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Back Clinic Neuropathy Treatment Team. Peripheral neuropathy is a result of damage to peripheral nerves. This often causes weakness, numbness, and pain, usually in the hands and feet. It can also affect other areas of your body. The peripheral nervous system sends information from the brain and spinal cord (central nervous system) to the body. It can result from traumatic injuries, infections, metabolic problems, inherited causes, and exposure to toxins. One of the most common causes is diabetes mellitus.

People generally describe the pain as stabbing, burning, or tingling. Symptoms can improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. It can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathies), or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy. Seek medical attention right away if there is unusual tingling, weakness, or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to the peripheral nerves. Testimonies

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The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*


Licensed in: Texas & New Mexico*


Pudendal Neuropathy: Unraveling Chronic Pelvic Pain

Pudendal Neuropathy: Unraveling Chronic Pelvic Pain

For individuals experiencing pelvic pain, it could be a disorder of the pudendal nerve known as pudendal neuropathy or neuralgia that leads to chronic pain. The condition can be caused by pudendal nerve entrapment, where the nerve becomes compressed or damaged. Can knowing the symptoms help healthcare providers correctly diagnose the condition and develop an effective treatment plan?

Pudendal Neuropathy: Unraveling Chronic Pelvic Pain

Pudendal Neuropathy

The pudendal nerve is the main nerve that serves the perineum, which is the area between the anus and the genitalia – the scrotum in men and the vulva in women. The pudendal nerve runs through the gluteus muscles/buttocks and into the perineum. It carries sensory information from the external genitalia and the skin around the anus and perineum and transmits motor/movement signals to various pelvic muscles. (Origoni, M. et al., 2014) Pudendal neuralgia, also referred to as pudendal neuropathy, is a disorder of the pudendal nerve that can lead to chronic pelvic pain.


Chronic pelvic pain from pudendal neuropathy can be caused by any of the following (Kaur J. et al., 2024)

  • Excessive sitting on hard surfaces, chairs, bicycle seats, etc. Bicyclists tend to develop pudendal nerve entrapment.
  • Trauma to the buttocks or pelvis.
  • Childbirth.
  • Diabetic neuropathy.
  • Bony formations that push against the pudendal nerve.
  • Thickening of ligaments around the pudendal nerve.


Pudendal nerve pain can be described as stabbing, cramping, burning, numbness, or pins and needles and can present (Kaur J. et al., 2024)

  • In the perineum.
  • In the anal region.
  • In men, pain in the scrotum or penis.
  • In women, pain in the labia or vulva.
  • During intercourse.
  • When urinating.
  • During a bowel movement.
  • When sitting and goes away after standing up.

Because the symptoms are often hard to distinguish, pudendal neuropathy can often be hard to differentiate from other types of chronic pelvic pain.

Cyclist’s Syndrome

Prolonged sitting on a bicycle seat can cause pelvic nerve compression, which can lead to chronic pelvic pain. The frequency of pudendal neuropathy (chronic pelvic pain caused by entrapment or compression of the pudendal nerve) is often referred to as Cyclist’s Syndrome. Sitting on certain bicycle seats for long periods places significant pressure on the pudendal nerve. The pressure can cause swelling around the nerve, which causes pain and, over time, can lead to nerve trauma. Nerve compression and swelling can cause pain described as burning, stinging, or pins and needles. (Durante, J. A., and Macintyre, I. G. 2010) For individuals with pudendal neuropathy caused by bicycling, symptoms can appear after prolonged biking and sometimes months or years later.

Cyclist’s Syndrome Prevention

A review of studies provided the following recommendations for preventing Cyclist’s Syndrome (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)


  • Take breaks at least 20–30 seconds after each 20 minutes of riding.
  • While riding, change positions frequently.
  • Stand up to pedal periodically.
  • Take time off between riding sessions and races to rest and relax the pelvic nerves. 3–10 day breaks can help in recovery. (Durante, J. A., and Macintyre, I. G. 2010)
  • If pelvic pain symptoms are barely starting to develop, rest and see a healthcare provider or specialist for an examination.


  • Use a soft, wide seat with a short nose.
  • Have the seat level or tilted slightly forward.
  • Seats with cutout holes place more pressure on the perineum.
  • If numbness or pain is present, try a seat without holes.

Bike Fitting

  • Adjust the seat height so the knee is slightly bent at the bottom of the pedal stroke.
  • The body’s weight should rest on the sitting bones/ischial tuberosities.
  • Keeping the handlebar height below the seat can reduce pressure.
  • The Triathlon bike’s extreme-forward position should be avoided.
  • A more upright posture is better.
  • Mountain bikes have been associated with an increased risk of erectile dysfunction than road bikes.


  • Wear padded bike shorts.


A healthcare provider may use a combination of treatments.

