Peripheral Neuropathy - MayoClinic.com
September 2nd 2012 Posted by Earl Stevens in Peripheral Neuropathy
EARL’s NOTE: During my last hip revision I ended up with
apparent damage to my peroneal nerve – branch of the sciatic nerve – and
numbness in my right foot. However, there is also numbness in the left but not
so bad plus the outside of my left knee. I blamed the epidural for this as one
might but who knows as there are many possibilities. I will finally get around
to nerve studies with a specialist soon – only taken me a year to get myself
organised! Hence the interest in this topic. Apparently nerve damage during hip
revisions is not uncommon.
Peripheral neuropathy, a
result of nerve damage, often causes numbness and pain in your hands and feet. People typically
describe the pain of peripheral neuropathy as tingling or burning, while they
may compare the loss of sensation to the feeling of wearing a thin stocking or
glove.
Peripheral neuropathy can result from problems such as
traumatic injuries, infections, metabolic problems and exposure to toxins. One
of the most common causes is diabetes.
In many cases, peripheral neuropathy symptoms improve with time — especially if the condition is
caused by an underlying condition that can be treated. A number of medications
often are used to reduce the painful symptoms of peripheral neuropathy.
Symptoms
The nerves of your peripheral nervous system send
information from your brain and spinal cord (central nervous system) to all other parts
of your body and back again. Nerves that may be affected by peripheral
neuropathy include:
Sensory nerves that receive
sensations such as heat, pain or touch
Motor nerves that control how your
muscles move
Autonomic nerves that control functions
such as blood pressure, heart rate, digestion and bladder function
Most commonly, peripheral neuropathy starts in the longest
nerves — the ones that reach to your toes. Symptoms vary, depending on which
types of nerves are affected. Signs and symptoms may include:
Gradual onset of numbness and tingling in your feet or hands, which may
spread upward into your legs and arms
Burning pain
Sharp, jabbing or electric-like pain
Extreme sensitivity to touch, even light touch
Lack of coordination
Muscle weakness or paralysis if motor nerves are affected
Bowel or bladder problems if autonomic nerves are affected
Peripheral neuropathy may affect one nerve (mononeuropathy),
two or more nerves in different areas (multiple mononeuropathy) or many nerves
(polyneuropathy).
When to see a doctor
Seek medical care right away if you notice any unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offers the best chance for controlling your symptoms and preventing further damage to your peripheral nerves. If your symptoms interfere with your sleep or you feel depressed, your doctor or pain specialist may be able to suggest treatments that can help.
Seek medical care right away if you notice any unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offers the best chance for controlling your symptoms and preventing further damage to your peripheral nerves. If your symptoms interfere with your sleep or you feel depressed, your doctor or pain specialist may be able to suggest treatments that can help.
Causes
It’s not always easy to pinpoint the cause of peripheral
neuropathy, because a number of factors can cause neuropathies. These factors
include:
Alcoholism. Many alcoholics develop peripheral neuropathy
because they make poor dietary choices, leading to vitamin deficiencies.
Autoimmune diseases. These include lupus, rheumatoid
arthritis and Guillain-Barre syndrome.
Diabetes. When damage occurs to several nerves, the cause
frequently is diabetes. At least half of all people with diabetes develop some
type of neuropathy.
Exposure to poisons. These may include some toxic
substances, such as heavy metals, and certain medications — especially those
used to treat cancer (chemotherapy).
Infections. Certain viral or bacterial infections can cause
peripheral neuropathy, including Lyme disease, shingles (varicella-zoster),
Epstein-Barr, hepatitis C and HIV/AIDS.
Inherited disorders. Examples include Charcot-Marie-Tooth
disease and amyloid polyneuropathy.
Trauma or pressure on the nerve. Traumas, such as motor
vehicle accidents, falls or sports injuries, can sever or damage peripheral
nerves. Nerve pressure can result from using a cast or crutches, spending a
long time in an unnatural position or repeating a motion many times — such as typing.
Tumors. Growths can form directly on the nerves themselves,
or tumors can exert pressure on surrounding nerves. Both cancerous (malignant)
and noncancerous (benign) tumors can contribute to peripheral neuropathy.
Vitamin deficiencies. B vitamins — B-1, B-6 and B-12 — are
particularly important to nerve health. Vitamin E and niacin also are crucial
to nerve health.
Other diseases. Kidney disease, liver disease and an
underactive thyroid (hypothyroidism) also can cause peripheral neuropathy.
Risk Factors
Peripheral neuropathy risk factors include:
Diabetes, especially if your sugar levels are poorly
controlled
Alcohol abuse
Vitamin deficiencies, particularly B vitamins
Infections, such as Lyme disease, shingles
(varicella-zoster), Epstein-Barr, hepatitis C and HIV/AIDS
Autoimmune diseases, such as rheumatoid arthritis and lupus,
in which your immune system attacks your own tissues
Kidney, liver or thyroid disorders
Exposure to toxins
Repetitive physical stress, possibly from occupational
activities
Complications
Complications of peripheral neuropathy may include:
Reduced feeling. Because parts of your body may be numb, you
may be less likely to feel temperature changes or pain. This can make you more
susceptible to burns or skin trauma.
Infection. Make sure to check your feet, as well as any
other areas lacking usual sensation, regularly so that you can treat minor
injuries before they become infected. This is especially important for people
with diabetes, who tend to heal more slowly.
Preparing for your Appointment
You’re likely to start by seeing your family doctor or a
general practitioner. However, you may then be referred to a doctor who
specializes in nervous system disorders (neurologist).
To make the most of your appointment time, it’s good to
arrive prepared. Here’s some information to help you get ready for your
appointment, and to know what to expect from your doctor.
