Neuropathy
Neuropathy Overview
Peripheral neuropathy is a type of damage to the peripheral nervous system, the network of nerves that transmit information from the brain and spinal cord (central nervous system) to the rest of the body. It is not a single disease, but rather a symptom with many possible causes.
The condition is sometimes likened to static on a telephone because peripheral neuropathy can interrupt messages between the brain and the rest of the body. Typically, neuropathy affects multiple nerves affecting all limbs. This is known as polyneuropathy. More rarely a single nerve is involved (mononeuropathy).
The condition can be inherited but is more typically acquired through physical injury to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Physical injury through automobile accidents, falls and sports is the most common cause of injury to a nerve.
Doctors use four categories to classify the many types of neuropathy.
- Motor neuropathy is damage to the nerves that control muscles and movement in the body, such as moving the hands and talking.
- Sensory neuropathy involves the sensory nerves, which control sensation such as pain or touch.
- Autonomic nerve neuropathy affects the autonomic nerves, which control biological functions performed unconsciously like breathing. Damage to these nerves can be serious.
- Combination neuropathies. Some patients have a combination of these or other types of neuropathy.
There are many different causes, some inherited and others due to an injury or another condition. In some acute neuropathies, such as Guillain-Barré syndrome, symptoms come on suddenly and progress rapidly, then slowly subside as nerves heal. In more chronic forms of neuropathy the symptoms begin subtly and progress slowly. Some patients experience a period of relief, followed by a relapse of symptoms. The condition is very rarely fatal unless it is complicated by the presence of other diseases.
If you or someone you know is experiencing these symptoms make an appointment with a Wellstar neurologist. The doctor will help you understand the symptoms and determine whether they indicate neuropathy or another possible cause.
Although the condition cannot be cured, there are a variety of treatments—including medications and other remedies—that can ease the discomfort.
Symptoms
Symptoms are many and varied depending on what part of the body is affected. These can range from mildly annoying tingling to burning pain or paralysis. Because a number of these mimic symptoms of other conditions, it’s important to see your doctor for help with diagnosis.
Among symptoms:
- Gradual onset of numbness and tingling in the hands or feet, possibly spreading into the legs and arm
- Sharp, burning, jabbing or electric-like pain
- Extreme sensitivity to touch
- Changes in skin, hair or nails
- Lack of coordination
- Muscle twitching
- Muscle weakness or paralysis
- Cramps
- Emotional disturbances
- Sleep problems
- Loss of pain or sensation that can put you at risk, for example not feeling an impending heart attack or limb pain
If autonomic nerves are involved symptoms can include:
- Heat intolerance
- Bowel, bladder or digestive problems
- Changes in blood pressure resulting in lightheadedness or dizziness
- Life threatening symptoms such as irregular heartbeat or difficulty breathing
The most common inherited form of neuropathy, Charcot-Marie-Tooth disease, is characterized by extreme weakening and wasting of the muscles in the lower legs and feet, gait problems, loss of tendon reflexes and numbness in the lower limbs.
Risk Factors
Risk factors for peripheral neuropathy include:
- Diabetes, especially if blood sugar is not well controlled
- Alcohol abuse
- Vitamin deficiencies
- Infections like Lyme disease, Epstein-Barr virus, hepatitis C and HIV
- Autoimmune conditions like rheumatoid arthritis and Lupus
- Problems with the liver, kidney or thyroid
- Exposure to certain toxins
- Repetitive physical stress
- Having an inherited form of peripheral neuropathy resulting in genetic flaws
Neuropathy Prevention
Lifestyle choices can play a role in preventing peripheral neuropathy. Wellstar doctors agree with exerts who recommend steps including:
- Avoid alcohol
- Correct any vitamin deficiencies
- Eat a healthy diet
- Maintain a healthy weight
- Avoid toxins
- Get regular exercise
Neuropathy Diagnosis
Peripheral neuropathy can be difficult to diagnose because it has so many possible causes. Your Wellstar neurologist will work to determine the source/location of the nerve damage and what is causing it. An office will typically include a medical history that addresses symptoms, lifestyle habits and any family history of neurological diseases. A neurological examination will check reflexes, muscle strength and tone, posture, coordination and your ability to feel certain sensations.