  • The neuropathy can be treated with rest if the cause is excessive sitting or cycling.
  • Pelvic floor physical therapy can help relax and lengthen the muscles.
  • Physical rehabilitation programs, including stretches and targeted exercises, can release nerve entrapment.
  • Chiropractic adjustments can realign the spine and pelvis.
  • The active release technique/ART involves applying pressure to muscles in the area while stretching and tensing. (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)
  • Nerve blocks may help relieve pain caused by nerve entrapment. (Kaur J. et al., 2024)
  • Certain muscle relaxers, antidepressants, and anticonvulsants may be prescribed, sometimes in combination.
  • Nerve decompression surgery may be recommended if all conservative therapies have been exhausted. (Durante, J. A., and Macintyre, I. G. 2010)

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness and nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, severe sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, and Functional Medicine Treatments. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.

Pregnancy and Sciatica


Origoni, M., Leone Roberti Maggiore, U., Salvatore, S., & Candiani, M. (2014). Neurobiological mechanisms of pelvic pain. BioMed research international, 2014, 903848.

Kaur, J., Leslie, S. W., & Singh, P. (2024). Pudendal Nerve Entrapment Syndrome. In StatPearls.

Durante, J. A., & Macintyre, I. G. (2010). Pudendal nerve entrapment in an Ironman athlete: a case report. The Journal of the Canadian Chiropractic Association, 54(4), 276–281.

Chiaramonte, R., Pavone, P., & Vecchio, M. (2021). Diagnosis, Rehabilitation and Preventive Strategies for Pudendal Neuropathy in Cyclists, A Systematic Review. Journal of functional morphology and kinesiology, 6(2), 42.

Preventing and Treating Peripheral Neuropathy: A Holistic Approach

Preventing and Treating Peripheral Neuropathy: A Holistic Approach

Certain neurological disorders can cause acute episodes of peripheral neuropathy, and for individuals diagnosed with chronic peripheral neuropathy, can physical therapy help improve the ability to move around safely along with medications, procedures, and lifestyle adjustments to help control and manage symptoms?

Preventing and Treating Peripheral Neuropathy: A Holistic Approach

Peripheral Neuropathy Treatments

Peripheral neuropathy treatment includes symptomatic therapies and medical management to help prevent worsening nerve damage.

  • For acute types of peripheral neuropathy, medical interventions and therapies can treat the underlying process, improving the condition.
  • For chronic types of peripheral neuropathy, medical interventions and lifestyle factors can help to prevent the condition’s progression.
  • Chronic peripheral neuropathy treatment focuses on controlling the pain symptoms and protecting areas of diminished sensation from damage or infection.

Self-Care and Lifestyle Adjustments

For individuals who have been diagnosed with peripheral neuropathy or are at risk of developing the condition, lifestyle factors play a significant role in managing symptoms and preventing nerve damage from worsening and can even prevent the condition from developing. (Jonathan Enders et al., 2023)

Pain Management

Individuals can try these self-care therapies and see if and which help reduce their discomfort and then develop a routine that they can work off of. Self-care for pain symptoms include:

  • Placing a warm heating pad on painful areas.
  • Placing a cooling pad (not ice) on painful areas.
  • Covering the area or leaving it uncovered, depending on comfort levels.
  • Wear loose-fitting clothes, socks, shoes, and/or gloves not made with material that can cause irritation.
  • Avoid using lotions or soaps that can cause irritation.
  • Use soothing creams or lotions.
  • Keeping the painful areas clean.

Injuries Prevention

Diminished sensation is one of the most common effects that can lead to problems like stumbling, difficulty getting around, and injuries. Preventing and regularly checking for injuries can help avoid complications like infected wounds. (Nadja Klafke et al., 2023) Lifestyle adjustments to manage and prevent injuries include:

  • Wear well-padded shoes and socks.
  • Inspect feet, toes, fingers, and hands regularly to look for cuts or bruises that may not have been felt.
  • Clean and cover cuts to avoid infections.
  • Use extra caution with sharp utensils like cooking and work or gardening tools.

Disease Management

Lifestyle factors can help prevent disease progression and are closely correlated with the risks and underlying causes. To help prevent peripheral neuropathy or its progression can be done by: (Jonathan Enders et al., 2023)

  • Maintain healthy glucose levels if you have diabetes.
  • Avoid alcohol for any peripheral neuropathy.
  • Maintain a well-balanced diet, which can include vitamin supplements, especially for vegetarians or vegans.

Over-the-Counter Therapies

A few over-the-counter therapies can help with painful symptoms and can be taken as needed. Over-the-counter pain therapies include: (Michael Überall et al., 2022)

  • Topical lidocaine spray, patch, or creams.
  • Capsaicin creams or patches.
  • Topical Icy Hot
  • Non-steroidal anti-inflammatory medications –  Advil/ibuprofen or Aleve/naproxen
  • Tylenol/acetaminophen

These treatments can help relieve painful symptoms of peripheral neuropathy, but they do not help improve diminished sensation, weakness, or coordination problems. (Jonathan Enders et al., 2023)

Prescription Therapies

Prescription therapies for treating peripheral neuropathy include pain medications and anti-inflammatories. Chronic types of peripheral neuropathy include:

  • Alcoholic neuropathy
  • Diabetic neuropathy
  • Chemotherapy-induced neuropathy

The prescription treatments for chronic types differ from the treatments for acute types of peripheral neuropathy.

