Neuropathy No More By JODI KNAPP Neuropathy No More is an eBook which is a compilation of all the essential information and details about the nervous system and how to keep it active and healthy. With the help of this program, one can get a relief from the symptoms of neuropathy. This eBook not only tells you about the nervous system, but also helps to provide essential information to get relief from the condition of neuropathy. It also provides information about how you can prevent this condition from coming back in the near future.
How is autonomic testing performed?
Autonomic testing is a collection of diagnostic tests that are used to assess the autonomic nervous system (ANS) function, which controls involuntary processes of the body such as heart rate, blood pressure, digestion, and body temperature. Autonomic dysfunction can lead to symptoms such as dizziness, fainting, abnormal heart rate, and changing blood pressure. These tests are widely used to diagnose autonomic neuropathy, postural orthostatic tachycardia syndrome (POTS), and neurodegenerative disease (e.g., Parkinson’s disease).
Following is an overview of conventional autonomic tests and their procedure:
1. Heart Rate Variability (HRV) Test
Purpose: It measures the variation in time between heartbeats, reflecting the equilibrium between the sympathetic and parasympathetic nervous systems.
How it’s done:
The patient is typically asked to lie down or sit in a quiet, relaxed manner.
Heart rate is measured by utilizing an electrocardiogram (ECG) or specialized heart rate monitors.
The patient may be asked to breathe at a certain rate (e.g., slow breathing) or perform other maneuvers to assess how the heart rate responds.
Reduced heart rate variability can indicate autonomic dysfunction.
2. Tilt Table Test
Purpose: Assesses how the body responds to changes in position (from lying to standing) and is commonly used to diagnose conditions like orthostatic hypotension or POTS.
How it’s done:
The patient lies on a tilt table that is tilted to the upright position.
Blood pressure and heart rate are monitored continuously as the table is tilted to different angles (usually from a horizontal to a nearly vertical position).
The cardiovascular response of the body is noted, along with any decreases in blood pressure or changes in heart rate.
A significant decrease in blood pressure or an abnormal response of the heart rate can indicate autonomic dysfunction.
3. Valsalva Maneuver
Purpose: Evaluates how the autonomic nervous system controls heart rate and blood pressure during stress.
How it’s done:
The patient is instructed to take a deep breath in and then forcefully exhale (as though one is attempting to blow air out with the mouth closed and nose pinched).
Heart rate and blood pressure are monitored during the maneuver.
This test can indicate how well the baroreceptor reflex (the body’s blood pressure control mechanism) is functioning. The absence of normal responses or the presence of abnormal responses can indicate autonomic dysfunction.
4. Sweat Test (Quantitative Sudomotor Axon Reflex Test – QSART)
Purpose: It assesses the function of the sweat glands, which are controlled by the autonomic nervous system. It’s useful for the assessment of small fiber neuropathy and autonomic neuropathy.
How it’s done:
Small electrodes are placed on the skin, usually on the forearm or foot.
A mild electrical current is applied to stimulate sweat glands.
The amount of sweat is measured to assess the autonomic nervous system function, specifically the sympathetic fibers responsible for sweating.
Reduced sweating may indicate autonomic dysfunction.
5. Blood Pressure and Heart Rate Response to Postural Changes
Purpose: Assesses the response of the cardiovascular system to a change in body position (e.g., standing from a sitting or lying position).
How it’s done:
The patient’s blood pressure and heart rate are measured while lying, sitting, and standing.
With intact autonomic function, blood pressure should rise slightly upon standing to prevent dizziness and fainting.
If there is a marked drop in blood pressure (more than 20 mmHg systolic or 10 mmHg diastolic) or abnormal heart rate changes, this is a sign of orthostatic hypotension or other autonomic dysfunction.
6. Deep Breathing Test
Purpose: Tests parasympathetic nervous system function, which controls the heart rate response to deep breathing.
How it’s done:
The patient is asked to breathe deeply at a specific rate (e.g., 6 breaths per minute).
The heart rate is measured during the respiratory cycle.
The normal autonomic response is a decrease in heart rate during inspiration and an increase during expiration. Lack of this response can point to parasympathetic dysfunction.
7. Microneurography
Purpose: Measures the activity of individual nerve fibers to evaluate small fiber function and sympathetic nerve activity.
How it’s done:
A small needle is inserted in the skin to record the activity of nerve fibers, usually in the leg.
The test can diagnose abnormalities of the small sympathetic nerve fibers and is used for diagnosing conditions like small fiber neuropathy.
8. Pupillary Light Reflex Test
Purpose: Evaluates the autonomic control of the pupil’s response to light (controlled by the parasympathetic nervous system).
How it’s done:
A light is shone into one of the patient’s eyes, and the pupil’s constriction is noted.
Normal response is for the pupil to constrict in reaction to light. Slowed or lack of pupil constriction may indicate parasympathetic dysfunction.
9. Electrodermal Response Test
Purpose: Measures electrical conductance of the skin, which is influenced by sweat gland function.
How it’s done:
Electrodes are placed on the skin, usually on the hands or feet.
The patient may be asked to perform various activities (such as deep breathing or tilting of the head) to note the variations in skin conductance.
Lack of fluctuation in electrodermal response may indicate autonomic dysfunction, especially of the sympathetic nervous system.
