Non-Medication treatments of neuropathy
The non-medication treatments of neuropathy takes several forms.
- Physiotherapy- this can be useful for some patients. Often having pain can lead to avoidance of certain movements because you may be afraid that it will not only make the pain worse but also cause more damage (which almost never happens). The value of physiotherapy here is to promote normal behaviour and discourage pain behaviours such as avoidance of movement.
- Massage therapy- this can be helpful both for relaxation purposes but also if there is a muscular component to the pain.
- Nerve blocks- these are procedures whereby a local anaesthetic or steroid is injected in to a certain area that is deemed responsible for the pain. This particularly applies to pain that is caused by nerves being compressed in the neck or back. This can lead to significant relief although it often takes more than one nerve block before an effect is seen. Also, the effect of this wears off in about 2-3 months and so these injections often need to be repeated. Nerve blocks when they work have the advantage of reducing the amount of regular medication that needs to be taken.
- Patient education- Having pain of any kind and being faced with possible long term pain medication can be a daunting prospect. There are many fears and concerns with being prescribed new medications especially when they may need to be taken for several months if not years.
- The concerns may be any or all of the following:
- Potential side effects
- Interactions with other medications
- Fear of addiction
- Medication not working
All of these are extremely reasonable concerns but a discussion with your prescribing doctor should alleviate most of them. These medications are safe when taken as prescribed. They may of course lead to side effects but knowledge of what to expect can actually be hugely helpful in lessening the impact of these. In general, they are not addictive and in most cases they will be of some benefit in terms of reducing pain. Often patients come to my clinic and tell me that these medications have not worked- for some this may be the case but for the vast majority they have been taken at too low a dose for too short a period of time or they caused a side effect that was unexpected (as they had not been told what to expect). If there is concern about interacting with other prescribed medication the best thing to do is keep a list of your medication and doses and make sure the prescribing doctor is aware of everything on this list. In general, the chances of interactions with other commonly prescribed medications is low.
In terms of addiction these medications do not tend to cause this but if you are concerned you should talk to your doctor.
It would be worth writing out a list of concerns and then discussing them one by one. By and large these medications are well tolerated, work to help the pain and allow people to have a better quality of life.
A pain diary may be useful especially if pain continues to some extent despite being on medications. Sometimes the pain killers can only relieve the pain to a certain level, for example from about 8/10 to 4/10 (on the pain scale where 10 is the worst pain and 0 is no pain). The pain diary can be a way of making note of things that you cannot do and would like to be able to do but because of pain cannot or can only to a limited extent. Then the aim of pain management is not really to reduce the pain further (but obviously if pain is reduced that is even better) but to allow you to do things on your list and the pain management becomes goal- directed.
References and useful links: