Therapy of a polyneuropathy

introduction

The Polyneuropathy is a mostly chronic nerve disease. Several nerves are always affected and their function is limited. This is often shown in Sensory disturbances or painful conditionswhich can be more or less violent. The Cause of a polyneuropathy usually lies in a previous underlying disease. The front runners are diabetes mellitus, alcohol addiction and Vitamin deficiency. Also special Infections can trigger neuropathies. The therapy is often complicated. Basically, it has to be responsible underlying disease treated, but should also be a Pain reduction be sought. For the latter goal in particular, a wide variety of ways have been found, both on a medicinal basis and on the basis of interventional therapy.

Guidelines

Regarding the pharmacological therapy from "chronic neuropathic pain" became different Therapy goals which should be fulfilled in the course of treatment if possible.

The Patient pain should according to his subjective perception at least 30 to 50 percent and reduced the Improved quality of sleep become. By maintaining or even resuming social and professional interactions and activities through therapy, the patient's quality of life increases.

All Goals of therapy in polyneuropathy need in advance discussed with the patient become. Expectations must not rise too high to avoid disappointment later. Such emotional stressful situations negatively affect that Sensation of pain out and can one aggravation cause.

By a Therapy with drugs can average one Pain reduction 50 to 80 percent can be brought about. A complete relief from pain is rare and should therefore be striven for, but in no way promised. There is also a risk that the patient may therapy resistant proves. In this case, the Pain reduction usually below 30 percent. About 30 percent of all patients who participate in a Polyneuropathy are suffering either resistant to therapy or suffer from severe side effectsso that treatment must be stopped. The trigeminal neuralgia, which is also a neuropathy, must be considered separately. There are drugs that work for this, but are useless for polyneuropathy.

Occupational therapy

Physiotherapy or occupational therapy should always be next to a drug treatment can be used. On the one hand, the therapeutic goal should be a Achieve pain relief and on the other hand to cure any malfunctions. These can manifest themselves in many ways. For example, are nerves affected by the neuropathic deficits, the motor tasks convey so it can too Movement disorders and especially often gait disorders come. It is important to create a therapy plan that must be individually adapted to each patient. In addition to training certain movement sequences, Aids such as rails, walking aids or special footwear be used. The main focus is on maintaining or restoring everyday skills in order to promote the patient's independence. The attending physician should discuss with the patient exactly which goals are to be achieved together.

Transcutaneous electrical nerve stimulation (TENS)

In the TENS electrodes (power connections) are attached to the skin. You should either in the pain area or above that supplying main nerve are located. By low electrical stimulationwhich is usually not associated with pain Nerves activated. These lie in the spinal cord near the nerve cords that are responsible for the Pain perception are responsible. Due to the permanent activation of the electrified nerves, the intensity of pain perception decreases in many patients. The result is one longer lasting pain reduction. In 60 percent in all cases this works Method of pain reduction in patients with diverse Pain syndromes. Even if the Success not guaranteed is, a stimulus attempt should nevertheless be undertaken, as this does not bring any disadvantages for the patient and is inexpensive.

nutrition

According to Nutrition experts can relieve the symptoms of a diabetic polyneuropathy can be alleviated without the use of medication. The goal of the change in diet is just one more low-fat and vegan food to take in. The blood sugar should be lowered and with it that too Patient weight. Possible Vitamin deficiencies (Vitamin D and B12) are temporarily balanced with appropriate preparations.

Is the Diet successfully changed and the patient's cooperation is sufficient, such dietary supplements can be dispensed with. If Fats included, these should be of high quality as well of vegetable origin and not come from animal products. Especially Alcohol, convenience products, fast food and cigarettes it must be avoided. The result is a better general condition and a healthier nervous and vascular system.

Medication

Non-opioid analgesics

So-called Non-opioid analgesics are Painkillerwhich do not belong to the group of opioids. Common examples are ASS (Aspirin), paracetamol and Metamizole (Novalgin). These medicines are against neuropathic pain usually not very effective. They also cause a Long-term use, strong side effects, such as gastrointestinal ulcers (gastrointestinal ulcers) or Kidney and liver damage. Painkillers are therefore the first choice Opioids represent.

