This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2021. For the original video go to https://www.youtube.com/watch?v=Kby8kvUpKvg.
Brad: Hi folks, Brad Heineck Physical Therapist.
Chris: Hey, I'm Chris the Pharmacist.
Brad: Bob's not with us today, I think he's out golfing, having some fun somewhere else.
Chris: Atta boy.
Brad: But today we are going to talk about neuropathy, causes, and symptoms, with at-home treatment and medications. We're going to talk about what you can do yourself and the medications, how they work, and some good information on that. Chris will give us his expertise.
Chris: All right.
Brad: I do want to mention that with neuropathy, you're going to go through some of the details on it. You can explain it much better than I do, but for this channel, we're related to physical therapy and almost always in my experience, and I think most PT's would agree, that neuropathy is associated with diabetics, in our field. You could have neuropathy from r diagnoses as well. We're going to talk about it.
Chris: I mean, there's a lot of things out there.
Brad: Say a few of them.
Chris: Post-herpetic neuralgia. I mean, you could have just an injury, a spinal injury. There are a lot of things that can cause it.
Brad: Okay. So there are some neurologic things that could cause it. MS. So the treatments are going to be similar for those, but we will kind of relate to diabetes because it is so prevalent in that diagnosis and that's our experience. So what is neuropathy? Can you explain that?
Chris: I hate to say it, it's not a real long flowery explanation, but basically neuropathy is that burning, stinging, pain, numbness that you get. How does it develop? With diabetes in mind, if our blood sugars are high and a lot of times our sugars are high, that means our cholesterol is high. So, circulation doesn't bid the nerve real well due to high blood sugars and probably cholesterol. As a result, the nutrients and oxygen that your blood flow carries, do not bid those nerve cells and they are not healthy. And as a result of that, they kind of die-off. So for lack of anything better to say, you just don't get what they call better neuronal transmission. So just think of it as a highway in your body and just the signal is interrupted. And so you don't get that good, nice confluent signal going back and forth as a nerve would.
Brad: So what, what are the most common locations in the body?
Chris: Well, a lot of cases with diabetic neuropathy, a lot of times it's going to be below the knee. So you're going to see a lot of problems in the feet and lower leg, which is why foot care is so important for diabetics. And we'll touch on that as we go forward. But I mean, you can have problems in your gut, particularly with a diabetic, but you can also have problems in your legs. You can have it in your arms and hands. So it just kind of depends on where it is on you, but the treatments in most cases are going to be similar, which is going to be pharmacological and physical therapy related.
Brad: Okay. And in my experience, and I've talked to Bob about this too. Usually, it's below the knees, on both sides typically.
Chris: Well, that's why we worry about, especially the diabetic foot.
Brad: Yeah. What kind of symptoms do these people typically complain of?
Chris: Symptoms kind of manifest themselves over time. So, I mean, the longer you're a diabetic, the more opportunity you have to become a patient that has neuropathy. So the less well-controlled your blood sugars are, and the longer you have diabetes, the more likely you are to get neuropathy. But they come in and they're going to complain about tingling, burning, pain, numbness. Even to the point where a diabetic with bad diabetic neuropathy could literally have a rock in their shoe, they could be walking around all day long and they won't even know it. So they lose that sensation and they might have like some very vague feeling, or it could have been one of my feet felt that way yesterday too. So it's so important as a diabetic, number one is to check your feet daily to make sure there are no little nicks, cuts, or blisters.
Chris: Those are the things that can lead to infection and other problems.
Brad: So with that, say there is a little stone in there and you walk on it. You did not feel it as a result of the neuropathy, and that stone may break the skin open. Then you have an open sore. And because of the lack of circulation, that can get infected and it's slow healing because of the diabetic side effects and it can actually lead to an amputation.
Chris: Yeah. That is the worst worst-case scenario. So the things that we're going to talk about today guys, are we want to make sure that we're controlling our blood sugars, we're exercising well, we're eating well, and we're using our medications appropriately. And those are the things that will help to stave it off.
Brad: So I do want to mention one other thing as a therapist, one thing that we deal with a lot with people with neuropathy, if they have numbness in their feet or their legs, you cannot feel the ground or the surface that you're on. That dramatically increases your risk for falls because your balance is heavily dependent on the feedback back from your proprioception, back from your feet where they're touching the ground. And it just really makes a big difference on your balance and a fall risk goes way up. So we do deal with that, we're not going to talk about that too much, that's probably all we're going to mention for now. We have balance videos out there. Can we go right to diet? How can these people with neuropathy change or manage their symptoms?
Chris: Yeah, absolutely. I mean we know neuropathy has no cure. That seems kind of damning for a lot of people, but at the same time, we can make it better. And so one of the simple tools that we have is just eating well. And so if you're a diabetic, that means going to the leaner proteins, your fibrous fruits, and veggies, those types of things.
Brad: Some examples of leaner proteins, we're talking about meats and fish?
Chris: Yep. So we're going to go with poultry like chicken, we'll go with fish, lean beef like grass-fed beef, very lean protein, and eggs. For our vegan folks, it's going to be your nuts and legumes. Those are going to be good protein sources. So you're going to want your leafy green vegetables. That's going to help with the B vitamins, that's going to help with nervous system development.
Chris: Spinach, kale, broccoli. So all the things your mother loves. Brussels sprouts, there's another one. Alfalfa sprouts. There is a lot of good stuff out there.
Brad: Sure okay.
Chris: Just eating well, helps our body with the nutrients that it provides it. So it's going to actually help with the circulatory system. It's going to help keep our weight at a better level. If we're going to McDonald's and just eating fries and chips, I mean, that's going to create problems from a circulatory standpoint. It's going to cause problems from a blood sugar standpoint. So like we always say, we don't want anything in a box. Whole foods are ideal.
