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Mononeuritis Multiplex Treatment & Management

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Dean H Hommer, MD  more...
 
Updated: May 31, 2016
 

Approach Considerations

The physician must try to elucidate the underlying cause and initiate appropriate treatment according to the established protocols for the specific disease condition. Disorders such as vasculitis[4, 5, 6] can be fatal if not treated. (A study by de Luna et al of plasma exchange in the treatment of systemic necrotizing vasculitides found that in patients with mononeuritis multiplex, improvement in severe motor weakness occurred.[54] )

In addition, the physician and the patient should have the understanding that the nerve pain may be persistent for an extended period and may require ongoing treatment, with possible referral to a comprehensive pain treatment center. Both must have realistic expectations.

Other treatment considerations include the following:

  • Use caution in treating the patients who are insensate, especially with the use of modalities (eg, ice, heat)
  • Monitor and help control blood sugar levels in individuals with diabetes
  • Institute nutritional supplementation
  • Monitor bony prominences for pressure points

Safety is an important consideration, and appropriate safety measures must be provided. These may include, but are not necessarily limited to, installation of railings, removal of obstacles (eg, loose rugs that may slip on the floor), installation of low-level lighting, and testing of water temperatures before bathing.

Consultations

Consultations in the treatment of mononeuritis multiplex can include the following:

  • Neurologist - If an underlying neurologic condition is suspected
  • Rheumatologist - If an underlying rheumatologic condition is suspected
  • Infectious disease specialist - If evidence of an infectious etiology is present
  • Pain management specialist and physiatrist referrals may be needed in selected cases

Follow-up

The patient should follow up with the primary physician for underlying disorders (eg, diabetes). In addition, the patient should follow up with the primary physician or with the rehabilitation physician for pain medications and/or monitoring of laboratory tests.

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Rehabilitation Therapies

Physical therapy

Physical therapy (PT) may be recommended for patients with mononeuritis multiplex, with the specific treatment generally depending on the site involved. PT can help to prevent contractures and maintain strength through the use of range of motion (ROM) and strengthening exercises, as appropriate. The physical therapist can assist the patient with positioning issues and recommend braces or splints (static and functional) to increase his/her independence with mobility.

Patients with mononeuritis multiplex often exhibit problems with diminished sensation and require instruction to improve their safety awareness. In some cases, a transcutaneous electrical nerve stimulation (TENS) unit may be recommended for pain control in patients with this condition. The physical therapist can instruct the patient in the appropriate setup and use of the unit.

Occupational therapy

Occupational therapy is directed toward maintaining functional independence in patients with mononeuritis multiplex. This training may include instructing the patient in the use of adaptive techniques for activities of daily living (ADLs). Built-up handles on eating utensils and adaptive aids (eg, long shoehorns, reachers) may be used to help the patient perform ADLs such as dressing and eating. A job-site analysis may need to be completed by the physical therapist and/or occupational therapist to ensure occupational safety. Therapy can incorporate job-specific training for those individuals who would benefit.

Recreational therapy

The primary focus of recreational therapy is to maintain the patient's activity level and self-esteem during recovery.

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Contributor Information and Disclosures
Author

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief, Department of Pain Management, Brooke Army Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, American College of Sports Medicine, American Institute of Ultrasound in Medicine, American Society of Interventional Pain Physicians, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Paul V Brooks, MD Medical Director, Department of Physical Medicine and Rehabilitation, Lexington Clinic, PSC; Assistant Professor, Department of Orthopedics, Division of Sports Medicine, Assistant Professor, Department of Surgery, University of Kentucky College of Medicine

Paul V Brooks, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Association of University Professors, American College of Sports Medicine, American Medical Association, American Pain Society, American Spinal Injury Association, Association for Academic Psychiatry, and Brain Injury Association of America

Disclosure: Nothing to disclose.

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