Neuropathy: |
Neuropathy is a medical term referring to disorders of the nerves of the peripheral nervous system (specifically excluding encephalopathy and myelopathy, which pertain to the central nervous system.) It is usually considered equivalent to peripheral neuropathy, which is defined as deranged function and structure of peripheral motor, sensory, and autonomic neurons, involving either the entire neuron or selected levels. According to some sources, a disorder of the cranial nerves can be considered a neuropathy. Neuropathy should not be confused with neuropathology, which deals with the pathology (i.e., the study of disease and disease processes) of nervous tissue.
Classification:
The four cardinal patterns of peripheral neuropathy are polyneuropathy, mononeuropathy, mononeuritis multiplex and autonomic neuropathy. The most common form is (symmetrical) peripheral polyneuropathy, which mainly affects the feet and legs.
A radiculopathy involves spinal nerve roots, but if peripheral nerves are also involved the term radiculoneuropathy is used.
The form of neuropathy may be further broken down by cause, or the size of predominant fiber involvement, i.e., large fiber or small fiber peripheral neuropathy. Frequently the cause of a neuropathy cannot be identified and it is designated idiopathic.
Neuropathy may be associated with varying combinations of weakness, autonomic changes and sensory changes. Loss of muscle bulk or fasciculations, a particular fine twitching of muscle may be seen. Sensory symptoms encompass loss of sensation and "positive" phenomena including pain (for a more detailed discussion, see peripheral neuropathy).
Symptoms
Symptoms depend on the type of nerves affected; motor, sensory, autonomic, and where the nerves are located in the body. One or more types of nerves may be affected.
Common symptoms associated with damage to the motor nerve are muscle weakness, cramps, and spasms. Loss of balance and coordination may also occur. Damage to the sensory nerve can produce tingling, numbness, and pain. Pain associated with this nerve is described in various ways such as the following: sensation of wearing an invisible "glove" or "sock", burning, freezing, or electric-like, extreme sensitivity to touch.
The autonomic nerve damage results in affects in involuntary functions. Symptoms from this type of damage include abnormal blood pressure and heart rate, reduced ability to perspire, constipation, bladder dysfunction (e.g., incontinence), and sexual dysfunction.
Neuropathic pain:
See also: Neuralgia:
According to the most widely accepted definition, neuropathic pain is "initiated or caused by a primary lesion or dysfunction in the nervous system."Neuropathic pain cannot be explained by a single disease process or a single specific location of damage.
As much as 7% to 8% of the of the population is affected and in 5% it may be severe. Neuropathic pain may result from disorders of the peripheral nervous system or the central nervous system (brain and spinal cord). Thus, neuropathic pain may be divided into peripheral neuropathic pain, central neuropathic pain, or mixed (peripheral and central) neuropathic pain.
Central neuropathic pain is found in spinal cord injury, multiple sclerosis, and some strokes. Fibromyalgia, a disorder of chronic widespread pain, is potentially a central pain disorder and is responsive to medications that are effective for neuropathic pain.
Aside from diabetes (see Diabetic neuropathy) and other metabolic conditions, the common causes of painful peripheral neuropathies are herpes zoster infection, HIV-related neuropathies, nutritional deficiencies, toxins, remote manifestations of malignancies, genetic, and immune mediated disorders.
Neuropathic pain is common in cancer as a direct result of cancer on peripheral nerves (e.g., compression by a tumor), or as a side effect of chemotherapy , radiation injury or surgery.
Diabetic Peripheral Neuropathy & Acupuncture:
This study is like so many other contemporary studies done in China on the treatment of diabetes and its complications with Chinese medicine in that it conclusively shows that Western medicine combined with Chinese medicine is more effective than Western medicine alone. Most Western patients with diabetes are going to be on some sort of Western medical treatment, and studies such as this show that it is not necessary to discontinue these treatments in order to make use of Chinese medicine. Further, not only was the combined acupuncture and Western medication regime more effective for the relief of the symptoms of peripheral neuropathy, it also was more effective for lowering the blood glucose levels. Hence this integrated Chinese-Western medical regime can be seen as treating both the root and the tip or branches of this disease.
Although acupuncture was traditionally forbidden in patients with diabetes due to fear of infection and subsequent gangrene, modern advances in needle manufacture and sterilization have allowed practitioners to perform acupuncture safely on patients with diabetes. Peripheral neuropathy is one of the main complications of diabetes mellitus for which Western medicine has relatively little to offer. Therefore, patients and practitioners alike are always on the lookout for effective alternatives and complementary therapies. Zhang Xiao-qin and Cheng Zong-peng have developed an acupuncture protocol which shows promise in the treatment of this condition. They describe this protocol in an article titled, “Clinical Observations on the Treatment of Diabetic Peripheral Neuropathy with Acupuncture.” This article was published in issue #3, 1999 of Zhong Guo Zhen Jiu (Chinese Acupuncture & Moxibustion) on pages 236-237. A precis of that article is given below.
Cohort description:
Altogether there were 90 patients described in this study. Of these, 53 were male and 37 were female. The youngest was 14 and the oldest was 76 years old. In addition, the shortest duration of disease was one year and the longest was 12 years, with an average of 4.1 years. All these patients were out-patients at the Su Song County Chinese Medical Hospital in Anhui. These 90 patients were randomly divided into two groups of 45 patients each, a so-called treatment group and a comparison group. All these patients met WHO diagnostic criteria for diabetes mellitus and all met the criteria for diabetic peripheral neuropathy established by Gao Yan-bin. There was no significant difference (P < 0.05) in results of routine examinations of blood, urine, and stool, hepatic or retinal functions, blood glucose, blood lipids, or urine sugar before treatment between these two groups. Likewise, the make-up of both groups were statistically comparable in terms of sex, age, and disease duration.
Treatment method:
Patients in the comparison group were asked to adhere to a relatively rigid diet and to engage in proper physical exercise. They were also administered 7.5-15mg of glyburide orally per day and 100mg of vitamin B1 and 500mg of vitamin B12 intramuscularly per day. Thirty days of this regime equaled one course of treatment.
Patients in the treatment group received the same Western medical treatment described above. In addition, they also received acupuncture at the following acupoints: Yi Shu (M-BW-12), Shen Shu (Bl 23), Ming Men (GV 4), Pi Shu (Bl 20), Wei Shu (Bl 21), Zu San Li (St 36), and San Yin Jiao (Sp 6). Shou San Li (LI 10), Qu Chi (LI 11), Wai Guan (TB 5), and He Gu (LI 4) were added for neuropathy of the upper extremities, while Yang Ling Quan (GB 34), Yin Ling Quan (Sp 9), Xuan Zhong (GB 39), Tai Xi (Ki 3), and Huan Tiao (GB 30) were added for neuropathy of the lower extremities. Four to six acupoints were chosen each treatment, and treatment was given once per day. Even supplementing-even draining hand technique was used with moderate stimulation. After withdrawal of the needles, warming moxibustion was applied on the acupoints with a warming_moxibustion instrument for 20 minutes. Thirty days of this regime also equaled one course of treatment.
Treatment outcomes:
Marked effect was defined as a fasting blood glucose of less than 6.7mmol/L, disappearance of symptoms such as numbness, stabbing pain, spasm, and other abnormal sensations, and restoration of normal tendon reflexes. Some effect was defined as fasting blood sugar less than 7.2mmol/L, decrease in the area and degree of numbness, stabbing pain, spasm, and other abnormal sensations, and the ability to work and carry on other normal daily activities. No effect was defined as no obvious improvement in the signs and symptoms. Based on these criteria, in the treatment group, 31 cases (68.89%) got a marked effect, 13 cases (28.89%) got some effect, and one case (2.22%) got no effect. Therefore, the total effectiveness rate in the treatment group was 97.78%. In the comparison group which was treated only with Western medicine, 20 cases (44.44%) got a marked effect, 15 cases (33.33%) got some effect, and 10 cases (22.23%) got no effect, for a total effectiveness rate of only 77.77%. Follow_up after six months found that the therapeutic effect in the treatment group was stable.
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