Peripheral neuropathy

What does peripheral neuropathy feel like?

Can you reverse peripheral neuropathy?

What is Peripheral Neuropathy?

Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body. This damage disrupts the nerves’ normal functioning. They might send signals of pain when there’s nothing causing pain, or they might not send a pain signal even if something is harming you.

Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. The peripheral nerves also send sensory information to the central nervous system.

Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes.

People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy.

Before Peripheral Neuropathy Treatment

What types of peripheral nerves are there and what do they do?

The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.

. Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.

. Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.

. Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body's temperature from rising too high.

The type of symptoms you feel depend on the type of nerve that is damaged.

Read more about : Neuralgia Types

Read more about : Arachnoid cyst size chart

Symptoms of Peripheral Neuropathy

Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected.

If Sensory nerves are affected, signs and symptoms might include:

The person may have:

. Tingling and numbness

. Pins and needles and hypersensitivity

. Increased pain or inability to feel pain

. Loss of ability to detect changes in heat and cold

. Loss of co-ordination and proprioception

. Burning, stabbing, lancing, boring, or shooting pains, which may be worse at night

It can also lead to foot and leg ulcers, infection, and gangrene.

If Motor nerves are affected, signs and symptoms might include:

. Muscle weakness, leading to unsteadiness and difficulty performing small movements, such as buttoning a shirt.

. Muscle wasting

. Muscle twitching and cramps

. Muscle paralysis

If autonomic nerves are affected, signs and symptoms might include:

. Heat intolerance

. Excessive sweating or not being able to sweat

. Bowel, bladder or digestive problems

. Changes in blood pressure, causing dizziness or lightheadedness.

Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.

When to see a doctor

Seek medical care right away if you notice 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 your peripheral nerves.

Read more about : How does deep brain stimulation?

Read more about : Treatment for trigeminal neuralgia

Causes

Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Health conditions that can cause peripheral neuropathy include:

. Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.

. Diabetes. More than half the people with diabetes develop some type of neuropathy.

. Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.

. Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.

. Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.

. Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.

. Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).

Other causes of neuropathies include:

. Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.

. Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.

. Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.

. Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.

. Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.

In a number of cases, no cause can be identified (idiopathic).

Read more about  Do arachnoid cysts require surgery?

Diabetic neuropathy

The most common cause of peripheral neuropathy is diabetes. Around 60 to 70 percent of people with diabetes have some degree of neuropathy.

High blood sugar levels cause damage to the walls of the tiny blood vessels that supply oxygen and nutrients to the nerves in the ends of the hands and feet, and the essential organs in the body, such as the eyes, kidneys, and heart.

As a result, not only does the skin becomes damaged, but the loss of sensation further increases the risk of damage.

Risk factors

Peripheral neuropathy risk factors include:

. Diabetes, especially if your sugar levels are poorly controlled

. Alcohol abuse

. Vitamin deficiencies, particularly B vitamins

. Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV.

. Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues.

. Kidney, liver or thyroid disorders

. Exposure to toxins

. Repetitive motion, such as those performed for certain jobs

. Family history of neuropathy

Complications

Complications of peripheral neuropathy can include:

. Burns and skin trauma. You might not feel temperature changes or pain on parts of your body that are numb.

. Infection. Your feet and other areas lacking sensation can become injured without your knowing. Check these areas regularly and treat minor injuries before they become infected, especially if you have diabetes.

. Falls. Weakness and loss of sensation may be associated with lack of balance and falling.

How quickly does Peripheral neuropathy develop?

Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.

Diagnosis

Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:

. A full medical history. Your doctor will review your medical history, including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases.

. Neurological examination. Your doctor might check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

Tests

Your doctor may order tests, including:

. Blood tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy.

. Imaging tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities.

. Nerve function tests. Electromyography (EMG) records electrical activity in your muscles to detect nerve damage. A thin needle (electrode) is inserted into the muscle to measure electrical activity as you contract the muscle.

