Peripheral neuropathy

2021-08-29 05:20 AM

Peripheral neuropathy is caused by nerve damage. It can be the result of problems such as injury, infection, metabolic problems, and exposure to toxins.

Define

Peripheral neuropathy often causes numbness and pain in the hands and feet. People often describe the pain of peripheral neuropathy as tingling or burning, while the loss of sensation can be compared to the sensation of wearing thin gloves.

Peripheral neuropathy is caused by nerve damage. It can be the result of problems such as injury, infection, metabolic problems, and exposure to toxins. One of the most common causes is diabetes.

In many cases, symptoms of peripheral neuropathy improve with time - especially if it is caused by an underlying problem that can be treated. Several medications are commonly used to relieve symptoms of peripheral neuropathy.

Symptoms

The nervous system is divided into two types. The central nervous system includes the brain and spinal cord. All other nerves in the body are part of the peripheral nervous system. Peripheral neuropathy affects these nerves, which include:

Nerves perceive sensations such as pain, heat, or touch.

Motor nerves control muscle movement.

Autonomic nerves control automatic functions such as blood pressure, heart rate, digestion, and bladder function.

Most commonly, peripheral nerves can start in the longest nerve - the toes. Specific symptoms vary, depending on the type of nerve affected. Signs and symptoms may include:
 
Gradual onset of numbness and tingling in the feet or hands, which can spread to the legs and arms.

Hot pain.

Needles or pain are like electricity.

Strongly sensitive to touch, even light.

Lack of coordination.

Muscle weakness or paralysis if motor nerves are affected.

Bowel or bladder problems if the autonomic nervous system is affected.

Seek medical attention right away if you experience unusual tingling, weakness, or pain in your arms or legs. Early diagnosis and treatment, provide the best chance of controlling symptoms and preventing further damage to peripheral nerves. If your symptoms are already affecting your sleep or feeling depressed, your doctor or pain specialist may recommend treatment.

Causes

It is not always easy to determine the cause of peripheral neuropathy, because a number of factors can cause neuropathies. These factors include:

Injury or pressure on the nerve. Trauma, such as a motor vehicle accident, fall, or sports injury, can sever or damage peripheral nerves. Nerves can be pinched from using crutches, spending a long time in an unnatural position, or repetitive motions - such as typing.

Diabetes. Diabetes frequently damages certain nerves. At least half of all diabetics develop some type of neuropathy.

Vitamin deficiency. B vitamins - B-1, B-6, and B-12 are especially important for nerve health. Vitamin E and niacin are also important for nerve health.

Alcoholism. Many alcoholics develop peripheral neuropathy because of poor eating habits, which lead to vitamin deficiencies.

Infection. Certain viral or bacterial infections can cause peripheral neuropathy, including Lyme disease, shingles (varicella-zoster), Epstein-Barr, hepatitis C, and HIV/AIDS.

Autoimmune diseases. These include lupus, rheumatoid arthritis, and Guillain-Barre syndrome.

Other diseases. Kidney disease, liver disease, and hypothyroidism can also cause peripheral neuropathy.

Hereditary disorder. Examples include Charcot-Marie-Tooth and amyloid polyneuropathy.

U. Growths can be directly on nerves, or tumors can put pressure on surrounding nerves. Both cancerous (malignant) and noncancerous (benign) tumors can contribute to peripheral neuropathy.

Toxic substances. Exposure can include certain toxic substances, such as heavy metals, and certain drugs - especially those used to treat cancer (chemotherapy).

Risk factors

Risk factors for peripheral neuropathy include:

Diabetes, especially if sugar levels are difficult to control.

Alcohol abuse.

Vitamin deficiency, especially vitamin B.

Infections, such as Lyme disease, shingles (varicella-zoster), Epstein-Barr, hepatitis C, and HIV/AIDS.

Autoimmune diseases like rheumatoid arthritis and lupus, in which the immune system attacks the body's own tissues.

Kidney, liver, or thyroid dysfunction.

Exposure to toxins.

Repetitive physical stress, possibly from occupational activities.

Complications

Reduced sensation. Parts of the body may be numb, which may be less able to sense temperature changes or injury.

Infection. Be sure to check your feet regularly, as well as any other lack of sensation, so minor injuries can be treated before they become infected. This is especially important for people with diabetes, who tend to heal more slowly.

Testing and diagnosis

Peripheral neuropathy is not a single disease, but rather a symptom with many potential causes. For that reason, it can be difficult to diagnose. To help make a diagnosis, your doctor will likely take a complete medical history and perform a physical and neurological exam, which may include checking tendon reflexes, muscle strength, and rhythm. certain sensory abilities and coordination.

Blood tests

Your doctor may also order blood tests to check for:

Vitamin levels.

Thyroid function.

Blood sugar.

Liver function.

Renal function.

Electromyography

This test measures the electrical signals in the peripheral nerves and transmits the signals to the muscles. Part of this test will study nerve conduction, the speed at which nerve signals are transmitted. Nerve conduction studies can be used to diagnose carpal tunnel syndrome and other peripheral nerve disorders.

Nerve biopsy

Your doctor may recommend a nerve biopsy, a procedure in which a small portion of a nerve is removed and examined for abnormalities. But even a nerve biopsy may not always reveal what's causing the nerve damage.