Brad: Right. In the grocery store, down the aisles, we got all these quick-make things. You know, open it up, open up the rapper and just eat that. Those health food bar things that usually are not healthy.
Chris: They're not as healthy as what they were advertised to be. Unfortunately, there's a lot of sugar and other processed things in there. Particularly for the diabetic too, and that's one of the things with advertising that makes it so challenging is, oh, well I'm having this particular bar and it seems like it's going to be a nutritious choice.
Brad: A health bar, it says health bar right on it.
Chris: Yeah they show people climbing mountains and everything else. And you think it's going to be a good thing to have, and all of a sudden it's made with tons of sugar or high fructose corn syrup and things of that nature.
Brad: A big one that I always look for now is yogurt. I used to just think yogurt was yogurt. And I started looking at the sugar content, and there's as much sugar in a thing of yogurt as there is in a can of Pepsi. And it's like, whoa!
Chris: There's a ton. It's kind of like the better it tastes, the worse it is.
Brad: Exactly. So be careful, look at your labels.
Chris: But you know, let's talk about yogurt. Yogurt is great, to me, it's kind of a power food you know. If you get plain yogurt. So what can you do? Add blueberries, add raspberries, or add some walnuts. You know, you can add the sweetness yourself.
Brad: Yeah. That's my recipe. I do blueberries, blackberries, walnuts, flax seed, and chia seed.
Chris: Yeah and all those products, nutritionally have actually kind of nutraceutical properties that will help your body. You have the flavonoids in those dark berries, those help with your circulation and with anti-inflammatory action. So there are a lot of nutrient-dense things in that. And then the yogurt it's got the protein, it keeps you full. So it's good for your muscles, it's good for your bones cause it's got calcium and vitamin D.
Brad: So I do want to mention it, because a lot of times people say, "oh, stick to your genre." So, you know, he's a pharmacist, I'm a therapist, but we're talking about pretty basic health. I think we're covering the basis pretty safely.
Chris: Oh yeah. I don't think we're too far out of our lane.
Brad: Yep. Should we go on to the next thing? Exercise. Why do you need to exercise? If you're got neuropathy, how's that going to help?
Chris: Well there are a lot of different reasons, but specifically, what happens when we exercise? Our heart rate comes up. So if our heart rate comes up, we're challenging our circulatory systems. That helps to bade those nerves and the muscles and it gives them some oxygenated blood that also is carrying nutrients from the good foods we've just eaten. And so that will help the body to develop and hopefully get stronger and more endurance and hopefully improve some circulation and moderate some of those neuropathy symptoms. So when you have better circulation, you have better strength, better coordination, and better proprioception as a result of exercising because these things all kind of build on one another. We hopefully help to minimize some of those diabetic neuropathy symptoms. So it's never going to be a cure guys, but it certainly could make them better and make your life a lot safer, more effective, longer, happier, and healthier.
Brad: Let's move on to medications in regard to neuropathy and the diabetic. Can you briefly go over some of the most common ones and some information?
Chris: Yeah, your physician is going to take into account, what's going to be best for you when you have neuropathy. But, what I see most often in my world, the big three are probably going to be pregabalin (generic Lyrica), Gabapentin (generic Neurontin), and then duloxetine (generic Cymbalta.) So those three are all widely recognized and used for the treatment of neuropathy. I mean, Lyrica or pregabalin is actually known for treating neuropathy. The advantage of pregabalin over Gabapentin they work similarly to kind of like Coke and Pepsi. So they have similar properties and they do similar things in the body, which is to actually improve neurotransmission and minimize pain. So basically that's what they believe is how it works. And so with that, if we can diminish the pain and discomfort, a drug like pregabalin, takes a lower dose, so it is less side effect prone. It acts faster than Gabapentin. The difference between those two drugs is pregabalin, a lower dose creates a nice effect. So we have to be careful because there is some addictive potential. So we have to be mindful of that. Caution with driving, because of dizziness and drowsiness are two primary side effects. And you'll see that with Gabapentin as well, but where they delineate, the pregabalin works better in a lot of cases. Whereas Gabapentin you keep having to take a bigger and bigger dose to get the same type of effects. And when we go to those bigger and bigger doses, what happens? Well, we have more side effects, so more dizziness, more drowsiness, and a little bit of forgetfulness. So things that we have to be careful with and, your doctor is taking that into account and your pharmacist is going to be talking to you about watching for things.
Chris: So we do want you to be mindful. And the other one that I didn't really touch on was the antidepressant Cymbalta or duloxetine. And that actually works by raising serotonin, it raises norepinephrine or noradrenaline. So those are two different neurotransmitters. They actually work with the body's nervous system to minimize pain and also to help improve neuronal transmission, is what they believe happens with the medications.
Chris: So, well-tolerated, generally not a lot of side effects associated with that either, so it's safe. Because there can be pain with neuropathy, it certainly is a great alternative to using opioids, which also is something that has its own series of bad. That's kind of where the utility came from.
Brad: That's a whole other video there.
Chris: Yup. Long video but I mean, those are kind of the main three. Any antidepressant and any antiseizure medication, just to kind of envelope them in, will have benefits for neuropathy. And sometimes if one, let's say pregabalin, Gabapentin, or duloxetine doesn't work for you, your doctor can try some of the more atypical things like maybe an old-school antidepressant, like a tricyclic amitriptyline or something to that effect. But, those are the things that your doctor would do based on your conversations, your appointments, and your follow-up.
Brad: That's pretty individual.
Brad: All right good luck on this.
Chris: All right. Bye guys.
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