Peripheral Neuropathy

Overview

Peripheral neuropathy is a condition in which the nerves located outside the brain and spinal cord (peripheral nerves) are damaged, leading to weakness, numbness, and pain, primarily in the hands and feet. This condition can also impact other areas and body functions, such as digestion and urination. Peripheral neuropathy can result from various causes, including traumatic injuries, infections, metabolic issues, inherited factors, and exposure to toxins. One of the most common causes is diabetes.

Understanding the disease

Symptoms

The symptoms of peripheral neuropathy may include:

• Gradual onset of numbness, prickling, or tingling in your feet or hands, which can spread upward into your legs and arms.
• Sharp, jabbing, throbbing, or burning pain.
• Extreme sensitivity to touch.
• Pain during activities that should not cause pain, such as pain in your feet when putting weight on them or when they are under a blanket.
• Lack of coordination and falling.
• Muscle weakness.
• Feeling as if you're wearing gloves or socks when you're not.
• Inability to move if motor nerves are affected. Additionally, if autonomic nerves are affected, symptoms may include:
• Heat intolerance.
• Excessive sweating or not being able to sweat.
• Bowel, bladder, or digestive problems.
• Drops in blood pressure, causing dizziness or lightheadedness. It's important to seek medical care right away if you notice unusual tingling, weakness, or pain in your hands or feet, as early diagnosis and treatment can help manage symptoms and prevent further nerve damage.

Risk Factors

Risk factors for developing peripheral neuropathy include:

1. Diabetes, especially if sugar levels are not well-controlled.
2. Alcohol misuse.
3. Low levels of vitamins in the body, particularly vitamin B-12.
4. Infections such as Lyme disease, shingles, hepatitis B and C, and HIV.
5. Autoimmune diseases, such as rheumatoid arthritis and lupus.
6. Kidney, liver, or thyroid disorders.
7. Exposure to toxins.
8. Repetitive motion, such as those performed for certain jobs.
9. Family history of neuropathy.

Development

Peripheral neuropathy develops when the peripheral nerves outside the brain and spinal cord are damaged. This can result from various causes, including traumatic injuries, infections, metabolic problems, inherited conditions, and exposure to toxins. One of the most common causes of peripheral neuropathy is diabetes. The condition can affect sensory, motor, and autonomic nerves, leading to a range of symptoms such as weakness, numbness, pain, heat intolerance, excessive sweating, digestive problems, and blood pressure fluctuations. Peripheral neuropathy can manifest in different ways, including mononeuropathy (affecting one nerve), multiple mononeuropathy (affecting two or more nerves in different areas), and polyneuropathy (affecting many nerves). It's essential to seek medical care promptly if you notice unusual tingling, weakness, or pain in your hands or feet, as early diagnosis and treatment can help manage symptoms and prevent further nerve damage.

Assessment and Diagnosis

Triage

You should see a doctor if you notice unusual tingling, weakness, or pain in your hands or feet, as early diagnosis and treatment can give you the best chance for controlling your symptoms and preventing further damage to your peripheral nerves.

Diagnosis

Diagnosis of peripheral neuropathy typically involves a combination of physical exams, medical history, and diagnostic tests. A healthcare professional will assess your symptoms, lifestyle, exposure to toxins, drinking habits, and family history of nervous system or neurological diseases. They may also perform a neurological exam to check tendon reflexes, muscle strength and tone, sensation, and balance and coordination. Blood tests can detect low levels of vitamins, diabetes, inflammation, or metabolic issues that can cause peripheral neuropathy. Imaging tests, such as CT or MRI scans, may be ordered to look for herniated disks, pinched nerves, growths, or other problems affecting blood vessels and bones. A nerve biopsy or skin biopsy may be recommended in some cases to determine the cause of neuropathy.

Management and Treatment

Complications

Complications of peripheral neuropathy can include:

1. Burns, skin injuries, and wounds on the feet: Lack of sensation in numb areas can lead to injuries or wounds going unnoticed, increasing the risk of infection.
2. Infection: Injuries or wounds on areas with decreased sensation may go unnoticed, increasing the risk of infection.
3. Foot ulcers: People with peripheral neuropathy are more susceptible to foot ulcers due to the loss of sensation, which can make it difficult to detect injuries or abnormalities.
4. Gait disturbances: Peripheral neuropathy can cause muscle weakness, leading to an unstable gait and an increased risk of falls.
5. Decreased coordination and motor function: Peripheral neuropathy can affect motor nerves, leading to a lack of coordination and difficulty with movement.
6. Digestive problems: Autonomic neuropathy can cause digestive problems, such as bloating, constipation, or diarrhea.
7. Bladder and bowel dysfunction: Autonomic neuropathy can result in bladder or bowel dysfunction, leading to urinary or fecal incontinence.
8. Blood pressure issues: Autonomic neuropathy may cause abnormal blood pressure fluctuations, leading to dizziness or lightheadedness upon standing. Seek medical care right away if you notice any unusual tingling, weakness, or pain in your hands or feet. Early diagnosis and treatment can help manage symptoms and prevent further nerve damage.

Treatment

Treatments for peripheral neuropathy depend on the underlying cause and severity of the condition. Some general approaches to managing peripheral neuropathy include:

1. Managing underlying conditions: Addressing the underlying cause of the neuropathy, such as diabetes, is essential for managing neuropathy symptoms.
2. Healthy lifestyle choices: Maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support nerve health. Regular exercise, as approved by a healthcare professional, can also be beneficial.
3. Medications: Various medications may be prescribed to alleviate pain, reduce inflammation, or treat any underlying infections causing the neuropathy.
4. Pain management: For pain associated with peripheral neuropathy, various pain management strategies can be employed, such as physical therapy, acupuncture, or topical treatments.
5. Nerve repair and regeneration: In some cases, nerve repair and regeneration may be possible through therapies such as nerve grafting or stem cell treatment. It is important to consult with a healthcare professional for personalized advice and treatment options based on the specific cause and severity of the peripheral neuropathy.

Preparing for medical consultation

To prepare for an appointment for peripheral neuropathy, you should:

1. Make a list of your symptoms, including any that seem unrelated to peripheral neuropathy.
2. Bring a list of all medications, vitamins, or supplements you are taking, including doses.
3. Consider bringing a family member or friend to help you remember information provided during the appointment.
4. Prepare questions to ask your healthcare professional, such as the most likely cause of your symptoms, possible alternative treatments, and potential side effects.
5. Follow any pre-appointment instructions provided, such as fasting for specific tests.
6. Maintain a healthy diet, avoid excessive alcohol consumption, and monitor your blood sugar levels if you have diabetes. Remember to be proactive in discussing your concerns and actively participating in the appointment to ensure the best possible care.