Neuralgia and Neuropathy - Naturopathic Treatments

https://drkaitlynzornnd.wixsite.com/naturopath

Peripheral neuropathy is a common type of neuralgia, with diabetic neuropathy and post-herpetic neuralgia being the most common types.

The pain is usually a tingling and burning sensation.

Other causes of peripheral neuropathy are ^[1]:

• drugs (ex. chemotherapy), kidney failure, vitamin deficiencies,
• nerve entrapments or injuries (carpal tunnel syndrome, meralgia parestheica, sciatica)
• auto-immune conditions (lupus, rhematoid arthritis, Guillain-Barre syndrome, multiple sclerosis)

Antidepressant medications including tricyclic antidepressants, lyrica and cymbalta are commonly used in chronic neuropathies.

NUTRITIONAL AND SUPPLEMENT THERAPIES

Supplements for nerve pain and neuropathy include ^[2]:

• alpha lipoic acid (ALA)
• vitamin B12
• coenzyme Q10
• marijuana
• st. johns wort

Other research shows that Vitamin D, acetyl-L-carnitine, topical peppermint and capsaicin, yoga, acupuncture, along with exercise and diet (to promote weight loss) have led to best results. Cannabis, meditation, electrical stimulation and neuromodulatory devices are other interventions.

ALA^[3]

ALA is commonly used as an agent for neuropathic pain and nerve injuries.

Research shows that doses of 1800mg and 600 mg  for 6 months did not produce significant adverse effects. ALA has many  qualities that allow it to be helpful in nerve repair. ALA regenerates endogenous antioxidants (such a Vitamin C, E and glutathione). It has also been shown to reduce cytokine-induced inflammation as an NF-kappaB inhibitor.

VITAMIN B12 ^[4,5]

Vitamin B12 has antinociceptive and anti-inflammatory effects, as seen in an animal study using cyanocobalamin . This is likely through inhibition of cyclooxygenase (pro-inflammatory enzymes), pain pathways and nerve regeneration. Research also shows pain-relieving benefits from combination of B12 with conventional treatments like NSAIDs. Vitamin B12 deficiency produces neurological symptoms such as neuralgias, along with anemias and gastric issues such as low stomach acid  (indigestion, H.pylori infection).

FISH OILS

Animal studies find that supplementing rodent diabetic diets with omega-3 fatty acids (EPA and DHA) improve vascular and neurologic deficits due to anti-inflammatory qualities (blocking NFkappa-B). Resolvins, which are metabolites of EPA and DHA can induce neurite grown in neuron cultures ^[6]. These qualities are particularly helpful for diabetic neuropathy in particular, as the anti-inflammatory effects help to downregulate hyperglycemia.

MARIJUANA & THE ENDOCANNIBINOID SYSTEM

Endocannibinoids found in marijuana, such as cannabidiol (CBD) lead to benefits in pain releif, including neuralgic conditions. Human trials do find benefit in using Marijuana-based medicines, such as greater than 50% in pain relief outcomes in chronic neuropathic pain patients, but more research is needed ^[7]. Despite this, marijuana-based products are a popular alternative in the chronic pain population. Although Nds are unable to make treatment recommendations for marijuana, there are various ways to increase endocannibinoids in the body. For example, exercise, fish oils, cocoa, EGCG (found in green tea and matcha powder), turmeric and resveratrol (found in red wine) exert endocannabinoid-mimicking effects ^[8]. Echinacea on the other hand, has been shown to actually interact with cannabinoid receptors in the body, similar to CBD and THC. Due to this, we have the ability to positively impact this body system in individuals with chronic pain conditions such as neuropathy.

ST JOHNS WORT (Hypericum)

 Antidepressants are often used for pain treatment, eluding to the possibility of serotonin dyrsregulation   in pain conditions such as neuralgias. Due to this, Hypericum may not only be useful for mental health disorders but also pain. Neuralgias seen in animal models show a reduction in nociceptive pain (ex nerv e pain), however mixed results are seen in humans ^[9].

CARPAL TUNNEL ^[10]

Carpal tunnel is quite a common condition, due to entrapment of the median nerve.

Symptoms include: pain and parasthesias in the distribution of the median nerve, which include

the palmar aspect of the thumb, index and middle fingers. This can be tested theough the flic sign, phalen maneuver and median nerve compression exam. Medical treatments involve splinting, corticosteroids, and physical therapy. Vitamin B6 and NSAIDs are thought to not be helpful.

Surgery is a last resort if conservative treaments werent successful.

Alpha lipoic acid at a dose of 300 mg per day may be helpful as well.

SCIATICA

Sciatica is one of the most common lower nerve injuries. Causes include: bulging intervertebral disc, compression (ex. Pregnancy) and other vascular issues. Symptoms are unilateral gluteal pain, and sensory or motor disturbances. Diagnosis is through methods such as the straight leg or well leg raise which produce radiating leg pain due to L4/L5 irritation. Reduced lumbar reflexes may also be seen.

A guideline called NICE (National Institute for Health and Care Excellence) for low back pain with or without sciatica suggests non-invasive therapies including physical therapy, tai chi, yoga or NSAIDs as  first line therapy ^[11]. Another study found acupuncture effective in treating sciatica when administered twice weekly for 4 weeks ^[12]. The visual analogue scale for pain rating was significantly reduced in this instance. Specific acupuncture points used were: BL23, GB30, BL40, ST36,  Overall, most of the acupuncture points are located in the gall bladder and bladder meridians, on the L4, L5 and S1 dermatomes. Acupuncture was also useful in 98% of patients with post partum sciatica in another study.

