I have treated neuropathology ever since I graduated from New York Chiropractic College in 1978. However, I have found that many patients did not know chiropractors treated neuropathy. Only a small percentage of people truly know what chiropractors do. Yes, we do more than just treat back pain.
My goal is to educate the public that conditions such as degenerative disc disease and neuropathy are the essence of what we do. There is a correlation between disc disease and neuropathy. Pain down the leg, numbness, and tingling leads to the obvious diagnosis is of sciatica. However, these are also neuropathy symptoms.
To treat both disc disease and neuropathy, doctors must understand the symptoms of both DDD and neuropathy. Symptoms of peripheral neuropathy typically begin in the longest nerves first, usually in the toes and feet. Symptoms can include numbness or altered sensations, such as a bunched sock feeling under the toes, which can be debilitating for the patient.
Peripheral neuropathy is damage to the nerves in the legs and arms. Idiopathic means that the underlying cause of the nerve damage is unknown, so an MRI may be necessary to look for disc occlusion.
This condition can have significant symptoms, and some patients notice no symptoms at all. The Cleveland Clinic estimates that 25 to 30% of Americans will be affected by peripheral neuropathy. They estimate that 30 to 40% of cases of peripheral neuropathy are idiopathic in nature. At our NeuroDoc and Disc Centers of America clinics, our doctors utilize laser, LED therapy, and electroanalgesics with a tremendous success rate. Some studies show up to a 90% success rate, especially when you supplement with nitric oxide.
Let’s review the basics. Symptoms of peripheral neuropathy typically begin in the longest nerves first, usually in the toes and feet. Symptoms can include numbness, tingling, pain, and oversensitivity to touch. Strange altered sensations may be present. Patients can describe the feeling that they have a bunched sock under their toes when they are not wearing a sock. Others report it feels as if they are walking on leather, rocks, or have something wrapped around their feet. Sometimes a stimulus that is not normally painful is now perceived as painful, such as a sheet touching a foot.
Some people do not notice any symptoms at all. These patients do not notice that they have lost sensation in their feet because the loss was so gradual that it seems normal. They have no abnormal or strange sensations in their feet but may gradually lose balance or develop a painless sore on their foot that normally would be expected to be painful.
Peripheral neuropathy can lead to loss of balance, weakness, hammertoes, and foot deformity. Severe peripheral neuropathy may require the use of a cane, walker, or foot braces. The condition typically worsens as a person ages.
Loss of sensation in the feet can be serious. A person can develop a sore on the foot that they do not feel even when it becomes severely infected, which can lead to amputation of toes, legs, and in rare cases, even death.
The loss of balance associated with peripheral neuropathy is also very serious since it puts a person at higher risk of falls. Falls can have catastrophic consequences, which is why your diagnosis and treatment protocols are so important.
Falls are the most common cause of injury in elderly adults (age 65 and older). One-third of elderly adults fall each year, and the risk of falling triples if you have a neurologic disorder such as peripheral neuropathy. Twenty to thirty percent of older people who fall suffer moderate to severe injuries, such as hip fractures and head traumas. These injuries can be life altering and even deadly. According to the Centers for Disease Control and Prevention, falls kill more than 18,000 older adults each year.
Why We Fall
Balance is the ability to maintain the body’s center of mass over its base of support. A properly functioning balance system allows humans to see clearly while moving, identify orientation with respect to gravity, determine direction and speed of movement, and make automatic postural adjustments to maintain posture and stability in various conditions and activities. Our balance depends on the coordination of input from the following multiple sensory systems:
Visual system: Sight provides information on the verticality of the body and spatial location relative to objects.
Proprioception provides information from skin (touch) and joints (pressure and vibratory senses).
Vestibular system: Our sense organs provide information on direction, motion, equilibrium, and spatial orientation.
Our bodies need to integrate sensory input and translate it into motor output that is sent to the eyes and muscles.
Maintaining balance depends on information received by the brain from three peripheral sources: eyes, muscles and joints, and vestibular organs. All three of these sources send information to the brain in the form of nerve impulses from special nerve endings called sensory receptors. Peripheral neuropathy (PN) is a disorder of the motor, sensory, and autonomic nerves. So, in addition to aging, PN patients are at a greater risk of falling because numbness, decreased sensitivity to touch, and muscle weakness can have significant adverse effects on their balance.
Treatment Options
1. To diagnose peripheral neuropathy as idiopathic, one must first evaluate for treatable causes of peripheral neuropathy. Evaluate for a demyelinating peripheral neuropathy with an EMG test. Also, do blood work that includes hemoglobin A1C to evaluate for prediabetes, a vitamin B12 blood test with the goal being greater than 400, a TSH to rule out hypothyroidism, and a serum protein electrophoresis test. If the peripheral neuropathy is idiopathic, all of these lab tests will be normal. An MRI to review the disc is essential to rule out kinesiopathology.
