Description

Peripheral neuropathy occurs when the nerves that lie outside the brain and spinal cord (peripheral nerves) are damaged. This condition often causes weakness, numbness and pain, usually in hands and feet. It can also affect other areas and functions of the body, including digestion and urination.

The peripheral nervous system sends information from the brain and the spinal cord, also called the central nervous system to the rest of the body through the motor nerves. The peripheral nerves also send sensory information to the central nervous system through the sensory nerves.

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

People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. Sometimes the symptoms improve, especially if caused by a condition that can be treated. Medications can reduce the pain of peripheral neuropathy.

Symptoms

Each nerve in the peripheral system has a specific job. The symptoms depend on the type of nerves affected. The nerves are divided into:

  • Sensory nerves that receive sensitivity, such as temperature, pain, vibration, or touch, the skin.
  • The motor nerves that control muscle movement.
  • The autonomic nerves that control functions such as blood pressure, sweating, heart rate, digestion and the function of the bladder.

The symptoms of peripheral neuropathy may include:

  • Gradual onset of numbness, tingling, or a sensation of tingling in the feet or hands. These sensations can spread to the legs and the arms.
  • A sharp, stabbing pain, a tingling or burning sensation.
  • Extreme sensitivity to touch.
  • Pain during activities that should not cause pain, as the pain in your feet when you put weight on them or when they are under a blanket.
  • The lack of coordination and falling.
  • The muscle weakness.
  • It feels as if you are wearing gloves or socks when you're not.
  • Inability to move when the engine of the affected nerves.

If autonomic nerves are affected, symptoms may include:

  • Intolerance to heat.
  • Excessive sweating or not being able to sweat.
  • Bowel, bladder or digestive problems.
  • The drops of the blood pressure, causing dizziness or lightheadedness.

Peripheral neuropathy can affect one nerve, is called mononeuropathy. If it affects two or more nerves in different areas, is called mononeuropathy multiplex, and if it affects many nerves, is called polyneuropathy. Carpal tunnel syndrome is an example of a mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.

When to see a doctor

Seek immediate medical attention if you notice any unusual tingling, weakness or pain in the hands or feet. The early diagnosis and treatment will give the best chance for controlling your symptoms and preventing further damage to the peripheral nerves.

Causes

Peripheral neuropathy is nerve damage caused by several different conditions. Health conditions that can cause peripheral neuropathy include:

  • Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and vasculitis. Also, some types of cancer related to the immune system of the body can cause polyneuropathy. These are a form of autoimmune disease called paraneoplastic syndrome.
  • Diabetes and the metabolic syndrome. This is the most common cause. Among people with diabetes, more than half will develop some type of neuropathy.
  • Infections. These include certain viral or bacterial infections, including Lyme disease, herpes, hepatitis B and hepatitis C, leprosy, diphtheria and HIV.
  • Inherited disorders. Disorders such as Charcot-Marie-Tooth disease, hereditary types of neuropathy that run in families.
  • Tumors. Cancerous growths, also called malignant, and noncancerous growths, also called benign, can grow and put pressure on the nerves.
  • Disorders of the bone marrow. These include a protein in the blood that usually does not exist, is called monoclonal gammopathies, is a rare form of myeloma that affects the bones, the lymphoma and the rare disease amyloidosis.
  • Other diseases. These include metabolic diseases, such as kidney disease or liver disease, and a low activity of the thyroid gland, also known as hypothyroidism.

Other causes of neuropathies include:

  • Alcohol use disorder. Unhealthy diet choices made by the individuals with alcohol use disorder, also known as alcoholism, and poor absorption of vitamins can lead to low amounts of essential vitamins in the body.
  • Exposure to poisons. Toxic substances include industrial chemicals, and heavy metals such as lead and mercury.
  • Drugs. Certain drugs, especially chemotherapy drugs used to treat cancer, can cause peripheral neuropathy.
  • Injury or pressure on the nerve. Injuries, such as from motor vehicle accidents, falls, or sports injuries, you can cut or damage the peripheral nerves. The pressure on the nerves as a result of having a cast or using crutches or the repetition of a movement of writing many times.
  • Low levels of vitamin. B vitamins, including B-1, B-6 and B-12, as well as copper and vitamin E are crucial to the health of the nerves.

In some cases, no cause can be identified. This is called peripheral neuropathy idiopathic.

Risk factors

Peripheral neuropathy risk factors include:

  • Diabetes, especially if blood sugar levels are not well controlled.
  • The misuse of Alcohol.
  • Low levels of vitamins in the body, especially vitamin B-12.
  • Infections, such as Lyme disease, herpes, hepatitis B and hepatitis C, and HIV.
  • Autoimmune diseases, such as rheumatoid arthritis and lupus, in which the immune system attacks its own tissues.
  • The kidneys, liver or thyroid disorders.
  • Exposure to the toxins.
  • Repetitive motion, such as those made for specific jobs.
  • The family history of neuropathy.