At the same time as an electromyogram, your doctor or an EMG technician typically performs a nerve conduction study. Flat electrodes are placed on the skin and a low electric current stimulates the nerves. Your doctor will record your nerves' responses to the electric current.

. Other nerve function tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test that measures your body's ability to sweat, and sensory tests that record how you feel touch, vibration, cooling and heat.

. Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.

. Skin biopsy. Your doctor removes a small portion of skin to look for a reduction in nerve endings.

Prevention

Manage underlying conditions

The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis.

Make healthy lifestyle choices

These habits support your nerve health:

. Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you're vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but talk to your doctor about B-12 supplements.

. Exercise regularly. With your doctor's OK, try to get at least 30 minutes to one hour of exercise at least three times a week.

. Avoid factors that may cause nerve damage, including repetitive motions, cramped positions that put pressure on nerves, exposure to toxic chemicals, smoking and overindulging in alcohol.

During Peripheral Neuropathy Treatment

Treatment

Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.

Medications

Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include:

. Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.

Medications containing opioids, such as tramadol (Conzip, Ultram) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are prescribed only when other treatments fail.

. Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.

. Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.

Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch.

. Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin (Silenor, Zonalon) and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also might ease the pain of peripheral neuropathy caused by diabetes.

Side effects of antidepressants may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation.

Therapies

Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.

. Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.

. Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.

Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).

. Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair.

. Surgery. If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure.

Alternative medicine

Some people with peripheral neuropathy try complementary treatments for relief. Although researchers haven't studied these techniques as thoroughly as they have most medications, the following therapies have shown some promise:

. Acupuncture. Inserting thin needles into various points on your body might reduce peripheral neuropathy symptoms. You might need multiple sessions before you notice improvement. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.

. Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years. Discuss using alpha-lipoic acid with your doctor because it can affect blood sugar levels. Other side effects can include stomach upset and skin rash.

. Herbs. Certain herbs, such as evening primrose oil, might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so discuss herbs you're considering with your doctor.

. Amino acids. Amino acids, such as acetyl-L-carnitine, might benefit people who have undergone chemotherapy and people with diabetes. Side effects might include nausea and vomiting.

After Peripheral Neuropathy Treatment

Lifestyle and home remedies

To help you manage peripheral neuropathy:

. Take care of your feet, especially if you have diabetes. Check daily for blisters, cuts or calluses. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet.

. Exercise. Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help.

. Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and other neuropathy complications.

. Eat healthy meals. Good nutrition is especially important to ensure that you get essential vitamins and minerals. Include fruits, vegetables, whole grains and lean protein in your diet.

. Avoid excessive alcohol. Alcohol can worsen peripheral neuropathy.

. Monitor your blood glucose levels. If you have diabetes, this will help keep your blood glucose under control and might help improve your neuropathy.

What is the long-term outlook?

If your neuropathy is due to an underlying, treatable condition, you may be able to stop your peripheral neuropathy by treating the larger problem. However, if this isn’t the case for you, you can successfully manage the symptoms of your peripheral neuropathy. Speak with your doctor to determine the best medical treatment for you, and explore alternative and self-care options that can supplement your medical care.

Neuropathy rarely leads to death if the cause is determined and controlled. The sooner the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or repaired. Recovery, if it’s possible, usually takes a very long time -- from months to even years. Some people live with a degree of neuropathy for the rest of their lives.

Can neuropathy be reversed?

If the underlying cause of the neuropathy can be treated and cured (such as neuropathy caused by a vitamin deficiency), it’s possible that the neuropathy can be reversed too. However, frequently by the time individuals are diagnosed with a neuropathy, there is some degree of permanent damage that can't be fixed.

Even though this is the general belief of today, it’s not the hope of tomorrow. Nerve damage may be reversible someday. Researchers are already seeing positive results – the regrowth of nerve fibers – in a drug study in mice with diabetes. Ongoing research combined with living a healthy lifestyle so the body can repair itself will likely be needed.