Pain Management

Prescription treatments can help manage the pain and discomfort. Medications include (Michael Überall et al., 2022)

  • Lyrica – pregabalin
  • Neurontin – gabapentin
  • Elavil – amitriptyline
  • Effexor – venlafaxine
  • Cymbalta – duloxetine
  • In severe cases, intravenous/IV lidocaine may be necessary. (Sanja Horvat et al., 2022)

Sometimes, a prescription strength supplement or vitamin B12 given through injection can help prevent progression when peripheral neuropathy is associated with a severe vitamin deficiency. Prescription treatment can help treat the underlying process in some types of acute peripheral neuropathy. Treatment for acute peripheral neuropathy, such as Miller-Fisher syndrome or Guillain-Barré syndrome, can include:

  • Corticosteroids
  • Immunoglobulins – immune system proteins
  • Plasmapheresis is a procedure that removes the liquid portion of blood, returning the blood cells, which modifies the overactivity of the immune system. (Sanja Horvat et al., 2022)
  • Researchers believe there is an association between these conditions and inflammatory nerve damage, and modifying the immune system is beneficial for treating symptoms and the underlying disease.


In some cases, surgical procedures can benefit individuals who have certain types of peripheral neuropathy. When another condition is exacerbating the symptoms or process of peripheral neuropathy, surgery may help relieve symptoms and prevent disease progression. This has proved effective when nerve entrapment or vascular insufficiency are factors. (Wenqiang Yang et al., 2016)

Complementary and Alternative Medicine

Some complementary and alternative approaches can help individuals cope with the pain and discomfort. These treatments can serve as an ongoing option for those who have chronic peripheral neuropathy. Options can include: (Nadja Klafke et al., 2023)

  • Acupuncture involves the placement of needles in specific areas of the body to help reduce pain symptoms.
  • Acupressure involves applying pressure on specific areas of the body to help reduce pain symptoms.
  • Massage therapy can help relax muscle tension.
  • Meditation and relaxation therapies can help manage symptoms.
  • Physical therapy can also serve as an important component of living with chronic peripheral neuropathy and recovering from acute peripheral neuropathy.
  • Physical therapy can help strengthen weak muscles, improve coordination, and learn how to adapt to sensory and motor changes to get around safely.

Individuals considering complementary or alternative treatment are encouraged to speak with their primary healthcare provider to determine whether it is safe for their condition. Injury Medical Chiropractic and Functional Medicine Clinic will work with the individual’s healthcare provider and/or specialists to develop an optimal health and wellness treatment solution to provide pain relief and improve quality of life.

Peripheral Neuropathy: A Successful Recovery Story


Enders, J., Elliott, D., & Wright, D. E. (2023). Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxidants & redox signaling, 38(13-15), 989–1000.

Klafke, N., Bossert, J., Kröger, B., Neuberger, P., Heyder, U., Layer, M., Winkler, M., Idler, C., Kaschdailewitsch, E., Heine, R., John, H., Zielke, T., Schmeling, B., Joy, S., Mertens, I., Babadag-Savas, B., Kohler, S., Mahler, C., Witt, C. M., Steinmann, D., … Stolz, R. (2023). Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Medical sciences (Basel, Switzerland), 11(1), 15.

Überall, M., Bösl, I., Hollanders, E., Sabatschus, I., & Eerdekens, M. (2022). Painful diabetic peripheral neuropathy: real-world comparison between topical treatment with lidocaine 700 mg medicated plaster and oral treatments. BMJ open diabetes research & care, 10(6), e003062.

Horvat, S., Staffhorst, B., & Cobben, J. M. G. (2022). Intravenous Lidocaine for Treatment of Chronic Pain: A Retrospective Cohort Study. Journal of pain research, 15, 3459–3467.

Yang, W., Guo, Z., Yu, Y., Xu, J., & Zhang, L. (2016). Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 55(6), 1185–1189.

Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

For individuals dealing with chronic pain, can undergoing a nerve block procedure help alleviate and manage symptoms?

Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

Nerve Blocks

A nerve block is a procedure done to interrupt/block pain signals due to nerve dysfunction or injury. They can be used for diagnostic or treatment purposes, and their effects can be short or long-term, depending on the type being used.

  • A temporary nerve block may involve the application or injection that stops pain signals from transmitting for a short time.
  • For example, in pregnancy, an epidural injection can be used during labor and delivery.
  • Permanent nerve blocks involve cutting/severing or removing certain parts of a nerve to stop pain signals.
  • These are used in cases with severe injuries or other chronic pain conditions that have not improved with other treatment approaches.

