Any damage to the peripheral nerves, that is the nerves that carry signals from the brain to rest of the body, is called peripheral neuropathy. Learn about its causes, symptoms, diagnosis, and treatment.
The peripheral nervous system carries information from the brain and spinal cord to the rest of the body, and also send sensory information to the central nervous system. The nerves that make up the peripheral nervous system are called peripheral nerves. Damage to these peripheral nerves resulting in weakness, numbness, and pain, is called peripheral neuropathy. It commonly affects the nerves in hands and feet, but can also affect internal organs, mouth, and face.
Diabetes is the primary cause of this condition. Trauma, infections, genetics, metabolic problems, and toxins can all result in peripheral neuropathy. It causes stabbing, burning or tingling pain in the extremities. Medications and treating the underlying condition helps improve symptoms in most cases.
There are more than 100 different kinds of peripheral neuropathies. This condition usually affects people over 55 years of age. Depending on the type and number of nerves they affect, peripheral neuropathy can be divided into:
1) Mononeuropathy - When a single peripheral nerve is damaged, it is called mononeuropathy. Injury or trauma is the most common cause. It can also result from prolonged pressure on a nerve and repetitive motions. The common examples include:
Carpal tunnel syndrome - It occurs when the nerve in the wrist is compressed due to overuse strain injury. It is mostly seen in people who use computer keyboards for a long time every day and physical labors. It results in numbness, tingling, and pain in the first three fingers from the thumb.
Ulnar nerve palsy - It occurs when the nerve present in the elbow is damaged. It causes pain and numbness in the 4th and 5th digit of the hand.
Radial nerve palsy - When the humerus bone in the upper arm fractures, it damages the nerve that is present on the underside of the upper arm, resulting in radial nerve palsy.
Peroneal nerve palsy - It results from damage or compression of the nerve present in the calf.
2) Polyneuropathy - Polyneuropathy is when multiple peripheral nerves are damaged at the same time throughout the body. Most cases of peripheral neuropathy are of this type. It can result from exposure to toxins, alcohol abuse, malnutrition, and conditions like kidney disease and cancer. The common examples are:
Diabetic neuropathy - It is the type of nerve damage seen in diabetic patients. It commonly affects patients with uncontrolled blood sugar levels. The symptoms include loss of sensation, tingling, and burning sensation in the limbs.
Guillain-Barre syndrome - It is a severe and rare condition where the body's immune system attacks nerves in the body. The symptoms appear suddenly and progress rapidly. It can cause weakness and tingling sensation in the arms, blood pressure and heart rhythm problems.
The symptoms vary depending on the type of peripheral nerve damaged. The types of nerves are:
Sensory nerves - These nerves receive sensations from the skin like pain, vibration, touch, and hot or cold temperatures.
Motor nerves - These nerves control the movements of the muscles.
Autonomic nerves - Such nerves are in charge of functions like heart rate, digestion, and blood pressure.
Peripheral neuropathy can affect any of the above nerves and can result in the following signs and symptoms:
Numbness, prickling or tingling in hands and feet, which spreads gradually.
Sharp and throbbing kind of pain.
Some people have burning sensations.
Increased sensitivity to touch.
Pain during activities like putting weight on the feet.
Dropping things from the hands frequently.
Lack of coordination.
Hands and feet of the patients feel as if they are wearing gloves or socks.
Thinning of the skin.
Difficulty digesting food.
Diarrhea or constipation.
Blood pressure changes cause dizziness.
The causes of peripheral neuropathy are:
Exposure to toxins.
Trauma or injury.
Kidney and liver disease.
Bone marrow disorders.
Infectious diseases like Lyme disease, hepatitis B, leprosy, or AIDS.
Hereditary (Charcot-Marie-Tooth disease).
Idiopathic (the cause is unknown).
The factors that increase the risk of peripheral neuropathy are:
Exposure to environmental toxins.
Autoimmune diseases like rheumatoid arthritis and lupus.
Vitamin B deficiency.
Kidney, liver or thyroid problems.
If your symptoms are in line with nerve pathology, your doctor will take a full medical history, which will include your symptoms, lifestyle, family history, and history of exposure to any toxins. The doctor will conduct a neurological examination, where he or she will check tendon reflexes, muscle strength, and coordination.
You might need to get the following tests done:
Blood tests - To diagnose diabetes, vitamin deficiencies, autoimmune conditions, etc.
CT or MRI scans - To check for disc herniation and tumors.
Electromyography (EMG) - This test records electrical activity in the muscles, which is used to determine if there is any nerve damage.
Nerve conduction test - Here, nerves response is recorded after the nerves are stimulated with low electric currents.
Nerve function tests - It includes tests like an autonomic reflex screen, a sweat test, and sensory tests.
Nerve biopsy - A small portion of a nerve is removed to look for abnormalities.