Image checking

Your doctor may also order a CT or MRI scan to look for a herniated disc, tumor, or other abnormalities.

Treatments and drugs

The goal of treatment is to manage the problem that is causing the neuropathy. If the underlying cause is corrected, often the neuropathy improves on its own. Another goal of treatment is to relieve painful symptoms. Various medications can be used to relieve the pain of peripheral neuropathy:

Analgesic. Symptoms can be relieved by pain medication. For many severe symptoms, your doctor may recommend prescription pain relievers. Opioids, such as codeine, can lead to constipation, dependence, or sedation, so these drugs are usually prescribed only when other treatments fail.

Antiepileptic drugs. Drugs such as gabapentin (Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Tegretol), and phenytoin (Dilantin) have been developed to treat epilepsy. However, doctors often also prescribe them to relieve nerve pain. Side effects may include drowsiness and dizziness.

Lidocaine patch. Contains the local anesthetic lidocaine. Apply it to areas where pain is most severe, and up to four copies a day can be used for pain relief. This treatment has almost no side effects except for some people, a local rash.

Antidepressants. Tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor), have been developed to treat depression. However, found to help relieve pain by interfering with chemical processes in the brain and spinal cord. The serotonin and duloxetine norepinephrine reuptake inhibitor (Cymbalta) has also demonstrated efficacy for peripheral neuropathy caused by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite, and constipation.

Electrical nerve stimulation (TENS). In this therapy, electrodes are placed sticky on the skin and a gentle electric current is passed through the electrodes at different frequencies. TENS has been performed routinely, but some people report this treatment improves their symptoms.

Lifestyle and remedies

The following suggestions may help manage peripheral neuropathy:

Take care of your feet, especially if you have diabetes. Check your feet daily for signs of acne, cuts, or calluses. Tight shoes and socks can worsen pain and itching and can lead to sores that won't heal.

Do exercise. Ask your doctor about a suitable exercise routine. Regular exercise can reduce nerve pain and may help control blood sugar.

Quitting smoking. Smoking can affect blood circulation, increase your risk of problems, and possibly amputation.

Eat healthy meals. If you're at high risk for neurological disease or have a chronic illness, eating healthy is especially important to make sure you're getting vitamins and minerals. Emphasize low-fat meats and dairy products, and include plenty of fruits, vegetables, and whole grains in your diet. Drink alcohol in moderation.

Foot massage. Massage improves blood circulation, stimulates nerves, and can temporarily relieve pain.

Avoid prolonged pressure. Do not hold your knees or lean on your elbows for long periods of time. Doing so can cause nerve damage.

Alternative medicine

Some people with peripheral neuropathy try alternative treatments to relieve their symptoms. Although these techniques have not been studied as closely as most drugs, the following therapies have shown some promise in the treatment of peripheral nerve diseases:

Acupuncture. Acupuncture involves inserting needles into different points of the body. Acupuncture can relieve symptoms in about three-quarters of people with peripheral neuropathy. However, it may take several sessions of acupuncture before an improvement is noticed.

Capsaicin. A cream containing this substance found in hot peppers may modestly improve peripheral nerve symptoms. It may take some time and gradual exposure upon application due to the hot sensation this cream produces. Pain relief usually does not occur until after heating use. Your doctor may recommend using this cream in combination with other treatments.

Alpha-lipoic acid. Used as a treatment for peripheral neuropathy in Europe for many years, this antioxidant can help reduce symptoms of peripheral neuropathy. Discuss the use of alpha-lipoic acid with your doctor before using it, because alpha-lipoic acid can affect blood sugar levels. Side effects may include stomach upset and skin rash.

Biofeedback. This therapy applies electrical sensors to parts of the body to monitor the body's physiological response to peripheral nerve symptoms. The biofeedback devices then direct the body to respond using a signal such as a beep or a flashing light. This feedback can help the body respond to certain physical functions. Once you start to recognize your body's responses, it's possible to reduce responses through techniques such as relaxation or image guidance.

Prevention

Managing the basics

The best way to prevent peripheral neuropathy is to carefully manage any potential medical problems. That means controlling blood sugar if you have diabetes, or talking to your doctor about safe and effective treatments if you think there might be a problem with alcohol.

Healthy lifestyle

With or without a medical condition, eating a healthy diet rich in fruits, vegetables, whole grains, and lean meats can help keep nerves healthy. For example, nerve damage is common if vitamin B-12 is lacking. The best food sources of vitamin B-12 are meat, fish, eggs, low-fat dairy foods, and whole grains. If you're a strict vegetarian, whole grains are a good source of vitamin B-12 but talk to your doctor about B-12 supplements. Regular exercise is also important. If possible, try to get at least 30 minutes to an hour of exercise at least three times a week.

As much as possible, avoid things that can cause nerve damage, such as:

Repetitive motion.

Narrow location.

Toxic chemicals.

Cigarette smoke.

Drinking too much alcohol.

Related articles:

- Peripheral neuropathy

- Peripheral neuropathy (PDF)

- Peripheral Neuropathy: When the Numbness, Weakness, and Pain Won't Stop (PDF)

- Diabetic cause neuropathy complications: diagnosis and medical treatment