Treatment Usage

When healthcare providers diagnose a chronic pain condition caused by nerve injury or dysfunction, they may use a nerve block to locate the area generating pain signals. They may perform electromyography and/or a nerve conduction velocity/NCV test to pinpoint the cause of chronic nerve pain. Nerve blocks can also treat chronic neuropathic pain, such as pain caused by nerve damage or compression. Nerve blocks are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis. (Johns Hopkins Medicine. 2024)


Three types include:

  • Local
  • Neurolytic
  • Surgical

All three can be used for conditions that cause chronic pain. However, neurolytic and surgical blocks are permanent and are only used for severe pain that has worsened with other treatments unable to provide relief.

Temporary Blocks

  • A local block is done by injecting or applying local anesthetics, like lidocaine, to a certain area.
  • An epidural is a local nerve block that injects steroids or analgesics into an area around the spinal cord.
  • These are common during pregnancy, labor, and delivery.
  • Epidurals can also be used to treat chronic neck or back pain due to a compressed spinal nerve.
  • Local blocks are usually temporary, but in a treatment plan, they can be repeated over time to manage chronic pain from conditions like arthritis, sciatica, and migraines. (NYU Langone Health. 2023)

Permanent Blocks

  • A neurolytic block uses alcohol, phenol, or thermal agents to treat chronic nerve pain. (National Institute of Neurological Disorders and Stroke. 2023) These procedures damage certain areas of the nerve pathway on purpose so that pain signals cannot be transmitted. A neurolytic block is mainly used for severe chronic pain cases, like pain from cancer or complex regional pain syndrome/CRPS. They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery. (Johns Hopkins Medicine. 2024) (Alberto M. Cappellari et al., 2018)
  • The neurosurgeon performs a surgical nerve block that involves surgically removing or damaging specific areas of the nerve. (National Institute of Neurological Disorders and Stroke. 2023) A surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.
  • Although neurolytic and surgical nerve blocks are permanent procedures, pain symptoms, and sensations can come back if the nerves are able to regrow and repair themselves. (Eun Ji Choi et al., 2016) However, symptoms and sensations may not return months or years after the procedure.

Different Body Areas

They can be administered in most body areas, including: (Hospital for Special Surgery. 2023) (Stanford Medicine. 2024)

  • Scalp
  • Face
  • Neck
  • Collarbone
  • Shoulders
  • Arms
  • Back
  • Chest
  • Ribcage
  • Abdomen
  • Pelvis
  • Buttocks
  • Legs
  • Ankle
  • Feet

Side Effects

These procedures can have the potential risk of permanent nerve damage. (Anthem BlueCross. 2023) Nerves are sensitive and regenerate slowly, so a tiny error can cause side effects. (D O’Flaherty et al., 2018) Common side effects include:

  • Muscle paralysis
  • Weakness
  • Frequent numbness
  • In rare cases, the block could irritate the nerve and cause added pain.
  • Skilled and licensed health practitioners like surgeons, pain management physicians, anesthesiologists, and dentists are trained to perform these procedures carefully.
  • There is always a risk of nerve damage or injury, but the majority of nerve blocks safely and successfully decrease and help manage chronic pain. (Anthem BlueCross. 2023)

What to Expect

  • Individuals may feel numbness or soreness and/or notice redness or irritation near or around the area that is temporary.
  • There can also be swelling, which compresses the nerve and requires time to improve. (Stanford Medicine. 2024)
  • Individuals may be asked to rest for a certain amount of time after the procedure.
  • Depending on the type of procedure, individuals may have to spend a few days in a hospital.
  • Some pain may still be present, but that does not mean the procedure did not work.

Individuals should consult with a healthcare provider about the risks and benefits to ensure it is the right treatment.

Sciatica, Causes, Symptoms, and Tips


Johns Hopkins Medicine. (2024). Nerve blocks. (Health, Issue.

NYU Langone Health. (2023). Nerve block for migraine (Education and Research, Issue.

National Institute of Neurological Disorders and Stroke. (2023). Pain. Retrieved from

Johns Hopkins Medicine. (2024). Chronic pancreatitis treatment (Health, Issue.

Cappellari, A. M., Tiberio, F., Alicandro, G., Spagnoli, D., & Grimoldi, N. (2018). Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series. Muscle & nerve, 58(5), 671–675.

Choi, E. J., Choi, Y. M., Jang, E. J., Kim, J. Y., Kim, T. K., & Kim, K. H. (2016). Neural Ablation and Regeneration in Pain Practice. The Korean journal of pain, 29(1), 3–11.

Hospital for Special Surgery. (2023). Regional anesthesia.

Stanford Medicine. (2024). Types of nerve blocks (For Patients, Issue.

Anthem BlueCross. (2023). Peripheral nerve blocks for treatment of neuropathic pain. (Medical Policy, Issue.