Complications

Complications of peripheral neuropathy may include:

  • Burns, skin lesions and wounds on the feet. You might not feel temperature change or pain in parts of the body are numb.
  • Infection. Her feet and other areas that lack of feeling may become injured without your knowledge. Check these areas regularly, wear close-toed shoes that fit well and treat minor injuries before they become infected, especially if you have diabetes.
  • Falls. Weakness and loss of sensation may be associated with the lack of balance and falling. Installation of handrails in the bathroom, the use of canes or walkers when necessary, and make sure you walk only in well-lit rooms can decrease the risk of falls.

Prevention

Manage the underlying conditions

The best way to prevent peripheral neuropathy is to manage medical conditions that put them at risk.

Make healthy lifestyle choices

These habits support your nerve health:

  • Eating a diet rich in fruits, vegetables, whole grains, and lean proteins to keep the nerves healthy. Protect against low levels of vitamin B-12 due to the consumption of meat, fish, eggs, low-fat dairy products and fortified cereals. If you're a vegetarian or a vegan, fortified cereals are a good source of vitamin B-12, but talk with your health care professional about B-12 supplements.
  • Exercise regularly. With a professional of the health well, try to do at least 30 minutes to an hour of exercise at least three times a week.
  • Avoid the factors that can cause damage to the nerves. These factors can include repetitive movements, exposure to toxic chemicals, smoking and drinking too much alcohol.

Diagnosis

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

  • A complete medical history. Your health care professional will review your medical history. The history will include your symptoms, lifestyle, exposure to toxins, drinking habits and a family history of nervous system, and / or neurological diseases.
  • Neurological examination. Your health care professional might check your tendon reflexes, your muscle strength and tone, and the ability to feel certain sensations, and balance and coordination.

Tests

A health care provider may order tests, including:

  • Blood tests. These can detect low levels of vitamins, diabetes, signs of inflammation or metabolic problems that can cause peripheral neuropathy.
  • Imaging tests. Computed tomography or magnetic resonance imaging can look for herniated disc, pinched nerves, also called compressed nerves, tumors, or other problems that affect the blood vessels and the bones.
  • Nerve function tests.Electromyography (EMG) measures and records the electrical activity in your muscles to find damage in the nerves. A fine needle (electrode) is inserted into the muscle to measure the electrical activity as a contract the muscle. During anEMG, a nerve conduction study is usually also done. Flat electrodes are placed on the skin and a low electrical current that stimulates the nerves. A health professional will record how the nerves respond to the electric current.
  • Other tests of the function of the nerve. These may include a self-reflection of the screen. This test records the autonomic nerve fibers of work. Other tests may include a sweat test that measures the ability of your body to sweat and sensory testing, that the record of how it feels to the touch, vibration, cooling, and heat.
  • In the nerve biopsy. This involves removing a small portion of a nerve, usually of a sensory nerve, to try to find the cause of the neuropathy.
  • Skin biopsy. A small portion of the skin is removed to look at the number of nerve endings.

Nerve function tests. Electromyography (EMG) measures and records the electrical activity in your muscles to find damage in the nerves. A fine needle (electrode) is inserted into the muscle to measure the electrical activity as a contract the muscle.

During an EMG , a nerve conduction study is usually also done. Flat electrodes are placed on the skin and a low electrical current that stimulates the nerves. A health professional will record how the nerves respond to the electric current.

Treatment

The goals of treatment are to manage the condition causing your neuropathy and to improve symptoms. If the lab tests do not show any condition that causes neuropathy, your health care professional may recommend watchful waiting to see if your neuropathy remains the same or gets better.

Medications

Medications may be used for the treatment of conditions associated with peripheral neuropathy. There are also medications that are used to improve the symptoms of peripheral neuropathy. These medications include:

  • Pain relievers. Medications available without a prescription, such as nonsteroidal anti-inflammatory drugs, can improve the symptoms mild.
  • Anti-epileptic drugs. Medications such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed for the treatment of epilepsy, often to improve the nerve pain. Side effects can include drowsiness and dizziness.
  • The topical treatments.Lidocaine cream is available without a doctor's prescription can be applied to the skin. The patches of lidocaine are other treatments that are applied to the skin to improve the pain. Side effects can include drowsiness, dizziness and numbness at the site of the patch.
  • Antidepressants.Certain tricyclic antidepressants, such as amitriptyline, and nortriptyline (Pamelor), can help to improve the pain. These drugs both interfere with the chemical processes in the brain and the spinal cord that causes you to feel pain. Serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta), and the extended-release antidepressant venlafaxine (Effexor XR), and desvenlafaxine (Pristiq) may also improve the pain of peripheral neuropathy caused by diabetes. Side effects of antidepressants include dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain, and constipation.

