Plexopathy is a disorder which can result in weakness, pain, lymphedema, reduction or complete loss of motor control over a certain part of the body and sensory deficits. These symptoms occur due to a problem with a network of nerves or lymph or blood vessels.
The two most common kinds are brachial plexopathy and lumbosacral plexopathy. The former is considered an injury to the nerves of the brachial plexus which transfer signals from the spinal cord to chest, hands, arms and shoulders. Brachial plexus can get damaged due to a number of reasons, including trauma of the significant area (shoulder dislocation, for example), different kinds of tumours or inflammation, the latter coming from some of the most common inflammatory agents, but also rare diseases such as Parsonage-Turner Syndrome.
Lumbosacral plexopathy, on the other hand, is focused on the injuries of the lumbosacral plexus and their negative effects. These are the nerves which can be found in the lumbar spine or pelvis and they can come from trauma, but also diabetes, tumors or obstetrical injuries.
Causes of Plexopathy
Plexopathy can be caused by many things. The most common cause is some kind of a localized trauma.
However, there are other causes as well. Nerve compression is a common cause, as are several different arteries and veins diseases and numerous infections.
Radiation therapy is another cause of plexopathy. This is not surprising having in mind that radiation therapy is notorious for adverse side effects on the healthy tissue and systems in the body, including both central (brain and spinal cord) and peripheral nervous systems. Both previously mentioned types of plexopathy can be induced by radiation.
Radiation-induced brachial plexopathy can be an adverse effect of a radiation treatment aimed at axilliary region, neck, thoracic outlet and chest. Brachial plexus gets irradiated during treatment of the supraclavicular and axilliary lymph nodes. Women are far more commonly affected by radiation-induced brachial plexopathy, but this is understandable, having in mind that breast cancer is often treated with radiation therapy in the mentioned region.
Radiation-induced lumbosacral plexopathy, on the other hand, comes from radiation treatment aimed at abdominal or pelvic regions. The affected nerves control thing such as motor and sensory aspects of the abdominal wall, anteromedial thigh, anterior, medial and posterior leg, posterior hip girdle… Risk of radiation-induced lumbosacral plexopathy is higher in the occurrence if intracavitary radiation and it usually comes with lymphomas, or uterine, ovarian, cervical, testicular or rectal cancers. Females are, once again, more susceptible to developing radiation-induced lumbosacral plexopathy, but the occurrence is just marginally higher than with men.
What is particularly interesting is that these kinds of radiation-induced brachial plexopathy and radiation-induced lumbosacral plexopathy can occur several decades after radiation therapy. Luckily, during the past few decades the frequency of both these types has been decreasing.
Lastly, it is called idiopathic plexopathy when there is no known cause.
Treatment of Plexopathy
Treatment is greatly dependent on the kind and severity of the condition. A reduction in physical activity is necessary, but it is also natural due to the debilitating nature of the condition. Almost all kinds will require some kind of pain management.
Brachial plexopathy can be treated through surgical nerve decompression in the case when compression is the cause. Surgeries can also be performed in order to repair or replace nerves.
Lumbosacral plexopathy that is caused by diabetes can be held under control by controlling the levels of blood sugar.
It is very important to note that rehabilitation can occur on its own in some milder cases, but it can also last years and even decades.
Physical therapy is also very important in order to prevent atrophy of muscles whose use is limited before the nerves recover and electrical stimulation is often a part of therapy.
Many exercises are designed both to improve muscle function and engage nerves at the same time. For example, for brachial plexopathy, patients can perform shoulder exercises which involve adduction, abduction, flexion, depression, elevation, stretching and extension.
Muscle relaxants are used to reduce spasms, hyperreflexia and pain. However, muscle relaxants are extremely powerful and they create a number of side effects including sedation, stomach issues, heartbeat changes, lethargy, headache, nausea, fatigue, confusion and even hallucinations, dry mouth, vision problems, constipation and mood changes.
Speaking of pain management, painkillers are the most common option. These include paracetamol, NSAIDs and opioids, all of which come with side effects.
Having in mind the longevity of the required treatment in some cases, muscle relaxants and painkillers’ side effects often prove to be a problem. Moreover, building up tolerance is another issue.
This is why alternative solutions such as PEA are important. Its benefits lie in efficacy, but also safety. PEA relieves pain and reduces inflammation through several different natural and endogenous processes.
PEA is 99.99% palmitoylethanolamide, which is an endogenous fatty acid produced by the body when it needs to calm cells and help them recover, or to relieve pain and inflammation. However, for long-term conditions such as plexopathy, the body cannot produce enough palmitoylethanolamide and this is where PEA jumps in.
After more than 400 medical studies performed on palmitoylethanolamide it is safe to say that PEA has no habituation issues, no side effects, no negative interactions with other medicine (it can be used with your regular therapy) and no overdose level. Moreover, many of those studies were aimed at observing the effect of palmitoylethanolamide on various kinds of neuropathy and it produced remarkable benefits.