O’Flaherty, D., McCartney, C. J. L., & Ng, S. C. (2018). Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA education, 18(12), 384–390.

Stanford Medicine. (2024). Common patient questions about nerve blocks. (For Patients, Issue.

Small Fiber Neuropathy: What You Need to Know

Small Fiber Neuropathy: What You Need to Know

Individuals diagnosed with peripheral neuropathy, or with small fiber neuropathy, can understanding symptoms and causes help with potential treatments?

Small Fiber Neuropathy: What You Need to Know

Small Fiber Neuropathy

Small fiber neuropathy is a specific classification of neuropathy, as there are different types, which are nerve injury, damage, disease, and/or dysfunction. Symptoms can result in pain, loss of sensation, and digestive and urinary symptoms. Most cases of neuropathy like peripheral neuropathy involve small and large fibers. Common causes include long-term diabetes, nutritional deficiencies, alcohol consumption, and chemotherapy.

  • Small fiber neuropathy is diagnosed after diagnostic testing showing it is clear that the small nerve fibers are involved.
  • The small nerve fibers detect sensation, temperature, and pain and help regulate involuntary functions.
  • Isolated small-fiber neuropathy is rare, but research is ongoing on the type of nerve damage and potential treatments. (Stephen A. Johnson, et al., 2021)
  • Small fiber neuropathy is not specifically dangerous but is a sign/symptom of an underlying cause/condition that is damaging the body’s nerves.


Symptoms include: (Heidrun H. Krämer, et al., 2023)

  • Pain – symptoms can range from mild or moderate discomfort to severe distress and can happen at any time.
  • Loss of sensation.
  • Because the small nerve fibers help with digestion, blood pressure, and bladder control – symptoms of autonomic dysfunction can vary and can include:
  • Constipation, diarrhea, incontinence, urinary retention – the inability to completely drain the bladder.
  • If there is progressing nerve damage, the intensity of the pain can decrease, but the loss of normal sensation and autonomic symptoms can worsen. (Josef Finsterer, Fulvio A. Scorza. 2022)
  • Hypersensitivity to touch and pain sensations can cause pain without a trigger.
  • The loss of sensation can make individuals unable to accurately detect sensations of touch, temperature, and pain in affected areas, which can lead to various types of injuries.
  • Although more research is needed, certain disorders that were not considered neuropathies may have small fiber neuropathy components involved.
  • A study suggested that neurogenic rosacea, a skin condition, could have some elements of small fiber neuropathy. (Min Li, et al., 2023)

Small Nerve Fibers

  • There are several types of small nerve fibers; two in small fiber neuropathy include A-delta and C. (Josef Finsterer, Fulvio A. Scorza. 2022)
  • These small nerve fibers are distributed throughout the body including the tops of the fingers and toes, trunk, and internal organs.
  • These fibers are usually located in the superficial areas of the body, such as close to the skin’s surface. (Mohammad A. Khoshnoodi, et al., 2016)
  • The small nerve fibers that get damaged are involved in transmitting pain and temperature sensations.
  • Most nerves have a special type of insulation called myelin that protects them and increases the speed of nerve impulses.
  • Small nerve fibers may have a thin sheath, making them more susceptible to injury and damage at earlier stages of conditions and diseases. (Heidrun H. Krämer, et al., 2023)

Individuals At Risk

Most types of peripheral neuropathy cause damage to the small and large peripheral nerve fibers. Because of this, most neuropathies are a mix of small-fiber and large-fiber neuropathy. Common risk factors for mixed fiber neuropathy include: (Stephen A. Johnson, et al., 2021)

  • Diabetes
  • Nutritional deficiencies
  • Overconsumption of alcohol
  • Autoimmune disorders
  • Medication toxicity

Isolated small-fiber neuropathy is rare, but there are conditions that are known to contribute to the cause and include: (Stephen A. Johnson, et al., 2021)

Sjogren Syndrome

  • This autoimmune disorder causes dry eyes and mouth, dental problems, and joint pain.
  • It can also cause nerve damage throughout the body.

Fabry Disease

  • This condition causes a buildup of certain fats/lipids in the body that can lead to neurological effects.


  • This is a rare disorder that causes a buildup of proteins in the body.
  • The proteins can damage tissues like the heart or nerves.

Lewy Body Disease

  • This is a neurological disorder that causes dementia and impaired movement and can lead to nerve damage.


  • This is an autoimmune disease that affects joints, skin, and sometimes nerve tissue.

Viral Infection

  • These infections typically cause a cold or gastrointestinal/GI upsetness.
  • Less often they can cause other effects like small fiber neuropathy.

These conditions have been seen to cause isolated small-fiber neuropathy or begin as small-fiber neuropathy before progressing to the large nerve fibers. They can also begin as a mixed neuropathy, with small and large fibers.