Skin biopsy - A skin biopsy shows if there is any reduction in nerve endings.
The treatment options are:
Painkillers - Nonsteroidal anti-inflammatory drugs (NSAIDs), or for severe pain, opioid medications like Tramadol or Oxycodone are used.
Anti-epileptic medications - Gabapentin and Pregabalin.
Topical medicines - Cream containing Capsaicin or Lidocaine.
Antidepressants - Tricyclic antidepressants like Amitriptyline and Nortriptyline, serotonin and norepinephrine reuptake inhibitors like Duloxetine and Venlafaxine.
Transcutaneous electrical nerve stimulation (TENS) - Gentle electric current is placed on the skin.
Plasma exchange and intravenous immune globulin - Helps suppress immune system activity.
Physical therapy - Improves muscle weakness.
Surgery - Surgery might be needed to relieve pressure on nerves.
Some of the complications include:
Skin injury - Due to loss of sensation, you might not feel temperature changes, which results in injury to the skin in the toes.
Infection - Minor injuries can go unnoticed, which might become infected.
Lack of balance - Patients often fall due to a lack of balance.
To know more about peripheral neuropathies, consult a neurologist now.
High blood sugar levels can contribute to nerve damage in peripheral neuropathy. So, patients should avoid foods such as soft drinks, fruit juices, ice cream, candy, and pastries. You should ask your doctor to recommend a proper diet for you.
Below are the suggestions to calm down neuropathy. They are:
- Quit smoking.
- Additional care to the feet, especially during diabetes.
- Eat healthy meals.
- Avoid prolonged pressure.
- Find the positive aspects of the disorder.
- Prepare for challenging situations.
- Consult or talk with the counselor or therapist.
The effect of caffeine was associated with side effects such as depression or locomotor stimulation. Thus, sudden and excessive caffeine intake reduced neuropathic pain state in nerve-injured rats, but only at very high doses. You should give a second thought before going for caffeine.
Water is a staple in all the diet, and even more comfortable for those who want to reduce nerve pain. It is critical to stay hydrated throughout the day to avoid triggering pain receptors and reduce inflammation. It is better to drink eight glasses of water each day. Drinking too much water is not a good choice for your kidneys.
Aim of treatment for peripheral neuropathy is to manage the condition caused by neuropathy and also to relieve symptoms. Depending on the condition, medications or therapies are chosen to be given to the patient. Therapies include:
- Transcutaneous electrical nerve stimulation (TENS).
- Plasma exchange and intravenous immune globulin.
- Physical therapy.
There are five stages involved in neuropathy. They are:
- The First Stage: Intermittent pain and numbness.
- The Second Stage: More constant pain.
- The Third Stage: The height of pain.
- The Fourth Stage: The numbness starts to set in.
- The Fifth Stage: Total loss of sensation
Before testing, the doctor will review full medical history and perform a neurological examination. Finally, the doctor may suggest doing the following test.
- Blood test.
- Imaging test (CT or MRI).
- Nerve function tests.
- Nerve biopsy.
- Skin biopsy.
The most usual type of peripheral neuropathy is diabetic neuropathy. This is caused due to high sugar levels. It results in nerve fiber damage in the feet and legs. Symptoms can range from numbness or tingling in a specific body part to more severe effects, such as paralysis or burning pain.
Medications such as Gabapentin (Neurontin, Gralise, Pregabalin, and Horizant), developed to treat epilepsy. It may relieve nerve pain only. Side effects can include dizziness and drowsiness.
First, start by tracking the neuropathy signs and sleeping patterns, and then make sufficient health changes to the bedtime routine and daytime habits:
- Keep a regular sleep and wake schedule.
- Develop a bedtime ritual, such as reading light material or taking a warm bath.
- Eliminate or limit caffeine 4 to 6 hours before bed and reduce consumption of daytime usage.
- Avoid smoking, especially before bedtime or in the middle of the night.
- Avoid heavy meals and alcohol before sleep.
- Turn off the smartphone, iPad, computer, and TV a few hours before bedtime.
In chronic forms, signs and symptoms will progress slowly and subtly. Few people have short periods of relief that is followed by relapse. Others reach a stage where symptoms remain the same for several months or years.
Based on many types of research, it is known that chronic stress may worsen neuropathic pain in affected individuals. It is noted in familial amyloid polyneuropathy patients, chronic stress adversely affects peripheral nerves, potentially worsening symptoms like numbness, burning, and tingling sensations that are felt on the skin and peripheral joints.
Neuropathy does not come under the category of diseases are considered disabilities in mild cases. But, when the severity of the disease condition affects the usual routine, work, and movement of the patient, it is considered a disability.
