Behandelcentrum Neuropathische Pijn

Diabetic neuropathy is long-term damage to the nerve fibres. The nerve damage affects usally each foot equally and eventually spreads up the legs and hands. Some people with diabetes will not develop nerve damage, while others may develop this condition early. Symptoms generally begin 10 to 20 years after the diabetes diagnosis. Approximately half of all people with diabetes will eventually develop neuropathy.

Small fibre neuropathic pain is very difficult to treat. By prescribing Normast®, a body own fatty compound modulating neuropathic pain via glia, we succeeded to reduce more than 50% the pain scores within 4 weeks, while the diagnostic neuropathic pain score on the DN4 decreased from 5 to 2! Small fiber peripheral neuropathy is a type of neuropathy. It is also called a small fiber neuropathy or small fiber sensory (or panful) neuropathy (SFSN) and also C fiber neuropathy. 

A nearly 80 year old lady suffering from CIAP pain, pain due to a polyneuropathy, as well as after a stroke. Due to the combination of these two diseases, her pain was difficult to treat. The first line analgesics gave too much side effects on the cognitive level. We treated with Normast and the patient could take up her life again. Normast is in Holland available asa foodsupplement with analgesic properties and many patients find great relief if treated with this body-own compound.

CIAP is also referred to as Idiopathic sensory-motor polyneuropathy, and it is an illness where sensory and motor nerves of the peripheral nervous system are affected and no obvious underlying etiology is found. In many respects, the symptoms are very similar to diabetic polyneuropathy. In idiopathic sensory-motor polyneuropathy, the patients may experience unusual sensations (paresthesias), numbness and pain in their hands and feet. In addition, there may be weakness of the muscles in the feet and hands. In this patient pain was the most troublesome symptom.

There is no evidence from randomised trials of drug therapy for chronic idiopathic axonal polyneuropathy, accrding to a Cochrane review. We quote from that review. Chronic idiopathic axonal polyneuropathy is a not uncommon disorder of the elderly causing very slowly progressive numbness or weakness of the feet and lower legs, and sometimes also the hands. By definition, the cause is not known. No randomised trials of drug treatment for chronic idiopathic axonal polyneuropathy have been conducted. Trials will need sensitive outcome measures and long follow-up periods.

That is why treatments like these need attention, palmitoylethalonamide clearly resulted in decreasing pain in an intractable pain patient suffering from CIAP.

We present a case of a 90-year old woman, born in 1920, suffering since years from axonal idiopathic neuropathy and neuropathic pain. Pain scored 7-9 on a 11-points Likert scale when I first saw her. Walking increased burining pain to a score of 9, and during resting the score was 7. On the DN-4 scale she scored 6, which is indicative for neuropathic pain. 

Chronic pelvic and urogenital pain is more common than we think and it is a debilitating problem that has a high negative impact on the quality of life of patients. We present a typical case of ca variety of chronic urogenital pain.

A 55-year-old male patient visited our clinic with complaints of chronic pain, numbness and tingling in the pelvic area and thighs since 3 years. It started with cold sensations in the medial thighs, and later on affecting also the perineum. The pain was more severe when sitting, but sleep was undisturbed, and pain was not noticeable lying down or walking.The urologist did not find any objective cause, and based on the symptoms the diagnosis was: pudendal neuropathy. When the patient visited our clinic, his pain scored 8 on an 11-points Numeric Rating Scale (NRS).We treated this patient topically, administrating 5% amitriptyline cream once daily. The pain severity decreased more than 50% after the first application (NRS 3-4). Adding topical capsaicine 0,025% after 4 weeks, helped to decrease the pain even more.

A patient suffering from pudendal neuropathy or neuralgia, or perineodynia, with high pain scores reacting positive on our in house developed 5% amitrptyline cream, pain severity decreased more than 50% after starting this cream. The pudendal nerve carries senations from the external genitals, the lower rectum, and the perineum (between the genitals and the anus).

Neuropathy is in general  disease of the peripheral nerves, so pudendal neuropathy can cause symptoms in any of these areas. Some people have mostly rectal pain, sometimes with defecation problems. Others have mostly pain in the perineum or genitals. The symptoms may include stabbing, twisting or burning pain, pins and needles, numbness or hypersensitivity, all classical neuropathic symptoms. Usually the symptoms are made worse by sitting, as in this patient.

We use physiotherapy and physiofitness as a part of an integrative medicine treatment concept to treat neuropathy or polyneuropathy including HMSN such as the disease of Charcot Marie Tooth: training on muscular strenght, compensation, stability and balance as well as condition in general. In this field we speak of Neurological Physiotherapy, and this can be of important help individuals with neuropathies. Physiotherapy treatment will control your symptoms improving your quality of life.  A Physiotherapy treatment program may involve:A structured exercise program increasing muscle strength and endurance. Advice on hand and foot orthotics to help with muscle weakness and pain. Active and passive movement to reduce muscle cramps, improve muscle and prevent muscle wasting.Improving stability, gait and coordination.

A presentation by the director R&D for the institute for the treatment of neuropathy and neuropathic pain in the Netherlands, Jan M. Keppel Hesselink, MD, PhD. www.neuropathy.nl