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Renaissance Family and Cosmetic Dentistry | Neuropathy in Folsom

          2180 E. Bidwell Street,
          Suite 100 Folsom,
          CA 95630

          Phone: 916-983-9800

Neuropathy
 

Diabetic peripheral neuropathy (DPN) is a painful complication of diabetes that reduces quality of life and can impair a person's motivation to exercise. In addition, neuropathies frequently disrupt sleep, which may impact energy levels and blood glucose control.

Neuropathies is a leading barrier to adopting better lifestyle choices, especially more exercise.

 

What Causes Neuropathy?

Neuropathy is caused by the oxidation and glycosylation (binding of sugar) of both nerve fibers and the small blood vessels that supply oxygen to nerve fibers. Eventually, the nerve fibers become physically squeezed by a thickening coating of glycosylation (imagine a lollipop stick getting coated with caramel!) and the blood vessels ultimately narrow to the point of no longer being able to supply blood. When nerve fibers become squeezed and lose their blood supply, pain and strange sensations - crawling sensations, pins and needles, and limbs falling “asleep” - may occur.

 

How Can I Tell if I Have Neuropathy?

In general your symptoms guide the diagnosis of neuropathy, although simple tests using a small piece of monofilament and a tuning fork can be performed in your doctor’s office to screen for neuropathy. Using a small piece of monofilament, your doctor will check your sensation on your feet to determine whether neuropathy is present. A tuning fork is used to check to see if you can detect vibration in your toes and feet as well. If either of these tests suggest neuropathy, additional testing can be done by a neurologist, however typically this is only done if the results of your physical exam are inconclusive.

 

Treatments for Neuropathy

Improve Glucose Control

Since neuropathies are caused by the glycosylation of basement membrane proteins in both nervous tissue and vascular tissue, neuropathy symptoms will continue to progress unless blood sugar control is optimized. A reduction in neuropathic symptoms typically occurs if blood sugar is optimized, however if neuropathy has been present for a very long time, or if blood sugar has been poorly controlled for a very long time, blood sugar lowering alone may not be enough to reduce or resolve neuropathy.

 

Oral Drug Therapy

Unfortunately, many drugs used to treat neuropathy have side effects that, in some cases, are worse than the neuropathy symptoms themselves and prescription medications do not actually address the causative process, but rather trick the brain and body into not feeling pain.  The following are FDA-approved for neuropathy and most insurance plans cover these medications.

-antidepressants like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs)

-dopamine-agonists (e.g., levodopa)

-analgesics (e.g., tramadol)

-anticonvulsants and antiarrhythmics. Cymbalta® (duloxetine) and Lyrica® (pregabalin)

 

Common side effects for Lyrica® include: dizziness, somnolence, impaired concentration, blurred vision, weight gain and edema in >5% of patients (Source: Lyrica® prescribing information).

 

Common side effects for Cymbalta® include: major depressive episode, generalized anxiety, fibromyalgia symptoms including fatigue, nausea, dry mouth, constipation, somnolence, hyperhidrosis, and decreased appetite in >5% of patients (Source: Cymbalta® prescribing information).

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Fat soulable Vitamins

-Benfotiamine (New Remedy)

Benfotiamine is a synthetic, lipid-soluble form of the B vitamin thiamine.  Benfotiamine has superior absorption to thiamine, allowing for much lower doses to be used clinically. The mechanism of benfotiamine in neuropathy is not definitively established, although it appears to block advanced glycosylation endproduct formation on nerve tissue, which may improve nerve function. To date, two clinical trials have demonstrated improvements in nerve conduction velocity and/or improvement in neuropathic pain scores. Standard doses used in clinical trials have been 320-400mg per day. Reductions in neuropathic symptoms can occur within three weeks of initiation of therapy.

No adverse effects of benfotiamine have been reported in clinical trials to date.  New Remedy is available in this clinic.

 

Topical Drug Therapy

-Capsaicin Cream (Zostrix®)

Zostrix® is a 0.075% capsaicin cream can be applied topically for pain relief in both arthritis and diabetic peripheral neuropathy. Capsaicin depletes Substance P, the chemical messenger that facilitates the sensory perception of pain at the nerve ending. It is important to note that capsaicin does not change the course of neuropathy, but only masks the pain. Because it takes up to a week or more to deplete Substance P, and because capsaicin does stimulate local burning, you have to stick with it for several weeks (and tolerate some discomfort) before it is effective.  It is recommended to use gloves when applying this product and wash hands thoroughly after.  Capsaicin is available over the counter without a prescription.

 

Injectable drug therapy

-Vitamin B12

            Vitamin B12 is a nutrient necessary for normal nerve conduction. The clinical use of B12 supplementation has recently undergone systematic review for the treatment of diabetic neuropathy with positive conclusions (1). Seven controlled, clinical trials of varying quality suggest benefit in autonomic or peripheral neuropathic symptoms.

             The impact of graded reductions in B12 status on nerve function have not been thoroughly explored, however clinically significant B12 deficiency is reported to occur in 7-8% of diabetic patients on metformin, suggesting reductions of B12 status may be common in those with diabetes. In addition, older adults are more at risk for B12 deficiency especially if they have a history of atrophic gastritis, proton pump inhibitor, or H2-receptor blocker medications.

            A common clinical protocol involves evaluating clinical response to an intramuscular injection of B12;  positive responses are rapid with in some patients reporting improvement in as little as 48 hours but some patient's require multiple injections before improvement is noticed. Duration of response is variable ranging between days to weeks to months.  Typical injection treatment involves one injection a week for 4 weeks, then one injection every two weeks until optimum results are reached.  Total treatment ranges for 8-12 weeks. 

Most insurance plans cover this treatment. 

 

 

 
 
Folsom Dentist | Neuropathy. Renaissance Family and Cosmetic Dentistry is a Folsom Dentist.