The condition of peripheral neuropathy due to infections, exposure to toxins, or vitamin and hormonal deficiencies, the symptoms of the disease usually resolve themselves, and these patients easily resume their normal lives. But, in most cases, neuropathy is not curable like diabetic foot, and the priority in treatment is to manage the symptoms that worry the patient each time. This might limit the patient from leading a normal life.
Death due to neuropathy is usually rare. If the cause of peripheral neuropathy is determined and controlled, the complications are less severe. The prognosis depends on how early the diagnosis and treatment is started. Early diagnosis and treatment lead to a greater chance that the nerve damage can be slowed or repaired. However, recovery usually takes a very long time that might range from a period of months to even years. On poor treatment and followup, the prognosis is very low.
There are several causes of peripheral neuropathy apart from diabetes mellitus. That includes chemo-induced neuropathy, hereditary disorders, infections of an inflammatory cause, auto-immune diseases, protein abnormalities, exposure to toxic chemicals leading to toxic neuropathy, poor nutrition, kidney failure, chronic alcoholism, and certain medicines.
Once a person has been affected by neuropathy, a few types are capable of getting cured. Early treatment can improve outcomes. Certain nerves get slowly regenerated if the nerve cell still remains alive. Eliminating the underlying cause prevents future nerve damage. Good nutrition, proper follow up of medications routine, mild exercise, and personal hygiene practices can speed up the healing process.
The vitamins for adequate nerve function and remodeling are vitamins E, B-1, B-6, B-12. Any deficiency in these vitamins may cause tingling in the hands or feet, which are symptoms of peripheral neuropathy. Thus, adequate levels of these vitamins must avoid the occurrence of peripheral neuropathy.
Loss of balance is the most common symptom related to walking noted in cases of peripheral neuropathy. Patients are noticed to be walking with a wobbly motion. In these circumstances wearing orthopedic shoes often helps with the imbalance. Loss of coordination is particularly most specific of diabetic peripheral neuropathy. However, other symptoms that are associated with walking are muscle weakness and pain on walking.
Peripheral neuropathy usually gets worsened in conditions when the disease has become chronic, progressive nerve disease. Sudden flare-ups can be caused as the result of injury or infection at the neuropathy site. The worst complication would be amputating the affected limb, which is common with uncontrolled diabetes mellitus. It is essential to control hyperglycemia and triggers of pain and infection in these patients.
Yes, in many people, peripheral neuropathy goes away with proper treatment. It is because the peripheral nerves have a high capability to heal independently, even though it may take months, recovery most usually occurs. However, in some cases, peripheral neuropathy may not completely go away, especially this is common in individuals with poor treatment of the underlying cause.
Peripheral neuropathy usually gets worse due to the drop in the temperature at night. The discomfort and pain caused by peripheral neuropathy can be prevented by keeping up a regular sleep and wake schedule. A warm bath before sleep and limiting caffeine intake four to six hours before bedtime and trying to minimize daytime use also Helps. Smoking should be avoided, especially near bedtime, or if the person wakes up in the middle of the night. Above all, maintaining warm room temperature can eliminate the midnight flare-ups.
The peripheral nervous system is the network of nerves outside your brain and spinal cord. Thus, peripheral neuropathies usually start in the person's hands and feet. When neuropathy does not involve the peripheral nervous system, it is then known as neuropathy alone.
When peripheral neuropathy is chronic, the damage caused to those nerves can affect the nature of the particular nerves affected to send signals to muscles, joints, skin, and internal organs. This presents with long term symptoms that involve pain, numbness, loss of sensation, and other symptoms. More than the difficulties, it can also cause complications like infections. This can lead to necrosis of tissues and nerves that can never be reversed.
One of the common side effects of antihypertensive drugs tends to be peripheral neuropathy. The essential drugs in that class that significantly cause peripheral neuropathy are Amiadarone and Hydralazine.
Tumors can cause peripheral nerve damage by invading the nerves as they grow close to and press on the nerve. It is more common in patients with cancers of the nervous system, such as brain tumors, spine tumors, and the skull base's tumors. Another non-nervous system tumor that causes peripheral neuropathy is known to be breast cancer.
Treating the underlying cause is vital to treat and reverse peripheral neuropathy. It varies in different people with different causes. The other ways to reverse peripheral neuropathy are by the intake of vitamin supplements (especially Vitamin B), physiotherapy, avoiding alcohol and smoking, and avoiding the triggers of the disease during the treatment process.
The treatment of peripheral neuropathy involves medications such as Gabapentin and Pregabalin. These medicines are primarily developed to treat epilepsy, but they are capable of relieving nerve pain. Vitamin B supplements can prevent symptoms such as tingling of the limbs. Non-steroidal anti-inflammatory drugs can be used to treat pain during flare-ups. Other than that topical treatments are used when the affected area is infected.
Last reviewed at:
30 Oct 2019 - 5 min read
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