Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

What is Chronic Inflammatory Demyelinating Polyneuropathy?

Chronic inflammatory demyelinating polyneuropathy, also called chronic inflammatory demyelinating polyradiculoneuropathy, is an immune-mediated disorder of the peripheral nerves and nerve roots. The immune system damages myelin, the insulating layer around nerve fibers, so signals travel more slowly or are blocked.^[1] It is rare, with a pooled estimate of about 3 cases per 100,000 people.^[2]

CIDP is closely related to acute inflammatory demyelinating polyneuropathy, the demyelinating form of Guillain-Barré syndrome. The two are told apart mainly by timing: CIDP symptoms last at least 8 weeks, and the disease can progress steadily or relapse.^[1] CIDP is not simply a long-lasting Guillain-Barré syndrome.

Common symptoms

Typical CIDP causes weakness on both sides of the body, in both upper and lower parts of the limbs, along with sensory loss that affects position and vibration sense more than pain and temperature.^[1]

• Weakness in the legs and arms, which can make stairs, walking or gripping hard
• Numbness, tingling or reduced feeling in the hands and feet
• Reduced or absent reflexes
• Tiredness that is out of proportion to activity
• Nerve pain in some people

The course may be steady, relapsing or progressive.^[1] Several variants exist, including forms that mainly affect one area, the sensory nerves or the motor nerves.^[3]

Causes and risk factors

The cause is not known. CIDP is considered immune-mediated, and some people who respond poorly to treatment have antibodies against proteins at the nodes of the nerve.^[4] A specific trigger such as an infection or vaccination has been suggested in some reports, but no trigger can be identified in most people, and none can be named as the cause in an individual.

How it is diagnosed and treated conventionally

Diagnosis is made by neurologists from the pattern of symptoms, nerve conduction studies that show demyelination, and the response to immune treatment.^[1] Nerve conduction studies are essential, and their poor performance or misinterpretation is a common reason for misdiagnosis.^[4] A spinal fluid test and blood tests may add information.

European guidelines recommend intravenous immunoglobulin (IVIg) or corticosteroids as initial treatment, with plasma exchange if those fail. For long-term maintenance they recommend IVIg, subcutaneous immunoglobulin or corticosteroids, with an immune-suppressing drug added if high doses are needed. If pain is present, they advise considering nerve pain medicines and multidisciplinary management.^[3]

CIDP is treatable, but maintenance treatment is often needed for years, and the regimen needs regular adjustment to avoid under- or over-treatment.^[4]

Why Chronic Inflammatory Demyelinating Polyneuropathy calls for a whole-person approach

CIDP is an immune disease of the nerves that needs specialist care. Alongside it, people often live with weakness, nerve pain, tiredness, balance problems, poor sleep and the effects of long-term treatment.

Supportive care can address some of these symptoms. It does not treat the immune attack on the nerves.

Nerve damage and weakness

Weakness and sensory loss affect movement and daily activity. Structured exercise has been studied for this. A systematic review of 13 studies (173 people, 37 of them with CIDP) found that supervised, individualized multicomponent exercise programs appeared to improve fatigue and functional capacity in Guillain-Barré syndrome and CIDP, although the study designs varied.^[5]

Nerve pain

Nerve pain occurs in some people with CIDP, and guidelines advise considering nerve pain medicines and multidisciplinary management.^[3]

Fatigue

Fatigue is common in peripheral neuropathy. A Cochrane review found only three trials of treatments for fatigue in neuropathy, none in CIDP, and no evidence for other interventions.^[6]

Treatment side effects

Long courses of corticosteroids carry a risk of bone thinning, and guidelines advise assessing fracture risk soon after starting steroids.^[7] Side effects are a main reason to coordinate any supportive care with your prescribers.

Acupuncture as supportive care in Chronic Inflammatory Demyelinating Polyneuropathy

What the research shows

No clinical trials of acupuncture in CIDP were found in PubMed. The evidence below concerns related symptoms in other patient groups and cannot be assumed to apply to CIDP. Acupuncture does not treat the immune process.

For nerve pain in general, a Cochrane review of 6 trials (462 people) found the evidence to be very low quality and insufficient to support or refute acupuncture for neuropathic pain. The trials were small and at high risk of bias.^[8] A review of 15 studies of neuropathy from several causes found that most randomized trials showed benefit in diabetic neuropathy, Bell's palsy and carpal tunnel syndrome, but there was insufficient evidence for idiopathic neuropathy, and the authors said better-designed trials with sham controls were needed.^[9] A meta-analysis of 25 trials (1,561 people) found that acupuncture added to conventional treatment eased pain in painful diabetic neuropathy more than conventional treatment alone, with limitations that call for further studies.^[10]

For fatigue, a meta-analysis of 16 studies of chronic fatigue syndrome (not CIDP) found a favorable effect of acupuncture over sham, but the studies were mostly low quality, and no firm conclusion was possible.^[11] A meta-analysis of 24 trials in insomnia found acupuncture improved sleep scores compared with medication, with benefit seen after about three weeks, though the trials differed widely from one another.^[12]

How acupuncture may work

A review of laboratory and clinical research proposes that acupuncture acts through the nervous, hormonal and immune systems together. The authors describe this as a hypothesis, and it has not been shown to change the course of CIDP.^[13]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with a short course of visits and reassessment. We would aim treatment at comfort, sleep and stress rather than the disease.

