Effective treatments for peripheral neuropathy (i.e. neuropathic pain relief) are few in number, as most physicians know. Medications taken by mouth usually
have disruptive side effects and most do not provide enough pain relief for chronic, intense, neuropathic conditions, including shingles pain relief (Post-herpetic Neuralgia).
Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system1, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Doctors may use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe a patient's condition.
The most common cause of neuropathy in clinical practice is diabetes. Diabetes causes several types of neuropathy, which include chronic symmetrical polyneuropathy, proximal neuropathy (diabetic amyotrophy), mononeuropathies, and cranial radiculopathies. The most common is a symmetrical sensorimotor neuropathy which causes pain, sensory loss, weak or absent tendon reflexes and, to a lesser extent, weakness.
PRINCIPAL CAUSES OF PERIPHERAL NEUROPATHY
| 1. Autoimmunity (inflammatory demyelinative polyradiculoneuropathies). | 6. Dysproteinemia (myeloma,cryoglobulinemia) |
| 2. Vasculitis (connective tissue diseases) | 7. Nutritional deficiencies and alcoholism |
| 3. Systemic illness (diabetes, uremia, sarcoidosis, myxedema, acromegaly) | 8. Compression and trauma |
| 4. Cancer (paraneoplastic neuropathy) | 9. Toxic industrial agents and drugs |
| 5. Infections (diphtheria, leprosy, lyme disease, AIDS, herpes zoster) | 10. Inherited neuropathies |
| Wikipedia states there are four cardinal patterns of peripheral neuropathy are polyneuropathy, mononeuropathy, mononeuritis multiplex and autonomic neuropathy. However a better source of definitions and understanding Peripheral Neuropathy can be found on the Neuropathology website. |
Common Oral Treatments: Commonly used treatments include using a tricyclic antidepressant (such as amitriptyline2) and antiepileptic therapies such as gabapentin3(Neurontin®) or sodium valproate (can't be used if pregnant). These oral treatments can have side effects that may be unwelcomed by the patient and/or the treating physician. If the patient needs to take additional pain meds such as hydorocodone, morphine and naproxen the treating physician should be aware of these and the possible interactions.
Alvarado Compounding Pharmacy's
alternative treatment to Peripheral Neuropathy
NON - Oral Treatment for peripheral neuropathy: Alvarado pharmacy compounding pharmacists have developed a series of transdermal(i.e., "through the skin") creams for treating various neuropathies, the ability to provide for neuropathic pain relief. The basic cream - called Neurocreme® is effective for many painful neuropathies. Bi-annual patient surveys since 2002 support this claim. The most recent results indicate 80% of the respondents were helped by one of the products.
Please note that "Post-surgical Neuropathy" is loosely defined as "any neuropathy not in evidence before a surgery, but present sometime after a surgery". Please note that "Miscellaneous Neuropathies"
include Carpal Tunnel Syndrome, Fibromyalgia, Guillame-Barre Syndrome, Hyperalgesia, Meralgia
Paresthetica, Myelitis, Neuritis, Neuromas, Rheumatoid Arthritis, and Spinal Stenosis.
A survey was given to each patient who used any Neurocreme® (or the older "Neurogel") transdermal
preparation. Returned surveys revealed many different diagnoses. The survey dates are from January 18, 2001, through July 31, 2009. A copy of the survey summary may be viewed on this webpage. The survey describes the various neuropathic conditions treated
successfully by Neurocreme® and the degree of pain reduction.
An easy-to-use prescription form is included on this webpage. This may be printed out for your convenience and shared with your physician.
Many health insurance plans pay for Neurocreme®. The main exceptions are Medi-Cal, Medi-Care, and PacifiCare. We will bill your prescription
online first to see if it is covered.
Health care providers – and their patients – are encouraged to know more about Neurocreme® and its treatment advantages. Please call the Compounding Laboratory at Alvarado Medical Plaza and Compounding Pharmacy (AMPP). The telephone number is 619-287-5107 from 9 AM to 1 PM and 2 PM to 6 PM Pacific Time, Monday thru Friday. Please ask for the "Compounding Pharmacist" when you call, or call direct at 619-287-5107.
All Compounds Require A Prescription!
Please note: A Credit Card must be on file prior to the compound being made if your insurance do not cover the item.
1National Institute of Neurological Disorders and Stroke (website)
2Common side effects of using amitriptyline are mostly due to its anticholinergic activity, including: weight gain, dry mouth, changes in appetite, drowsiness, muscle stiffness, nausea, constipation, nervousness, dizziness, blurred vision, urinary retention, insomnia and changes in sexual function.
3Gabapentin should not be discontinued abruptly after long term use. Abrupt or over rapid withdrawal may provoke a withdrawal syndrome similar to alcohol or benzodiazepine withdrawal. Gradual reduction over a period of weeks or months helps minimize or prevents the withdrawal syndrome. Gabapentin's most common side effects in adult patients include dizziness, drowsiness, and peripheral edema (swelling of extremities); these mainly occur at higher doses, in the elderly.
