Peripheral Neuropathies (Diabetic, Toxic, Pharmacological)

Peripheral neuropathy is a condition where the nerves in the arms and legs no longer function correctly. This can cause symptoms such as:

tingling,
electric shocks,
numbness,
burning,
persistent pain.

When pain becomes a primary symptom, we refer to it as painful peripheral neuropathy.

What are the most Common Causes?

Neuropathies can have many causes. Among the most common are:

Diabetes (very common),
Medication side effects, such as chemotherapy,
Nutritional deficiencies (e.g., vitamin B12),
Autoimmune diseases,
Certain infections (such as HIV or herpes zoster),
Genetic (hereditary) causes.

How Does it Affect Daily Life?

Neuropathic pain can be continuous or “shock-like,” worsen at night, and make it difficult to:

sleep well,
walk,
work,
perform everyday activities.

Additionally, many people with painful neuropathy also suffer from:

anxiety or depression,
chronic fatigue,
social isolation.

How is it Treated?

Personalized Approach

There is no single treatment that works for everyone. For this reason, we offer a tailored approach for each patient, which may include:

Treatments

Specific medications: such as gabapentinoids, low-dose tricyclic antidepressants (e.g., amitriptyline).
Physical therapy and rehabilitation: to maintain strength and mobility.
TENS (Transcutaneous Electrical Nerve Stimulation): a small device that sends painless electrical impulses to “calm” the nerves.
Capsaicin patch 8% (Qutenza®): for localized neuropathic pain.
Psychological support: if pain affects mood or sleep.
Spinal neuromodulation: electrical nerve stimulation through a small implant. This treatment is only considered if simpler therapies don’t work.

Note: Medications Alone are not Enough

Many patients with neuropathy use various medications but without satisfactory results. Sometimes medications cause side effects or are not tolerated. Therefore, it is important to:

avoid self-treatment,
avoid prolonged use of opioids (they are not effective for neuropathic pain),
seek specialist evaluation to develop a personalized treatment plan.

What Does Research Say?

Recent studies show that:

Neuropathic pain has a significant impact on quality of life,
Multimodal treatments (combining medications, physical therapy, psychological support, and neuromodulation) work better than medications alone,
People with well-controlled pain can return to work, sleep better, and resume their activities.

Lifestyle Interventions

Gentle physical activity (walking, stretching), regular sleep, a balanced diet, and stress reduction techniques can improve resilience and enhance the effectiveness of medical therapies.

Psychological support

The management of chronic pain can be aided by psychological interventions (such as relaxation techniques or cognitive behavioral therapy), which help reduce anxiety, insomnia, and the impact of pain on quality of life.