Acetyl -L carnitine and Alpha lipoic acid have shown benefit supplement-wise. 1800Mg/d of Acetyl L carnitine and 600mg of ALA in particular ^[2]. ALA was capable of reducing signs and symptoms of sciatica, along with EMG findings and need for analgesics.

CONDITION EXAMPLES

OCCIPITAL AND TRIGEMINAL NEURALGIA

Occipital neuralgia involves paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve.

Medical treatments involve local corticosteroid injection such as radiofrequency of nerve or gangliotomy of C2 or C3. These procedures can be quite invasive and have complications, so a nerve disorder such as this lends itself well to alternative treatments ^[13]. Furthermore, tricyclic antidepressants along with physical therapy and occipital nerve blocks may be suggested as a more conservative approach. ^[14] There are several clinical trials and case reports of using acupuncture for occipital neuralgia treatment.

One clinical trial in particular assessed the visual analogue scale (VAS) and found that the pain-rating scale was significantly lower than before treatment by using electroacupuncture. The acupuncture points used were BL9, BL10, GB20 and GB12. ^[15] These acupuncture points are located around the back of the neck and head where the occipital pain is, which are considered Ashi acupuncture points. A case study of a patient with longstanding occipital neuralgia endured 5 acupuncture sessions over a short period of time. After just one treatment she experienced releif and complete resolution after all of the sessions. ^[16]

DIABETIC NEUROPATHY

Commonly seen in diabetic populations, diabetic peripheral neuropathy is defined as: burning, shooting pain, parasthesias, muscle cramps in the feet that interfere with daily life or sleep. A study found that 600mg of alpha lipoic acid for 40 days led to a significant reduction in 14 out of 15 neuropathy questions. Other sources suggest 300-600 mg daily. Fish oils, acupuncture and Vitamin D have also shown benefit ^[17]. Vitamin D, which is known for its hormone-like effects, was shown to produce a significant reduction in symptoms and signs of diabetic neuropathy. Vitamin D deficiencies should be corrected in order to lower symptom severity ^[18].

REFERENCES

1. Diabetic Peripheral Neuropathy: Improve Diabetes Nerve Pain. MedicineNet. 2016. https://www.medicinenet.com/diabetic_peripheral_neuropathy_pictures_slideshow/article.htm
2. Nerve Pain. 2020. NDAssist. https://www.nhpassist.com/conditions/nerve-pain
3. Shay K et al. Alpha-lipoic Acid as a Dietary Supplement: Molecular Mechanisms and Therapeutic Potential. Biochim Biophys Acta. 1790 (10). 1149-60. 2009.
4. Buesing S et al. Vitamin B12 as a Treatment for Pain. Pain Physician. 22(1), E45-52. 2019
5. Hvas Anne-Mette, Nexo Ebba, Diagnosis and Treatment of Vitamin B12 Deficiency – An Update. Haematologica. Review. 91(11), 1506-12. 2006
6. Yorek M. The Potential Role of Fatty Acids in Treating Diabetic Neuropathy. Curr Diab 18(10), 86. 2018
7. Muke et al.  Cannabis-based Medicines for Chronic Neuropathic Pain in Adults. Cochrane Database Syst Rev. 3(3).2018
8. Gertsch J, Pertwee R, Marzo V. Phytocannabinoids beyond the Cannabis plant – do they exist? Br J Pharmacol. Jun; 160(3): 52. 2010
9. Sanna D et al. St. John's Wort Potentiates anti-Nociceptive Effects of Morphine in Mice Models of Neuropathic Pain,18 (7), 1334-1343. 2017.
10. Wipperman J and Goerl K. Carpal Tunnel Syndrome: Diagnosis and Management. Am Fam Physician, 94 (12) 993-999. 2016
11. Chou R et al. Noninvasive Treatments for Low Back Pain [Internet]. Review. 2016.
12. Therapeutic Efficacy and the Impact of the “Dose” Effect of Acupuncture to Treat Sciatica: A Randomized Controlled Pilot Study. J Pain Res. Lui Ching- Hsiung. 12, 3511-3520. 2019
13. Choi & Jeon. Neuralgias of the Head: Occipital Neuralgia. J Korean Med Sci. 31(4), 479-88. 2016
14. Dougherty C. Occipital Neuralgia. Curr Pain Headache Rep. 18(5), 411. 2014
15. Wang Y, Guo Zi, Yang Z, Wang S. Treatment of Occipital Neuralgia by Electroacupuncture Combined With Neural Mobilization. Zhen Ci Yan Jui. 43(3), 185-8. 2018
16. Mallory M, Bauer B, Chon T. Occipital Neuralgia Treated with Acupuncture: A Case Report. Glob Adv Health Med. 2019.
17. Agathos E. Effect of alpha-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. Clinical Report. Journal of International Medical Research. 46(5). 2018.
18. Lv W et al. Serum 25-hydroxyvitamin D Levels and Peripheral Neuropathy in Patients with type 2 diabetes: A Systematic Review and Meta-Analysis. J Endocrinol Invest. 38 (5), 513-8. 2015