Peripheral Neuropathy
En Español (Spanish Version)

Definition
Peripheral neuropathy is damage to the peripheral nerves. These are the nerves that connect your spinal cord to the rest of your body.

Peripheral Nerves of the Foot

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Causes
Many health conditions can cause peripheral neuropathy. The damage may occur due to:

  • Trauma from nerve compression or inflammation
  • Certain medications, such as chemotherapy treatments for cancer
  • Vitamin deficiencies
  • Hereditary syndromes
  • Exposure to toxins and heavy metals, such as lead, mercury, or pesticides
  • Exposure to cold or radiation
  • Prolonged treatment in the intensive care unit
Health conditions that can damage peripheral nerves include:

Risk Factors
Having certain health conditions may increase your chance of getting peripheral neuropathy.

Symptoms
Damage to the peripheral nerves often results in sensory and motor symptoms in the:

  • Arms
  • Legs
  • Hands
  • Feet
Other parts of the body can also be affected. Symptoms depend on which nerves are involved. They can range from mild to severe and may seem worse at night. Sensations and pain may occur in the upper or lower limbs and move toward the trunk, such as from the feet to the calves.

Symptoms include:

  • Numbness or reduced sensation
  • Tingling
  • Pain, often a burning or sharp, cutting sensation
  • Sensitivity to touch
  • Muscle twitches
  • Muscle weakness
  • Difficulty with walking
  • Loss of coordination or balance
  • Paralysis
If untreated, peripheral neuropathy can lead to:

  • Loss of reflexes and muscle control
  • Muscle atrophy—loss of muscle bulk
  • Foot deformities
  • Injuries to the feet that go unnoticed and become infected
If you have motor or sensory neuropathy, you may also have autonomic neuropathy. This is associated with symptoms such as:

  • Problems regulating blood pressure
  • Constipation
  • Erectile dysfunction
  • Difficulty breathing
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. It may include examining:

  • Muscle strength
  • Reflexes
  • Balance
  • Coordination
  • Ability to feel vibration, temperature, and light touch
  • Semmes-Weinstein monofilaments test—measures sensation in the feet using a fine flexible wire
Additional tests may also include:

  • You may need to have tests of your bodily fluids and tissues. This can be done with:
    • Blood tests, such as glucose, vitamin B12 level, and thyroid function tests
    • Serum/urine electrophoresis
    • Genetic testing
    • Lumbar puncture
    • Nerve fiber density skin biopsy
    • Nerve or muscle biopsy
  • You may need to have your nerves and muscles tested. This can be done with:
  • You may need to have pictures taken of your bodily structures. This can be done with:
  • Your doctor may need to evaluate other family members for this condition.
Treatment
Talk with your doctor about the best treatment plan for you. Options may include:

Treatment for the Underlying Illness or Exposure
Treating the underlying illness can decrease symptoms or make them go away. For instance, if it is caused by diabetes, controlling blood sugar levels may help. In some cases, neuropathy caused by medications or toxins is completely reversed when these substances are stopped or avoided. Correction of vitamin B12 deficiency often improves symptoms.

Physical Therapy
Certain exercises may help stretch shortened or contracted muscles and increase joint flexibility. In long-standing cases, splinting the joint may be required to protect and rest it, while maintaining proper alignment.

Orthotics, such as supports and braces, may help with:

  • Deformities
  • Balance issues
  • Muscle weakness
Maintaining physical activity is also important.

Medications
Prescription and over-the-counter pain medications are often used to ease discomfort.

Medications used to treat depression and prevent convulsions can relieve neuropathy symptoms.

For severe and potentially life-threatening cases, such as Guillain-Barre syndrome, treatment includes:

  • IV immunoglobulins
  • Plasmapheresis—done to exchange plasma in the blood
Other Therapies
These therapies are aimed at reducing symptoms:

Surgery
Surgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat carpal tunnel syndrome.

Prevention
To help reduce your chance of getting peripheral neuropathy, take these steps:

  • Manage chronic medical conditions with the help of your doctor. If you have diabetes, make sure you have regular foot exams.
  • Eat a healthy diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Limit your alcohol intake to a moderate level. This means two or fewer drinks per day for men and one or fewer for women.
  • Avoid toxic chemicals.



RESOURCES:
American Chronic Pain Association

The Neuropathy Association

CANADIAN RESOURCES:
Canadian Diabetes Association


References:
Baron R, Binder A, et al. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807-819.

Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.aspx. Updated June 25, 2012. Accessed July 11, 2013.

Karlsson P, et al. Epidermal nerve fiber length density estimation using global spatial sampling in healthy subjects and neuropathy patients. J Neuropathol Exp Neurol. 2013 Mar;72(3):186-93.

Peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 4, 2013. Accessed July 11, 2013.

12/20/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine.

10/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Feng Y, Schlösser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50:675-682,682.

Last Reviewed July 2013



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