The topical treatments. Lidocaine cream is available without a doctor's prescription can be applied to the skin.

The patches of lidocaine are other treatments that are applied to the skin to improve the pain. Side effects can include drowsiness, dizziness and numbness at the site of the patch.

Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, and nortriptyline (Pamelor), can help to improve the pain. These drugs both interfere with the chemical processes in the brain and the spinal cord that causes you to feel pain.

Serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta), and the extended-release antidepressant venlafaxine (Effexor XR), and desvenlafaxine (Pristiq) may also improve the pain of peripheral neuropathy caused by diabetes.

Side effects of antidepressants include dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain, and constipation.

Therapies

Several therapies and procedures can help with the symptoms of peripheral neuropathy.

  • Encoder therapy. This treatment uses electrical impulses to send nonpain messages to the brain. These messages override the pain messages from the nerves send to the brain. The goal is to retrain the brain to think that there is no pain.
  • Stimulation of the spinal cord. This type of therapy works across devices put in the body. These devices are referred to as neurostimulators. Send low-level electrical impulses, which can block pain signals from reaching the brain.
  • The Plasma exchange, steroids, and intravenous immunoglobulin. These treatments are often used if the inflammation or autoimmune diseases are causing neuropathy with weakness, numbness, or imbalance. These therapies are not to be used to treat the pain alone.
  • The physical therapy. If you have muscle weakness or problems with balance, physical therapy can help improve your ability to move. You may also need the hand or foot braces, a cane, a walker or a wheelchair.
  • Surgery. Neuropathies caused by pressure on the nerves, such as tumors, may require surgery.

Alternative medicine

Some people with peripheral neuropathy try complementary treatments for relief. Researchers have not studied these techniques as thoroughly as have the majority of the medicines. But the following therapies have shown some promise:

  • Acupuncture. The insertion of thin needles at various points in your body could reduce the symptoms of peripheral neuropathy. You may need several sessions before you see an improvement. Acupuncture is generally considered safe when performed by a certified professional the use of sterile needles.
  • Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years, and there is some evidence that it may be useful in those with painful diabetic neuropathy. Discuss the use of alpha-lipoic acid with your health care professional since it can affect the levels of sugar in the blood. Other side effects may include upset stomach and skin rashes.
  • Amino acids. Amino acids, such as acetyl-L-carnitine, could benefit people who have undergone chemotherapy and people with diabetes. Side effects may include nausea and vomiting.

Lifestyle and home remedies

To help you cope with 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 bedspreads hot or sensitive feet.
  • Exercise. Regular exercise, such as walking three times a week, can reduce the pain of neuropathy, improving muscle strength, and help control blood sugar levels. Soft routines such as yoga and tai chi may also help. If you have pain in neuropathy in the feet, you may want to try the pool of exercise such as swimming.
  • Stop smoking. Cigarette smoking can cause problems with circulation. This increases the risk of foot problems and other neuropathy complications.
  • Eating healthy meals. A good nutrition is especially important to make sure that you get important vitamins and minerals. Include fruits, vegetables, whole grains, and lean proteins in your diet.
  • Avoid excessive consumption of alcohol. Alcohol can make peripheral neuropathy worse.
  • Monitor your blood sugar levels. If you have diabetes, this will help keep your blood sugar under control and can help to improve your neuropathy.

Preparing for your appointment

It is likely to start by seeing your health care professional. Then, you may be referred to a doctor trained in nervous system disorders, also called a neurologist.

Here is the information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting for a specific test. Make a list of:

  • Your symptoms, including any that may seem unrelated to your reason for scheduling the appointment.
  • Key personal information, including the recent tensions or significant changes in the life, family medical history, and alcohol consumption.
  • All medications, vitamins or other supplements that you take, including over-dose.
  • Questions to ask your health care professional.

Have a friend or family member, if possible, to help you remember the information they give you.

For peripheral neuropathy, basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • Is this condition temporary or long-term?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • There are alternatives to the approach that you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • I need to restrict your activities?
  • Are there brochures or other printed material that I can take? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your healthcare provider is likely to ask you questions, such as:

  • Do you have health problems, such as diabetes or kidney disease?
  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Does anyone in your family has symptoms similar to yours?
  • Have fallen in the last year?
  • Have you had any injury in your feet?
Symptoms and treatment of Peripheral neuropathy