Complementary and Alternative Medicine for Painful Peripheral Neuropathy

Purpose of review The purpose of our manuscript is to review the current evidence supporting the use of complementary and alternative medicine (CAM) in neuromuscular disease, specifically in painful peripheral neuropathy (PPN). We outline the therapeutic challenges of this debilitating condition and describe the best evidence for incorporating such therapies into clinical practice. The most studied modalities include lifestyle modifications with diet and exercise, supplements, and acupuncture. CAM therapies such as yoga, meditation, electrical stimulation, neuromodulatory devices, and cannabis are mentioned as emerging therapies. Recent findings Current data suggests that targeted lifestyle modifications, including aerobic exercise and diet modifications that promote weight loss, may improve the natural course of diabetic painful neuropathy and potentially other types of neuropathy. A number of studied dietary supplements and vitamins including B vitamins, vitamin D, alpha-lipoic acid, and acetyl-l-carnitine improve both subjective and objective neuropathic measures. A wide range of neuromodulatory devices and electrical stimulation modalities demonstrate mixed results, and further studies are needed to confirm their benefit. Finally, acupuncture and yoga both demonstrate benefit in a variety of PPNs. Multiple CAM therapies show efficacy in the treatment of PPN. From the strongest level of evidence to the least, lifestyle modifications including exercise and diet; supplements including B12, alpha lipoic acid, acetyl-l-carnitine, and vitamin D in deficient patients; followed by acupuncture and yoga may alleviate symptoms of PPN.