Often the damage progresses at a relatively moderate rate, leading to added symptoms within months or years. The fiber nerves that are affected by the underlying condition usually progressively deteriorate, regardless of where they are located. (Mohammad A. Khoshnoodi, et al., 2016) Medications can help alleviate damage to the peripheral nerves. For individuals that are diagnosed in the early stage, it is possible to stop the progression, and potentially prevent involvement of the large fibers.


Treatment toward preventing the progression requires controlling the underlying medical condition with treatment options depending on the cause. Treatments that can help prevent the progression include:

  • Blood sugar control for individuals with diabetes.
  • Nutritional supplementation for the treatment of vitamin deficiencies.
  • Quitting alcohol consumption.
  • Immune suppression for control of autoimmune diseases.
  • Plasmapheresis – blood is taken and the plasma is treated and returned or exchanged for the treatment of autoimmune diseases.

Symptom Treatment

Individuals can get treatment for the symptoms that will not reverse or cure the condition but can help with temporary relief. Symptomatic treatment can include: (Josef Finsterer, Fulvio A. Scorza. 2022)

  • Pain management can include medications and/or topical analgesics.
  • Physical therapy – stretching, massage, decompression, and adjustments to keep the body relaxed and flexible.
  • Rehabilitation to help improve coordination, which can be impaired by loss of sensation.
  • Medications to relieve GI symptoms.
  • Wearing specialized clothes such as neuropathy socks to help with foot pain symptoms.

Treatment and medical management of neuropathies usually involve a neurologist. A neurologist may prescribe medication to help alleviate pain symptoms and provide medical interventions like immunotherapy if there is concern that an autoimmune process could be the cause. Additionally, treatment could include the care of a physical medicine and rehabilitation physician or a physical therapy team to provide stretches and exercises to help strengthen the body and maintain mobility and flexibility.


Johnson, S. A., Shouman, K., Shelly, S., Sandroni, P., Berini, S. E., Dyck, P. J. B., Hoffman, E. M., Mandrekar, J., Niu, Z., Lamb, C. J., Low, P. A., Singer, W., Mauermann, M. L., Mills, J., Dubey, D., Staff, N. P., & Klein, C. J. (2021). Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology, 97(22), e2236–e2247.

Finsterer, J., & Scorza, F. A. (2022). Small fiber neuropathy. Acta neurologica Scandinavica, 145(5), 493–503.

Krämer, H. H., Bücker, P., Jeibmann, A., Richter, H., Rosenbohm, A., Jeske, J., Baka, P., Geber, C., Wassenberg, M., Fangerau, T., Karst, U., Schänzer, A., & van Thriel, C. (2023). Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers. Journal of neurology, 270(8), 3981–3991.

Li, M., Tao, M., Zhang, Y., Pan, R., Gu, D., & Xu, Y. (2023). Neurogenic rosacea could be a small fiber neuropathy. Frontiers in pain research (Lausanne, Switzerland), 4, 1122134.

Khoshnoodi, M. A., Truelove, S., Burakgazi, A., Hoke, A., Mammen, A. L., & Polydefkis, M. (2016). Longitudinal Assessment of Small Fiber Neuropathy: Evidence of a Non-Length-Dependent Distal Axonopathy. JAMA neurology, 73(6), 684–690.

Idiopathic Peripheral Neuropathy Alleviated With Spinal Decompression

Idiopathic Peripheral Neuropathy Alleviated With Spinal Decompression


The central nervous system is responsible for sending neuron signals to all the organs and muscles in the body, allowing for mobility and proper functioning. These signals are constantly exchanged between the organs, muscles, and brain, informing of their activities. However, environmental factors and traumatic injuries can impact the nerve roots, disrupting the flow of signals and leading to musculoskeletal disorders. This can result in misalignments in the body and chronic pain if left untreated. Today’s article will inform us about peripheral neuropathy, a nerve injury correlated with back pain, and how spinal decompression can relieve this condition. We work with certified medical providers who use our patients’ valuable information to provide non-surgical treatments, including spinal decompression, to relieve pain-like symptoms associated with peripheral neuropathy. We encourage patients to ask essential questions and seek education about their condition. Dr. Jimenez, D.C., provides this information as an educational service. Disclaimer


What Is Peripheral Neuropathy?


Peripheral neuropathy refers to a range of conditions that affect the nerve roots and can cause chronic symptoms throughout the body, as research studies revealed. The nerve cells in our body transmit messages between the brain and other body parts. When these cells are damaged, it can disrupt communication between the central nervous system, leading to muscle and organ problems. Studies have linked peripheral neuropathy to pain and other symptoms, which can have a negative impact on daily activities, quality of life, and mental and physical well-being. Additionally, peripheral neuropathy may increase the risk of falls.