Conclusion:
Autonomic testing is an important diagnostic examination to assess the function of the autonomic nervous system, particularly if symptoms suggest dysfunction (e.g., dizziness, fainting, heart rate problems). The tests provide excellent insight into autonomic neuropathy, POTS, orthostatic hypotension, and neurodegenerative disease. A doctor can use the tests to make the diagnosis and develop a treatment plan if autonomic dysfunction is suspected.
The treatment of neuropathy, mainly peripheral neuropathy (damage to peripheral nerves), depends on the cause of the condition. Medications are often used to provide symptom relief from pain, burning, tingling, and numbness. Some of the most commonly used medications for neuropathy include:
1. Pain Relievers
Over-the-counter (OTC) painkillers:
Acetaminophen (Tylenol): Can be used for mild pain relief, but it may not work for nerve-caused pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen): Sometimes used for mild neuropathic pain but may not be effective for more severe pain. Long-term use should be used cautiously due to the risk of side effects like stomach ulcers.
Prescription opioids:
Tramadol and other opioid medications (e.g., oxycodone, hydrocodone) may be given for severe pain, but due to the risk of dependency and side effects, they are generally used with caution and for short periods.
2. Antidepressants
Certain antidepressants may be used to manage nerve pain, even if you are not depressed:
Tricyclic antidepressants (TCAs):
Amitriptyline, nortriptyline, and desipramine are some of those that are commonly used for nerve pain. They act by increasing the levels of some neurotransmitters in the brain and spinal cord that block pain messages.
Serotonin-norepinephrine reuptake inhibitors (SNRIs):
Duloxetine (Cymbalta) and venlafaxine (Effexor) are SNRIs and are also effective in the treatment of neuropathic pain by increasing the levels of serotonin and norepinephrine, which can reduce the feeling of pain.
3. Anticonvulsants (Antiepileptic Drugs)
These medications are commonly utilized to ease nerve pain because they stabilize nerve activity:
Gabapentin (Neurontin) and pregabalin (Lyrica): Both are commonly used to treat neuropathic pain, as they soothe overactive nerve signals.
Carbamazepine and lamotrigine: These are less commonly used for neuropathy, but they can be helpful, especially for neuropathies like trigeminal neuralgia.
4. Topical Treatments
Capsaicin cream: Derived from chili peppers, this topical treatment reduces pain by depleted substance P, a neurotransmitter that carries pain messages.
Lidocaine patches: These patches contain a local anesthetic that can be applied directly to painful areas to block pain.
Other topical analgesics: Some other topical creams, gels, and ointments, such as those containing menthol or camphor, can provide temporary relief.
5. Antiarrhythmic Medications
Mexiletine: This antiarrhythmic agent is utilized off-label in the management of neuropathic pain in conditions like chronic painful neuropathy and inherited neuropathies.
6. Opioid Alternatives
Tapentadol (Nucynta): This medication has a dual mechanism of action with opioid-like analgesia and norepinephrine reuptake activity and is effective in neuropathy pain.
7. Alpha-2-Delta Ligands
Gabapentinoids (gabapentin and pregabalin) are often used to treat neuropathic pain. They decrease the number of pain messages sent by the nerves by affecting calcium channels in the nerve fibers.
8. Steroids
Corticosteroids: Medications like prednisone can be given if neuropathy is due to inflammation, as in autoimmune conditions or nerve compression. Steroids can reduce inflammation and pain but are typically taken for short periods due to side effects with long-term use.
9. Vitamin Supplements
B vitamins: Some neuropathy patients, especially those with diabetic neuropathy or alcoholic neuropathy, may be assisted by taking supplements of vitamin B12, B6, or B1. Taking excessive vitamin B6, however, is toxic and may exacerbate neuropathy, so doses must be carefully monitored.
Alpha-lipoic acid: This antioxidant is sometimes used as a supplement to treat neuropathy, especially diabetic neuropathy.
10. Other Medications
Clonidine: Originally an antihypertensive medication, clonidine can be used to treat some types of nerve pain, including that of conditions like diabetic neuropathy.
Botulinum toxin (Botox): Injections of Botox are occasionally utilized in the management of nerve pain of conditions like trigeminal neuralgia.
11. Treating Underlying Conditions
For neuropathy caused by an underlying condition (e.g., diabetes, infections, autoimmune disease), the condition must be treated to improve symptoms. For example, blood sugar control in diabetes can retard the progression of diabetic neuropathy.
Conclusion:
The kind of medicine that is used to manage neuropathy depends on the type of neuropathy, the cause, and the severity of symptoms. In most instances, a combination of therapies—pain medicines, antidepressants, anticonvulsants, and topical creams—are used together to manage neuropathic pain and improve quality of life. Patients must work closely with their healthcare provider to establish the correct medicine regimen and dosage because side effects and patient responses also vary.
Neuropathy No More By JODI KNAPP Neuropathy No More is an eBook which is a compilation of all the essential information and details about the nervous system and how to keep it active and healthy. With the help of this program, one can get a relief from the symptoms of neuropathy. This eBook not only tells you about the nervous system, but also helps to provide essential information to get relief from the condition of neuropathy. It also provides information about how you can prevent this condition from coming back in the near future.