Ischemic Neuropathy

This chapter discusses the subset of ischemic neuropathy which is due primarily to peripheral arterial disease. Peripheral arterial disease affects 5% of men and 2.5% of women and results in ischemic pain and claudication. Disease progression occurs in a small minority of patients to a stage of critical ischemia with rest pain and threatens limb survival. Ischemic neuropathy encompasses pain due to several stages of progression of tissue ischemia. Patients may have multiple comorbid conditions due to the same pathological process that affects coronary, cerebral, and other circulations. Diabetes mellitus is commonly associated with vascular ischemia and results in arterial occlusive diseases. Pathological changes involve demyelination, axonal loss, and disorderly remyelination. In addition to simple palpation of a pulse, Doppler flow estimation and angiography are used to determine the location and extent of the disease process. Ankle-brachial index, toe-brachial index, and digital flow estimations are more sensitive methods used for early identification. In addition to controlling risk factors and the management of comorbid conditions, medication and procedures to restore blood flow play a prominent role in management of ischemic neuropathy. Sympatholysis and spinal cord stimulation are effective methods to help manage chronic pain in advanced cases that are refractory to conventional treatment measures.