In prospective studies, about 9 in 100 patients had a minor reaction such as soreness, bleeding or bruising at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you take immune-suppressing medicine, since infection risk matters, and if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker. Numb areas may not feel needling in the usual way, so tell the practitioner where your sensation is reduced.

Ayurvedic medicine as supportive care in Chronic Inflammatory Demyelinating Polyneuropathy

The Ayurvedic view

Ayurveda has no classical name for CIDP. Weakness, numbness and tingling are traditionally described as Vata disorders, since Vata is the principle said to govern movement and the nervous system. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

In a supportive role, care is chosen for the individual and may include:

• Diet and daily routine intended to calm Vata, such as warm, regular meals and steady sleep hours
• Gentle warm oil massage, with care over numb skin because reduced sensation can hide burns from heat
• Breathing and relaxation practices
• Herbs such as ashwagandha or turmeric, prescribed individually after review of your medicines

Panchakarma cleansing procedures are not appropriate during pregnancy, acute illness or frailty. They are also generally unsuitable during relapses, with significant weakness, or while taking immune-suppressing medicine, unless your neurologist agrees.

What the research shows

No Ayurvedic studies in CIDP were found, so there is no evidence of benefit for the disease. For related symptoms, a meta-analysis of 9 trials (558 people) found ashwagandha extracts lowered stress and anxiety scores and blood cortisol compared with placebo. Four trials reported mild to moderate adverse events, and long-term safety is not established.^[15] These trials were not in people with neuropathy. Turmeric has been tested for nerve symptoms in only one clinical trial in other neuropathies.^[16]

Herbal medicine as supportive care in Chronic Inflammatory Demyelinating Polyneuropathy

Herbs and formulas that have been studied

No herbs or formulas have been tested in CIDP. A review of 22 clinical studies of plant-derived medicines in other neuropathies, such as diabetic and chemotherapy-related, found the most evidence for cannabis, linseed oil, capsaicin applied to the skin and a Japanese formula called Goshajinkigan. Chamomile, turmeric and colocynth each had only one trial.^[16]

Transdermal medication therapy, meaning an herbal preparation applied to the skin, has no CIDP research behind it, and should not be used over broken skin or numb areas where irritation may go unnoticed.

What the research shows

There is no evidence for herbal medicine in CIDP. The review authors noted that some studies reported improved pain, nerve function and quality of life in other neuropathies, and that more studies are needed.^[16]

Safety and herb-drug interactions

This is the most important section for this condition, because many people with CIDP take corticosteroids or immune-suppressing drugs. Herbs and prescription drugs can interact. Published cases include St John's wort lowering blood levels of cyclosporin and tacrolimus, with organ rejection reported when cyclosporin levels fell.^[17] Herbs described as immune-stimulating may also work against the purpose of your treatment, so each herb must be reviewed with your prescriber.

Herbal and dietary supplements account for about 20% of drug-induced liver injury cases in the United States, which matters if you take azathioprine, methotrexate or other drugs that affect the liver.^[18] In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[19] Heavy metals can themselves injure nerves, so use only tested products prescribed individually, and tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe limb weakness and numbness through patterns such as qi and blood deficiency, blood stasis or obstruction in the channels. Researchers instead study immune signaling, nerve conduction and the nervous system's role in pain, and some propose that acupuncture acts on the nervous, hormonal and immune systems.^[13]

In Ayurveda, aggravated Vata describes numbness, weakness and pain. It might loosely parallel nerve dysfunction, but no study has shown that a dosha corresponds to a biological process or that either framework changes demyelination.

How this care fits with your medical care

Supportive care here is complementary. CIDP needs specialist treatment, and we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change prescribed immunoglobulin, steroids, immune-suppressing drugs or physical therapy without your prescriber.

We do not diagnose or manage the disease. Please bring your diagnosis, nerve conduction results, a full list of medicines and supplements, and the names of your specialists. Report new or worsening symptoms to your neurologist rather than waiting for a visit with us.

When to seek urgent medical care

Rapidly worsening weakness may signal a relapse or another serious nerve problem, and needs prompt assessment.

• Weakness that is spreading or worsening over hours to days
• Trouble breathing, swallowing or speaking, or a weak cough
• Difficulty walking, repeated falls or inability to stand
• New loss of bladder or bowel control
• Fever, spreading redness or other signs of infection while on immune-suppressing treatment

For trouble breathing, trouble swallowing or any emergency, call 911 or go to the nearest emergency department.