How Peripheral Neuropathy Correlates With Back Pain

Have you recently felt a tingling or sharp sensation when you stepped or experienced constant lower back pain? These symptoms could be related to peripheral neuropathy, which can cause back pain. “The Ultimate Spinal Decompression,” a book by Dr. Perry Bard, D.C. and Dr. Eric Kaplan, D.C., FIAMA, explains that peripheral neuropathy is nerve damage that affects the legs, causing numbness, pain, tingling, and oversensitivity to touch in the toes and feet. This can cause the muscles in the lower back to shift weight away from the painful areas, leading to low back pain. Research studies have revealed that chronic low back pain can involve both nociceptive and neuropathic pain mechanisms. Nociceptive pain is a response to tissue injury that activates the muscles. In contrast, neuropathic pain affects nerve roots branching from the spine and lower limbs, often resulting from damaged spinal discs. Fortunately, there are ways to manage peripheral neuropathy and its associated back pain.


Peripheral Neuropathy Relief & Treatment- Video

Peripheral neuropathy is a nerve injury that affects people differently and can cause sensory symptoms in the upper and lower body. Those with peripheral neuropathy may experience constant pain in their extremities, which can lead to compensation in other muscles and spinal misalignment. This can result in chronic musculoskeletal conditions. Studies show that peripheral neuropathy, especially in cases of low back pain, can cause a malfunction in the brain’s pain modulatory system, leading to overlapping risks and dysfunction. However, various treatments are available to restore the body and reduce neuropathic pain, including chiropractic care and spinal decompression. The video above explains more information on how these treatments can help alleviate neuropathic pain and release the body from subluxation.

Spinal Decompression Alleviates Peripheral Neuropathy


Peripheral neuropathy can cause a lot of pain, and many people consider surgery to treat it. However, this can be expensive, so some people opt for non-surgical treatments like spinal decompression and chiropractic care. Studies have shown that spinal decompression can be very helpful in relieving nerve entrapment and improving low back pain symptoms. It’s a safe and gentle treatment that uses traction to help the spine return to its position and allow fluids and nutrients to flow back in. Combining spinal decompression with other therapies can also help reduce peripheral neuropathy symptoms, improving people’s quality of life and helping them become more mindful of their bodies.



Peripheral neuropathy is a condition that results from nerve injuries and can affect both the upper and lower parts of the body. This disorder can cause sensory symptoms that may lead to musculoskeletal conditions, spinal misalignment, and disability. Pain and discomfort are common experiences for those with this condition, which can negatively impact their daily lives. Fortunately, spinal decompression can help alleviate the effects of peripheral neuropathy by gently stretching the spine, releasing entrapped nerves, and correcting subluxation. These treatments are safe, non-invasive, and can be incorporated into an individual’s health and wellness plan.



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Hicks, C. W., & Selvin, E. (2019). Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Current Diabetes Reports, 19(10).

Kaplan, E., & Bard, P. (2023). The Ultimate Spinal Decompression. JETLAUNCH.

Li, W., Gong, Y., Liu, J., Guo, Y., Tang, H., Qin, S., Zhao, Y., Wang, S., Xu, Z., & Chen, B. (2021). Peripheral and Central Pathological Mechanisms of Chronic Low Back Pain: A Narrative Review. Journal of Pain Research, 14, 1483–1494.

Ma, F., Wang, G., Wu, Y., Xie, B., & Zhang, W. (2023). Improving Effects of Peripheral Nerve Decompression Microsurgery of Lower Limbs in Patients with Diabetic Peripheral Neuropathy. 13(4), 558–558.


Why The Spine Goes Out of Alignment: El Paso Back Clinic

Why The Spine Goes Out of Alignment: El Paso Back Clinic

As humans, there are a variety of stressors experienced daily. Stress collects in various body areas, most commonly the upper back, jaw, and neck muscles. Stress leads to tension in the muscles. The built-up tension can cause the spinal bones to shift out of alignment, irritating the nerves between the spinal bones. A cycle begins as increased nerve tension causes the muscles to continue to contract/tighten. The extra muscle tension continues to pull the spinal bones out of alignment, making the spine stiff and less flexible affecting posture, balance, coordination, and mobility, causing the spine to become further unstable. Chiropractic treatment at regular intervals is recommended to help realign and maintain proper position.

Why The Spine Goes Out of Alignment: EP Chiropractic ClinicWhy The Spine Goes Out of Alignment

The nerves in the body are intricately linked to the spinal cord, and small distortions in the alignment can cause nerves to misfire and malfunction. When the spine goes out of alignment, the nervous system/brain and nerves get stuck in a stressed or tense state. Even a minor misalignment can cause a series of discomfort symptoms to travel throughout the body.


Causes of misalignment that creates tension in the nerves and muscles include:

  • Previous injuries.
  • Unhealthy sleep.
  • Stress – mental and physical.
  • Physically demanding jobs.
  • Overtraining.
  • Sedentary habits.
  • Foot conditions and problems.
  • Unhealthy eating habits.
  • Being overweight.
  • Chronic inflammation.
  • Arthritis.