2. Excessive alcohol can cause a peripheral neuropathy determination, which is based on patient history.
3. Monitoring feet for any sores or cuts is important. Take vigilant care if a wound is discovered. The Burke, Horowitz, and Carnegie study shows progress and healing with light therapies.
4. Medications can help neuropathic pain, which include Neurontin (gabapentin), Lyrica (pregabalin), and Cymbalta (duloxetine). These medications only help with pain and do not correct numbness or balance problems. They also do not slow the progression of the neuropathy as we age and also have risk of dizziness, which can increase fall risk.
5. Prescription drugs come with some very bad side effects including:
• Dizziness
• Nausea
• Skin rashes
• Confusion
• Drowsiness
• Dry mouth
Tricylic anti-depressants imapramine are often prescribed, but many find their side effects of drowsiness, dizziness, and urinary retention to be extremely unpleasant. Also, drugs like ibuprofen and acetaminophen can damage the liver and kidneys, while aspirin may cause bleeding in the stomach in certain individuals.
Over-the-counter (OTC) relief for neuropathy include topical treatments such as ointments and creams that include the active ingredient capsaicin, which is derived from chili peppers, while others contain botanical oils. The major benefit of topical treatments is that they can be applied directly to the points of pain at the time the pain is occurring. However, some topical treatments may cause contact dermatitis or worsen certain skin conditions.
6. Avoid falls by eliminating throw rugs, having a night light, and using a cane or walker for safety. Most falls occur inside the home.
7. Avoid smoking and limit alcohol intake.
8. Laser treatment may help temporarily with pain, but it does not fix numbness or cure neuropathy.
9. Supplements such as alpha-lipoic acid are available, but the benefits are still uncertain.
10. Regular exercise such as walking improves circulation, helps control weight, and helps maintain balance. Exercise is a must. Strengthening exercises for the back, legs, and core improve balance. A 2012 study of balance disorders in diabetic peripheral neuropathy patients (Journal of Rehabilitation Research and Development, 2012) showed that they could achieve better balance and stability through progressive balance training. They recommended that training be gradual and persistent to promote long-term effects on the patient. Clinical studies have also shown that tai chi helps stabilize gait, improve balance, and reduce falls among people with peripheral neuropathy.
Idiopathic peripheral neuropathy is very frustrating when found in a patient who is otherwise healthy. Knowledge about the condition is important. Ruling out treatable causes of peripheral neuropathy is imperative. Knowing that peripheral neuropathy increases the risk of falls can lead a person to be more careful and help prevent a fall. Medication treatment can help with neuropathic pain symptoms, but we know treating the symptoms alone will not be a cure. We must detect the regions of kinesiopathology and subluxations while treating these pathophysiologies with chiropractic care to remove the nerve interference, using laser to assist in stimulating the cells and electroanalgesics to reduce the symptoms while healing the nerves and increasing circulation. This com-
bined with proper nutrition and supplementation actually positions chiropractors to be the leaders in both disc and neuropathy treatment.
The Mayo Clinic Offers Some Home Remedies
• Take care of your feet, especially if you have diabetes. Check daily for blisters, cuts, or calluses. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop (available in medical supply stores) to keep bedcovers off hot or sensitive feet.
•Exercise. Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength, and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help.
• Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and other neuropathy complications.
• Eat healthy meals. Good nutrition is especially important to ensure that you get essential vitamins and minerals. Include fruits, vegetables, whole grains, and lean protein in your diet.
• Avoid excessive alcohol. Alcohol can worsen peripheral neuropathy.
• Monitor your blood glucose levels. If you have diabetes, it will help keep your blood glucose under control and might help improve your neuropathy.
This makes chiropractic, the perfect choice as we have been treating Neuropathy, Neuropathology with every single adjustment we provide.
NeuroDoc Favorite Treatment Options
1. Chiropractic care
2. Laser therapy
3. Non Surgical Spinal Decompreson
4. LED Therapy
5. Electroanalgesia
6. Supplements.
During 32 years as business partners, Dr. Eric Kaplan and Dr. Perry Bard have developed Disc Centers of America, Concierge Coaches, and the first national certification program for nonsurgical spinal decompression.
Dr. Jason Kaplan is a Parker University graduate practicing in Wellington, Florida with his wife, Dr. Stephanie Kaplan. Jason also is an Instructor for Disc Centers of America and teaches technique for the National Certification Program at Life University. To learn more, call 888-990-9660 visit thechiroevent.com or decompressioncertified.org.
