Toxic Neuropathy Treatment & Management

Updated: Dec 01, 2022
  • Author: Jonathan S Rutchik, MD, MPH, FACOEM; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Medical Care

Advise removal from occupational or environmental exposure.

Advise discontinuation of medication or recreational drug habit. Also provide information regarding how alcohols affect those with exposures.

Acute care for those intoxicated with recreational, industrial, or other agents is discussed in other articles on this website.

Preventive care and supportive care should include consideration of life stressors, diet, and overall behavior modifications.

Treatment options also include the following:

  • Nonpharmacologic options include cool soaks, heat, massage, elevation or lowering of the limbs, shoe tightness, and/or exercise.

  • Pharmacological options include tricyclic antidepressants, anticonvulsants, opiates, or topical capsaicin cream. Other options include intravenous gamma globulin, aldose reductase inhibitors, nerve growth factor, anti–tumor necrosis factor-α; these are mainly research ideas. Three that may be helpful presently include lipoic acid, evening primrose, and vitamin E.

    • Alpha lipoic acid is well reviewed by Halat and Dennehy. [56] Thiolic acid is a free radical scavenger and chelator. It is approved for use in Germany for neuropathy. The best studies suggest parenteral use followed by oral use relieves symptoms and improves nerve blood flow. Oral preparations are available in United States. Two studies suggest increased nerve conduction (600/1200 mg for 2 y, oral) and reduced symptoms (1800 mg/d for 3 wk, oral). The mechanism of action includes chelation and, thus, a concern for mineral shortage exists. Monitoring iron levels is suggested, and persons with alcoholism need to take vitamin B.

    • Evening primrose is also well summarized by Halat and Dennehy. [56] It includes omega 6 essential fatty acids: gamma linoleic acid (GLA) and linoleic acid. It is an essential component of myelin and the neuronal cell membrane. Dosages ranging from 360-480 mg/d for 6 months to 1 year improved nerve function measurements. It has mild side effects including inhibition of platelet aggregation. Concern also exists for those with seizure disorders.

    • Vitamin E is discussed in the article Argyriou et al. [57] Vitamin E has been administered to patients on chemotherapy for prevention of neuropathy at doses of 600 mg/d during treatment and then for 3 months after treatment. A reduced peripheral neuropathy score has been noted. A neuroprotective effect has been described.



Consultation with an occupational therapist or environmental medicine specialist may be helpful.



Although diet does not play a specific role in reparation of the PNS, a balanced diet is important for various reasons related to general health. Since various B vitamins have been implicated in the development of neuropathies, some physicians suggest supplementation.


Long-Term Monitoring

Consistent follow-up care with a neurologist is necessary to monitor the progress of neurological findings.

Follow-up with an occupational medicine specialist may be important to assist with return to work and reduction of exposure. This clinician may be able to work with the company supervisors or management to improve the work environment. This may occur if the company chooses to substitute the neuropathy-causing agent with a less-toxic agent in the workplace, to change the schedules of workers so that their exposure is less during a period of time, or to promote safer personal protective equipment. Communication between health care provider and management is essential for this individual's health as well as his or her status for disability or ability return to work.