Diabetes Neurology / Neuroscience Pain / Anesthetics

Peripheral neuropathy: What you should know

A issue with the peripheral nerves leads to peripheral neuropathy. These nerves relay signals to the rest of the body from the central nervous system, the brain and the spinal cord.

The peripheral nerves inform the body when the hands are cold, for example. In different areas of the body, it can lead to tingling, prickling, numbness, and muscle fatigue.

A number of different nerves can be affected by peripheral neuropathy, meaning it can affect a multitude of locations in distinct ways. It may affect a single nerve or, at the same time , multiple nerves.

A variety of different underlying medical problems are also associated with it. There is no identifiable cause occasionally.

In the United States ( U.S.), it affects about 20 million residents.

Important facts about peripheral neuropathy

  • Neuropathy is a common complication of a number of different medical conditions.
  • It can involve the autonomic nerves, the motor nerves, and the sensory nerves.
  • Sometimes it affects a single nerve or nerve set, for example, in Bell’s Palsy, which affects a facial nerve.
  • Physical trauma, repetitive injury, infection, metabolic problems, and exposure to toxins and some drugs are all possible causes.
  • People with diabetes have a high risk of neuropathy.

Treatment

Carpal tunnel syndrome is an example of a mononeuropathy, which affects a single nerve.
Carpal tunnel syndrome is an example of a mononeuropathy, which affects a single nerve.

Treatment usually focuses on the root cause, or seeks to offer relief from symptomatic discomfort and avoid more damage.

Addressing elevated blood sugar levels will avoid more nerve injury in the case of diabetic neuropathy.

Removing exposure to a potential poison or stopping a drug will halt any nerve damage for toxic purposes.

Medications can minimize inflammation and decrease pain, numbness , and tingling.

Drug treatment for neuropathic pain

Medications that may help include:

  • drugs normally used for epilepsy, such as carbamazepine
  • antidepressants, such as venlafaxine
  • opioid painkillers, for example, oxycodone or tramadol

Opioid painkillers come with protection risk notices.

Duloxetine may help people with chemotherapy-induced neuropathy.

For temporary, localized pain relief, doctors can also prescribe skin patches like Lidoderm. This includes lidocaine, the local anesthetic. The patches are like bandages and it is possible to cut them to scale.

In order to prevent unintended interactions, the choice of treatment should take into account medicines for other disorders.

Managing neuropathy

Pain management can be improved by non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen. These are available over the counter.

Topical ointments and creams containing chili pepper, such as 0.075 percent capsaicin cream, can relieve pain. Patches are also available.

Treating mononeuropathies

When neuropathy is induced by compression of a single nerve, the treatment of each nerve concerned is equivalent. If the compression is constant or transient depends on the method.

Ulnar, radial, or peroneal nerve palsy can be temporary and reversible by merely removing the source of compression of the nerve. An individual with ulnar nerve palsy, for instance, does not lean on the affected elbow.

It may be beneficial for the patient to relax and to use heat and a minimal course of medicine to minimize inflammation.

Conservative therapy for carpal tunnel syndrome involves wrist splinting, oral or injected corticosteroid drugs, and ultrasound.

If neuropathy involving a single nerve does not respond to these measures, surgery may be an option. Surgery may also be necessary if the compression of the nerve is fixed, such as when a tumor is caused.

At any stage, referral to specialist pain services or an appropriate clinical specialty should be considered if:

  • pain is severe
  • pain significantly limits daily activities and quality of life
  • an underlying health condition is getting worse

Symptoms

Symptoms vary according to the types of neuropathy.

Sensory neuropathy

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.

Motor neuropathy

This affects the muscles.

Symptoms include:

  • muscle weakness, leading to unsteadiness and difficulty performing small movements, such as buttoning a shirt.
  • muscle wasting
  • muscle twitching and cramps
  • muscle paralysis

There may be issues with sweating, heat sensitivity, bowel or bladder issues, and changes in blood pressure if the autonomic nerves are impaired, leading to dizziness.