Opioid analgesics

Many patients who attend a Polyneuropathy suffer, speak up Opioid analgesics positive.Scientific studies have shown that, for example, the drugs Tramadol and Oxycodone contribute to neuropathic pain Provide relief. Oxycodone was particularly effective at diabetic cause profile can be used. In the Adjustment of the dosage is initially built on basic therapies. If this does not help to achieve the desired result, the dosage can be increased slowly. Before powerful opioids must be used previous treatment potential be fully exploited. The administration of long-acting drugs in the form of tablets or plasters is the means of choice. Although the Opioid analgesics are not very toxic to organs such as the liver and kidneys are should this through laboratory tests be checked regularly. Beats the Treatment with opioids not on, must Therapy canceled become. When taking opioid analgesics it can various side effects that can affect the patient's cooperation. Play it Digestive tract discomfort such as constipation, nausea and vomiting play an important role. With the help of Anti-emetic and laxatives these adverse drug effects can be circumvented. Does the Patient already had indigestion before treatment, therapy must not be started.

Continue to influence Opioids in some cases affect the nervous system and the Patient psyche - it can lead to tiredness, dizziness, Confusion and Hallucinations come. If the patient has a Addiction problem (the patient is dependent on medication or drugs), so depends on Use of opioid analgesics is not recommended. These can increase with long-term therapy Dependence and development of tolerance to lead. Tolerance development means that always higher doses needed to achieve the desired pain relieving effect. Due to the potential for dependency, the Medication slowly reduced on discontinuation to avoid withdrawal symptoms.

Antidepressants

This group of drugs will though primarily used to treat depression used, but can also do that Affect the perception of pain. Antidepressants among other things suppress the transmission of signals from pain fibers in the spinal cord.

Around Side effects to prevent treatment with a very low dose started, which is slowly increased until the desired effect occurs. By reviewing the Level of medication in the blood, the dose can be easily controlled. If there are side effects, they can be seen in, for example Fluctuations in blood pressure and Cardiac arrhythmias, nausea and Vomit, Problems urinating or neurological-psychiatric symptoms how forgetfulness, Fatigue and trouble sleeping. Medicines that are used as standard in this context are for example Amitriptyline, Duloxetine and Venlafaxine.

Alpha lipoic acid

At diabetic polyneuropathy can Alpha lipoic acid be used for pain relief. The drug improves the blood supply to the nerves and thus not only treats the symptoms, but eliminates the cause of their formation. Damage that is too severe cannot be reversed, but it is Alpha lipoic acid through his good tolerance an alternative to other drugs that contribute Polyneuropathy be used despite their side effects.

Gabapentin

Gabapentin is primarily a drug used to treat epilepsy as well Convulsive states, which is also effective against polyneuropathic pain has proven. The dosage should strictly monitored by the attending physician and on the individual Kidney function can be set. It is only few side effects described, mainly focused on Tiredness and dizziness restrict. Generally this will Gabapentin well tolerated and rarely has to be discontinued due to its effectiveness profile. It can too Water retention (Edema) come.

Lyrica

Lyrica® is the Trade name of pregabalin, the how Gabapentin primarily for the treatment of Epilepsy and convulsive states is prescribed.

The gift of Lyrica® relieves polyneuropathy the pain of many patients. Although the dose of this drug must also be adjusted according to kidney function, it is improving in many patients, the sleep behavior is independent of the dose.

The Side effects mainly limit themselves to Tiredness and dizziness as well as a Weight gain. An increasing weight can reduce the patient's cooperation, which is why there must be good doctor-patient contact. Edema (Water retention) are also common when taking Lyrica® possible.

homeopathy

At a homeopathic therapy a distinction is made primarily between the various symptoms that occur in a Polyneuropathy may occur. Aconitum is used at stabbing or burning pain recommended and Agaricus muscarius at Paresthesia. Spigelia and Verbascum can also provide relief from neuropathic pain.

The dosage as well as the Form of ingestion should be discussed with a professional be discussed. Does the patient have a diabetic neuropathy, the underlying disease can be treated and the pain can be reduced. Also for nutrition comment on common homeopathic treatment methods. Particular attention is paid to the one described vitamin-rich and low-fat food added value.