Basics of Peripheral Neuropathy

Peripheral Neuropathy2The peripheral nervous system consists of a communications network that transmits messages from the spinal cord and brain to every part of the body. The peripheral nerves send sensory information to the brain, such as when the finger is burned. Damage to this system is called peripheral neuropathy, which means there is an interruption of messages between the brain and the rest of the body. Often, the neuropathy is a complication of another condition.

Researchers estimate the prevalence of peripheral neuropathy is 8% for people older than 55 years. In the general population, approximately 2.5% of people suffer with this condition. For diabetics, the rate of peripheral neuropathy is as high as 27%. Male patients with type 2 diabetes are more likely to develop neuropathy earlier than female patients. However the condition occurs in both sexes, all races, and is more common with increasing age and duration of diabetes.

Symptoms of Peripheral Neuropathy

There are more than 100 types of peripheral neuropathy, and symptoms depend on the type of nerves involved (motor, sensory, and autonomic). Motor nerves control muscle movement, such as grasping, talking, and walking. Sensory nerves transport messages about feelings, such as pain and heat. Autonomic nerves regulate breathing, digestion, and heart activity. Symptoms include:

  • Motor – Weakness, pain, muscle twitching, and changes in hair/skin/nails.
  • Sensory – Lack of feeling, sense of numbness, severe pain, and loss of perception.
  • Autonomic – Heat intolerance, loss of bladder control, dizziness, lightheadedness, diarrhea, and problems swallowing.

Causes of Peripheral Neuropathy

  • Physical injury – Nerves get crushed, severed, or compressed and cannot transmit message.Neuropathy
  • Endocrine disorders – High circulating levels of glucose damage the nerves.
  • Renal disease – Toxic substances buildup in the blood and damage nerve tissue.
  • Vitamin deficiencies – Vitamins B1, B6, B12, and E are essential for nerve function. Any deficiency of these can cause long-standing damage.
  • Chronic inflammation – Connective tissue and autoimmune disorders inflame nerve fibers and result in progressive destruction of the structures.
  • Repetitive stress – A compression injury causes nerve damage from repetitive activities that constrict the passageways through which nerves pass. This results in irritation and swelling.
  • Heredity – Inherited forms of neuropathy result from genetic errors, such as Charcot-Marie-Tooth disease.

Peripheral Neuropathy Diagnosis

Diagnosing peripheral neuropathy is difficult because the symptoms vary from patient to patient. The doctor will conduct a comprehensive history of illness, family history, and past medical history, as well as a physical examination. Diagnostic tests include:

  • Blood tests – To detect abnormal immune system activity, liver and kidney function, and metabolic and vitamin deficiencies.
  • Computed tomography (CT) scan – To assess the soft tissues of the body, to rule out herniated discs, spine abnormalities, tumors, cysts, and vascular irregularities.
  • Magnetic resonance imaging (MRI) scan – To assess nerve fibers and muscle tissue.
  • Electromyography (EMG) – Fine needles inserted into the muscle to compare the amount of electrical activity present when muscles contract and are at rest.
  • Nerve conduction velocity (NCV) test – Used to assess the degree of damage to the nerve fibers. A problem stimulates the nerve by electrical impulse, and the nerve responds by contracting. Slow contraction indicates impulse blockage and nerve damage.

Treatment Options

 

  • Medications – this may include NSAIDs, Opiates, Neurogenic Medications (Lyrica, Neurontin), Vitamins.Spinal Cord Stimulator3

 

  • Physical Therapy and Chiropractic – this may include massage, TENS Units, laser therapy, modalities and more.

 

  • Spinal cord stimulation – This is an effective measure for neuropathy pain. The doctor surgically implants a small device near the spinal cord, which emits electrical currents to the spinal column. This creates a pleasant sensation that blocks the brain’s ability to sense any pain. It also restores sensation that has been lost.

 

Resources

 

Azhary H, Farooq MU, Bhanushali M, et al. (2010). Peripheral Neuropathy: Differential Diagnosis and Management. American Family Physician, 1(81), 887-892.

Dorsey RR, Eberhardt MS, Gregg EW, Geiss LS. Control of risk factors among people with diagnosed diabetes, by lower extremity disease status. Prev Chronic Dis. Oct 2009;6(4):A114.

Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. Feb 2000;47(2):123-8.