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If the cause of the peripheral neuropathy cannot be determined or if the underlying cause of the neuropathy cannot be resolved, therapy focuses on managing the symptoms. There is not one adequate, predictable, and specific treatment to control established neuropathic pain. However, there are a variety of medications available to manage the pain at least partially. Some of the medications may take several weeks to reach their maximal potential and may be effective for some patients but not for others. Therefore, attainment of adequate pain control requires a good working relationship with the health care team as well as time and patience.

Currently, there are no standard guidelines available for the treatment of peripheral neuropathy. Clinical trials to identify effective treatments have been inconclusive for several reasons including:

• Medications are considered effective even if only a small number of subjects experience limited pain relief.
• People with peripheral neuropathy want pain relief without side effects from the medication which is unrealistic. Since results from clinical trials often involve subjective evaluation of a treatment efficacy, results are not very accurate or reliable.
• The response to placebo ("sugar pill") treatment in clinical trials is significant and can be seen in up to 30-50% of patients.

Most clinicians consider successful treatment to result in a 30-50% reduction in pain, which is usually significantly less than patient expectations. Treatment of peripheral neuropathy is typically a combination of various modalities as any single modality is usually insufficient. Some of the treatment options that clinicians have found to be effective include:

• Adopting healthy living habits
• Drug therapy
• Physical and/or occupational therapy
• Surgical therapy

Adopting Healthy Living Habits

Clinicians agree that adopting a healthy lifestyle is important in the ongoing management of peripheral neuropathy. While lifestyle changes may not affect the pain directly, they improve the overall health of the patient and thus reduce some of the physical and emotional effects of the pain. According to the National Institute of Neurological Diseases and Stroke (NINDS), some of these measures include:

• Maintaining optimal weight
• Eating a healthy diet with attention to adequate vitamin intake

• Following an exercise program approved by the physician as it may help to:

  • reduce cramps associated with peripheral neuropathy
  • prevent muscle wasting in weakened or paralyzed limbs
  • increase muscle strength

• Meticulous daily foot care

• Use of appropriate, supportive shoes
• Limit alcohol consumption
• Stop smoking

Drug Therapy

In general, drug therapy for peripheral neuropathy is individualized for each patient and depends upon a number of factors that your doctor will take into consideration such as your past and present medical history, extent of pain, other medications that you may be taking, presence of other serious comorbid conditions (such as kidney disease, liver disease) and history of drug allergies. Many of the drugs used to treat peripheral neuropathy are used "off-label", meaning that they are approved by the U.S. Food and Drug Administration (FDA) for the treatment of other specific conditions (not for peripheral neuropathy) but have been shown over time to be effective also for the treatment of peripheral neuropathy. Recently, two drugs, an anticonvulsant called pregabalin (Lyrica) and an antidepressant called duloxetine (Cymbalta) received FDA approval for the treatment of neuropathic pain associated with diabetic neuropathy (see below for details).