Causes

Many forms of neuropathy are “idiopathic,” or have an unexplained cause, although it may be caused by a variety of conditions.

The most frequent cause of chronic peripheral neuropathy is diabetes. It develops when the nerves are affected by elevated blood sugar levels.

Other medical conditions and injuries include:

  • Chronic kidney disease: if the kidneys are not functioning normally, an imbalance of salts and chemicals can cause peripheral neuropathy.
  • Injuries: Broken bones and tight plaster casts can put pressure directly on the nerves.
  • Infections: Shingles, HIV infection, Lyme disease, and others can lead to nerve damage.
  • Guillain-Barré syndrome: This is a specific type of peripheral neuropathy, triggered by infection.
  • Some autoimmune disorders: These include rheumatoid arthritis and systemic lupus erythematosus (SLE).

Other causes include:

  • excessive alcohol intake
  • some drugs, for example, chemotherapy and HIV treatment
  • B12 or folate vitamin deficiencies
  • poisons, such as insecticides and solvents
  • some kinds of cancer, including lymphoma and multiple myeloma
  • chronic liver disease

Small blood vessel disorders can decrease the blood flow to the nerves, resulting in damage to nerve tissue.

Neuromas, benign tumors that damage the tissue of the nerve, may contribute to discomfort that is neuropathic.

Diabetic neuropathy

Peripheral neuropathy is most often caused by diabetes. Any degree of neuropathy develops in about 60 to 70 percent of people with diabetes.

High levels of blood sugar destroy the walls of the tiny blood vessels that provide the nerves at the ends of the hands and feet with oxygen and nutrients, and the vital organs in the body, such as the eyes, kidneys , and heart.

As a consequence, not only does the skin get damaged, but the likelihood of injury is further exacerbated by the loss of sensation.

In the U.S., the primary source of foot complications and ulcers in people with diabetes is diabetic neuropathy. It is estimated that about half of the persons with diabetes have diabetic neuropathy.

Types

The nervous system is a dynamic information network in which various kinds of nerves communicate. Peripheral neuropathy refers to a dysfunction of the peripheral nerves in particular.

It has described over 100 forms of neuropathy, each with its own causes and symptoms.

Neuropathy can affect the:

  • Sensory nerves: These nerves control sensation, and damage can cause tingling, pain, numbness, or weakness in the feet and hands.
  • Motor nerves: These nerves allow power and movement, and damage can cause weakness in the feet and hands.
  • Autonomic nerves: These nerves control body systems such as the digestive or cardiovascular system. Damage can affect the heart rate, blood pressure, and other functions.

Mononeuropathy involves a single nerve. In polyneuropathy, several nerves are affected.

Examples of neuropathy include:

  • postherpetic neuralgia, which can follow shingles. Sensory neuropathy can last for many months after the rash disappears.
  • ulnar nerve palsy, following an injury to the elbow
  • carpel tunnel syndrome, a compression of the nerves in the wrist
  • peroneal nerve palsy, caused by compression of a nerve in the leg that runs by the neck of the fibular, or the calf bone, between the knee and ankle
  • Bell’s palsy, a single-nerve neuropathy that affects the face

Natural treatments

Hot or cold pack may help relieve discomfort.
Hot or cold pack may help relieve discomfort.

Non-drug measures include:

  • wearing fabrics that do not irritate, such as cotton
  • covering sensitive areas with a plastic wound dressing or cling film
  • using warm or cold packs, unless the problem is worsened by heat or cold

Meditation, relaxing methods, massage, and acupuncture include stress-relief and other alternative treatments.

Some people find that using a transcutaneous electrical nerve stimulation (TENS) machine helps. By supplying a small electric current, this system prevents nerve messages. Research has not verified its efficacy.

Any supplements should first be discussed with a doctor.

Outlook

Depending on the underlying cause, and which nerves have been impaired, the outcome for peripheral neuropathy varies.

If the root trigger is treated, some cases may change over time, but in others, the damage may be permanent or progressively escalate over time.