Chiropractic Treatment

Chiropractic examination procedures:


  • A chiropractor will feel/palpate the spine to see if the bones are in alignment, move well, or are out of alignment and not moving correctly or moving at all.

Posture Exam

  • If the head, shoulders, and hips are uneven or the shoulders and head are pulling forward, the spinal bones are out of alignment/subluxations.

Balance and Coordination

  • Unhealthy balance and coordination can indicate the brain, nerves, and muscles are malfunctioning by spinal misalignment.

Range of Motion

  • A loss of spinal movement flexibility can show tension in the nerves, muscles, and misalignments.

Muscle Test

  • Loss of strength in a muscle can indicate the nerve signals are weak.

Orthopedic Tests

  • Tests that put the body in stressful positions focus on what tissue/s may be injured and the causes.


  • X-rays look for abnormalities, dislocations, bone density, fractures, hidden/invisible injuries, and infections.

Injury Medical Chiropractic and Functional Medicine Clinic provide personalized treatment plans. These specific therapies are made to generate long-term spine benefits. Spinal manipulation, deep tissue massage, MET, and other manual therapy techniques, combined with exercise, help get the bones moving properly, the muscles functioning correctly, and the spine back into proper form. Treatment relieves muscle spasms, tension, and joint dysfunction, increases circulation, and retrains the muscles to remain relaxed.

The Natural Way to Heal


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Oakley, Paul A et al. “X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks.” Dose-response: a publication of International Hormesis Society vol. 16,2 1559325818781437. 19 Jun. 2018, doi:10.1177/1559325818781437

Shah, Anoli A, et al. “Spinal Balance/Alignment – Clinical Relevance and Biomechanics.” Journal of biomechanical engineering, 10.1115/1.4043650. 2 May. 2019, doi:10.1115/1.4043650

Knee Neuropathy: El Paso Back Clinic

Knee Neuropathy: El Paso Back Clinic

Individuals dealing with aching knees is one of the most common health problems and affects people of all ages. The knee is the largest joint in the body, comprised of muscles, tendons, ligaments, cartilage, and bones. The knees support walking, standing, running, and even sitting. Constant use makes them highly susceptible to injuries and conditions. The knees are also surrounded by a complex network of nerves that transmit messages to and from the brain. Damage to the nerves from an injury or disease can create various symptoms of discomfort in and around the knee joint.

Knee Neuropathy: EP's Chiropractic Team

Knee Neuropathy


Knee discomfort symptoms can be brought on by injury, degenerative disorders, arthritis, infection, and other causes, including:

Rheumatoid arthritis

  • This is a chronic inflammatory disorder that causes the knees to swell and causes damage to the cartilage.


  • This type of arthritis causes the cartilage to steadily wear away, causing damage to the joints and various symptoms.

Cartilage Issues

  • Overuse, muscle weakness, injury, and misalignments can cause compensating postures and movements that can wear down and soften the cartilage, generating symptoms.

Several factors can increase the risk of developing knee neuropathy, including:

  • Previous knee injury
  • Undiagnosed and untreated knee injury
  • Unhealthy Weight
  • Gout
  • Compromised leg muscle strength and/or flexibility


Symptoms associated with a knee injury or disorder can vary, depending on the severity and damage. Symptoms can include:

  • Joint stiffness
  • Swelling in the joint.
  • Reduced movement/flexibility in the joint.
  • Increased instability/feeling of weakness in the knee.
  • Changes in skin color around the knee joint, like increased redness or pale discoloration.
  • Numbness, coldness, or tingling in and/or around the joint.
  • Pain symptoms could be a dull ache or throbbing felt throughout the knee.
  • Sharp, stabbing discomfort in a specific area.

If left untreated, knee neuropathy could permanently affect the ability to walk and lead to partial or total loss of knee function and mobility. Doctors recommend taking note of the following:

  • What activity/s generates symptoms?
  • Where are the symptoms located?
  • What the pain feels like?

Treatments available for knee pain

Chiropractic treatment offers various approaches to addressing the pain caused by nerve damage. Standard treatment includes chiropractic adjustments, therapeutic massage, non-surgical decompression, stretching, posture and movement training, and nutritional anti-inflammatory plans. Our medical team specializes in non-surgical treatments that decrease symptoms and increase strength, flexibility, mobility, and restore function.

Knee Injuries Adjustment


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Hunter, David J et al. “Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY.” BMC musculoskeletal disorders vol. 19,1 132. 30 Apr. 2018, doi:10.1186/s12891-018-2048-0

Kidd, Vasco Deon, et al. “Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How.” JBJS essential surgical techniques vol. 9,1 e10. 13 Mar. 2019, doi:10.2106/JBJS.ST.18.00016

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Speelziek, Scott J A, et al. “Clinical spectrum of neuropathy after primary total knee arthroplasty: A series of 54 cases.” Muscle & nerve vol. 59,6 (2019): 679-682. doi:10.1002/mus.26473