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Dana-Farber Comments
on Neuropathies Treatment sheet:
Neuropathies
can take the form of tingling or numbness, cramping, outright pain, sensitivity
to touch, coldness, electric-like shocks in legs, trouble buttoning buttons,
picking up small objects, carpal tunnel-like syndrome, etc.
Actual
cramping of the muscles is relieved very well with a glass of Seltzer Water
every evening and any other time they get a cramp. It has Quinine in it and
Quinine works great on muscle cramps.
It
has been found in studies that increased Magnesium (either in the diet or
through supplements) can really reduce muscle cramps. Even if their Mg levels
are within normal limits, extra magnesium can help, but be very careful with
renally compromised patients.
Same
with Potassium and calcium although you would not want these levels to go too
high.
Neurontin
(gabapentin) works very well with painful leg neuropathy.
Start
with 300mg tid working up to 900mg tid if needed.
Cymbalta
and Lyrica are new anti-depressants recently approved by the FDA for diabetic
neuropathies. They have shown some efficacy in some patients. Patients seem to
like Lyrica a lot. I usually start with 75mg bid, then increase to as high as
150mg bid as needed. It can also be taken qd if preferred.
We
start all patients on Velcade on the following:
Amino
acids – Acetyl-L-Carnitine with Alpha Lipoic Acid
B-vitamins
– as listed
Folic
acid 1mg (1000mcg)
The
fish oils and omega 3’s may also help regenerate nerve cells
This
combo seems to prevent the neuropathies from becoming severe.
We
are in the midst of a study that starts patient on above. If their neuropathies
or cramps worsen we add Neurontin and Elavil.
Massages
twice a day with a Vitamin E cream such as Cocoa Butter are also important as
it is thought the neuropathies may be caused by the drug interfering with
vascular integrity.