Tools and Tests
Wellstar neurologists use a variety of tests depending on your symptoms and health status. These can include:
- Blood tests to measure vitamin and blood sugar levels as well as thyroid, liver and kidney function
- Imaging tests including CT or MRI to reveal problems like herniated disks or tumors
- Nerve function tests such as electromyography to determine nerve or muscle damage that may be the source of weakness
- Nerve or skin biopsies that remove a small amount of nerve or skin to look for abnormalities including nerve damage
- Lumbar puncture (spinal tap), a procedure to determine whether the issue may be related to brain/spinal fluid
Neuropathy Treatment
There is no known cure for peripheral neuropathy. But in many cases, the neuropathy itself will improve if the underlying source is treated. In general, healthy habits (avoiding alcohol, maintaining a healthy weight, eating healthfully and exercising regularly) can help relieve symptoms. In extreme cases surgery may be an option to destroy nerves or repair inuries causing the symptoms.
Medication
A variety of medications can help relieve the discomfort and pain associated with peripheral neuropathy.
- Pain relievers including over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs).
- Anti-seizure medications developed to treat epilepsy can help relieve symptoms in some patients. Talk with your doctor about drugs like Gralise, Neurontin, Topamax and Tegretol and other prescription medications.
- Immunosuppressive medications such as prednisone that reduce the reaction of the immune system.
- Capsaicin is a naturally occurring pepper-based substance that can cause modest improvement in symptoms. It is available in a topical cream. Users are advised to apply it gradually over time to get used to the hot sensation caused by the cream, which leads to pain relief.
- Lidocaine patch containing lidocaine, a topical anesthetic.
- Antidepressants help some patients by interfering with chemical processes in the brain and spinal cord that cause feelings of pain.
Other Treatment Options
Discuss with your doctor about other possibilities such as TENS, a non-invasive nerve stimulation/pain reduction system that sends a gentle electric current through electrodes placed on the skin. Hand or foot braces can help support weakened muscles.
Ongoing Care for Neuropathy
Some patients may benefit from physical therapy to help improve mobility. Wellstar offers physical therapy at several convenient locations. Our skilled, licensed physical therapists develop individualized programs that meet specific patient needs. Ask your doctor if physical therapy could help ease the discomfort of your peripheral neuropathy.
Self-management Approaches
Individuals with peripheral neuropathy can take steps such as the following to self-manage their condition.
- Take care of your feet, especially if you have diabetes. Check for signs of cuts or blisters. Avoid overly tight shoes and socks; instead choose soft, loose cotton socks and padded shoes. For those who find contact with bedcovers painful, a special hoop (available in medical supply stores) can keep the covers off the feet. Consider shoe orthotics.
- Talk with your doctor about an appropriate exercise program. Regular movement can help reduce pain while building muscle and helping to control blood sugar.
- Quit smoking or don’t start, as smoking has a negative effect on blood circulation. Wellstar offers excellent smoking cessation programs.
- Eat well. Getting essential vitamins and minerals is an important element in managing peripheral neuropathy. Choose whole grains, low-fat meat and dairy and lots of fruit and vegetables.
- Avoid alcohol, which can worsen neuropathy.
- Monitor blood glucose levels.
- Make sure to treat any wounds or injuries
- Massage hands and feet.
- Avoid long periods of crossing your knees or leaning on the elbows.
Alternative Treatments
Some patients report that alternative treatments help reduce symptoms:
- Acupuncture
- Biofeedback
- Yoga
- Certain herbs
- Fish oil
- Amino acids
Many of these have not been studied as thoroughly as traditional treatments.