cause bruising. Walking barefoot can lead to foot injuries. Diabetics should inspect their feet daily to changes and maintain the feet gently, is best supported by a specialist in medical pedicure. Podiatrists treat warts, calluses, corns or ingrown toenails. Cave: If the foot of a diabetic injured, there is always an emergency and must be treated urgently. /