Our local newspaper recently had a four-page full-color advertising insert titled "Encouraging News for Neuropathy Patients." As neuropathy is a common and frustrating complication of diabetes, I was intrigued, and read the entire insert. According to the insert, "Local Doctor's Drug-Free, Neuropathy Treatment Relieves Poor Balance and Numbness in Feet and Legs." And the local doctor (a chiropractor) indicates that he has developed his own way to treat neuropathy His ad states:
"This successful protocol is a pain-free treatment available only at the [name deleted] Chiropractic Pain Relief Center. It is noninvasive and drug-free so there are no concerns about drug interactions. It is completely safe and effective in the treatment of neuropathy pain.
Many patients have been able to get off medications that can affect them both mentally and physically. Each patient’s care is tailored to his or her own specific condition."
That seems almost too good to be true -- a local chiropractor here in South Carolina has an exclusive treatment for a complication about which it is said "there are no miracle cures or treatments for neuropathy."
Let's be specific. Although neuropathy has many causes, it's very common in diabetes, with about half of all people with diabetes having some form of nerve damage. Probably the most common diabetic "neuropathy" is what's medically called distal (that is, at the far ends of the body such as the feet), symmetric (both left and right sides approximately equally affected), sensory (pertaining to feeling rather than control of muscle movement) polyneuropathy (affecting multiple nerves). It's sometimes abbreviated DSPN (Distal Symmetric Peripheral Neuropathy or Distal Sensory Peripheral Neuropathy: take your choice). It can be painful, with sensations described as burning, crawling or tingling, or can result in numbness rather than pain.
Well, I wanted to see what else has been said on the Internet about this "Drug-Free, Neuropathy Treatment." Surprise, surprise: it turns out that other clinics have made precisely the same boast of having an exclusive treatment protocol. From a clinic in central Florida:
"The successful protocol is a pain-free treatment available only at The [deleted] Clinic of Chiropractic. It is non-invasive and drug-free so there are no concerns about drug interactions. It is completely safe and effective in the treatment of neuropathy pain.
Frequently, patients have been able to get off of many medications that can affect them both mentally and physically. Each patient’s care is tailored to his or her own specific condition and needs."
and, from another chiropractor in Miami, Florida:
"The successful protocol is a pain-free treatment protocol that can only be provided in a healthcare professional’s office. It is non-invasive and drug-free so there are no concerns about drug interactions. It is completely safe and effective in the treatment of neuropathy pain. Frequently, patients have been able to get off of many medications that can affect them both mentally and physically. Each patient’s care is tailored to his or her own specific condition."
Ahh! Do I sense a pattern here? Or merely plagiarism?
First of all, let's be sure what we're talking about. "Neuropathy" is a very broad term -- encompassing peripheral neuropathy or DSPN (which is what these protocols claim to treat) and a multitude of other nerve damage issues. There are various causes of neuropathy, and depending on the cause, treatment will differ. The best example of a specific treatment for a specific form of peripheral neuropathy? Neuropathy due to vitamin B-12 deficiency: the treatment is B-12, not chiropractic manipulations.
What about treatment of the peripheral neuropathy due to diabetes? The first step in treatment is controlling blood glucose levels. Additional treatment depends on the type of nerve problem and the symptoms. Pain relief, foot care, a search for associated problems such as poor circulation, measurement of B-12 and other lab studies, are all appropriate. Smoking cessation is urged.
But not chiropractic. Some modalities commonly advertised by chiropractors such as pulse laser therapy, have been available for years but haven't entered mainstream medicine. (As a 2010 review article concluded, "There is some evidence that pulsed light does have effects that are different from those of continuous wave light. However further work is needed to define these effects for different disease conditions and pulse structures.") Others are more widely accepted, transcutaneous electrical nerve stimulation (TENS), acupuncture, biofeedback, and physical therapy seem to help relieve pain in some people.
Best bet for PWD with DSPN? Talk to your diabetes doctor, both to seek possible causes besides diabetes, and to prescribe medications as might be needed for pain (Duloxetine, pregabalin and tapentadol are approved by the FDA specifically for treating painful diabetic peripheral neuropathy). Protect your feet from damage (I recall one patient who noticed a thumbtack painlessly jammed into the sole of his foot -- he never felt its presence.) Stop smoking if you still are.
And control your blood glucose.