What you can do
Write down any symptoms you’re experiencing, including any
that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, vitamins and supplements
you’re taking.
Ask a family member or friend to come with you, if possible.
Sometimes it can be difficult to remember all of the information provided to
you during an appointment. Someone who accompanies you may remember something
that you missed or forgot.
Write down questions to ask your doctor.
Preparing a list of questions can help you make the most of
your time with your doctor. For peripheral neuropathy, some basic questions to
ask your doctor include:
What’s the most likely cause of my symptoms?
Are there other possible causes for my symptoms?
What kinds of tests do I need? Do these tests require any
special preparation?
Is this condition temporary or long lasting?
What treatments are available, and which do you recommend?
What types of side effects can I expect from treatment?
Are there alternatives to the primary approach that you’re
suggesting?
I have other health conditions. How can I best manage them
together?
Do I need to restrict any activities?
Is there a generic alternative to the medicine you’re
prescribing?
Are there brochures or other printed material I can take
home with me? What websites do you recommend?
Don’t hesitate to ask other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
Your doctor is likely to ask you a number of questions, such as:
Do you have any underlying health conditions, such as
diabetes or kidney disease?
When did you begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
Does anything seem to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Tests & Diagnosis
Peripheral neuropathy isn’t a single disease, but rather a
symptom with many potential causes. For that reason it can be difficult to
diagnose. Your doctor will need to determine where the nerve damage is and
what’s causing it.
Diagnosis usually requires:
A full medical history. This includes your symptoms, your
lifestyle, exposure to toxins, drinking habits and a family history of
neurological disease.
Neurological exam. This may include checking your tendon
reflexes, your muscle strength and tone, your ability to feel certain
sensations, and your posture and coordination.
Physical exam. Your doctor will likely do a complete
physical exam.
Your doctor may order tests, including:
Blood tests. These measure various levels, such as vitamin
and blood sugar levels; and bodily functions, such as thyroid, liver and
kidney.
Imaging tests. Your doctor may request a CT scan or MRI to
look for herniated disks, tumors or other abnormalities.
Nerve function tests. These may include electromyography —
which reads electrical activity in your muscles to determine if your weakness
is caused by muscle damage or nerve damage — and nerve conduction studies —
which assess how your nerves and muscles respond to small electrical stimuli,
generated by a probe and measured by an electrode placed along the nerve’s
pathway.
Nerve biopsy. Your doctor may recommend this procedure to
try to determine what’s damaging your nerves. A small portion of a nerve is
removed and examined for abnormalities.
Treatments & Drugs
One goal of treatment is to manage the condition causing
your neuropathy. If the underlying cause is corrected, the neuropathy often
improves on its own. Another goal of treatment is to relieve the painful
symptoms.
Medications
Many types of medications can be used to relieve the pain of peripheral neuropathy, including:
Many types of medications can be used to relieve the pain of peripheral neuropathy, including:
Pain relievers. Mild symptoms may be relieved by
over-the-counter pain medications. For more-severe symptoms, your doctor may
recommend prescription painkillers. Drugs containing opiates, such as codeine,
can lead to dependence, constipation or sedation, so these drugs are generally
prescribed only when other treatments fail.
Anti-seizure medications. Drugs such as gabapentin (Gralise,
Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine
(Carbatrol, Tegretol) and phenytoin (Dilantin, Phenytek) were originally
developed to treat epilepsy. However, doctors often also prescribe them for
nerve pain. Side effects may include drowsiness and dizziness.
Capsaicin. A cream containing this naturally occurring
substance found in hot peppers can cause modest improvements in peripheral
neuropathy symptoms. Like spicy foods, it may take some time and gradual
exposure to get used to because of the hot sensation this cream creates.
Generally, you have to get used to the heat before you can experience pain
relief. Doctors may suggest you use this cream with other treatments.
Lidocaine patch. This patch contains the topical anesthetic
lidocaine. You apply it to the area where your pain is most severe, and you can
use up to four patches a day to relieve pain. This treatment has almost no side
effects except, for some people, a rash at the site of the patch.
Antidepressants. Tricyclic antidepressant medications, such
as amitriptyline and nortriptyline (Aventyl, Pamelor), were originally
developed to treat depression. However, they have been found to help relieve
pain by interfering with chemical processes in your brain and spinal cord that
cause you to feel pain. The serotonin and norepinephrine reuptake inhibitor
duloxetine (Cymbalta) also has proved effective for peripheral neuropathy
caused by diabetes. Side effects may include nausea, drowsiness, dizziness,
decreased appetite and constipation.
Therapies
Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. In this therapy, adhesive electrodes are placed on the skin, and a gentle electric current is delivered through the electrodes at varying frequencies. TENS has to be applied regularly.
Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. In this therapy, adhesive electrodes are placed on the skin, and a gentle electric current is delivered through the electrodes at varying frequencies. TENS has to be applied regularly.
Lifestyle & Home Remedies
The following suggestions can help you manage peripheral
neuropathy:
Take care of your feet, especially if you have diabetes.
Check your feet daily for signs of blisters, cuts or calluses. Tight shoes and
socks can worsen pain and tingling and may lead to sores that won’t heal. Wear
soft, loose cotton socks and padded shoes. You can use a semicircular hoop,
which is available in medical supply stores, to keep bedcovers off hot or
sensitive feet.
Exercise. Ask your doctor about an exercise routine that’s
right for you. Regular exercise may reduce neuropathy pain and can help control
blood sugar levels.
Quit smoking. Cigarette smoking can affect circulation,
increasing the risk of foot problems and possibly amputation.
Eat healthy meals. If you’re at high risk of neuropathy or
have a chronic medical condition, healthy eating is especially important to
ensure that you get essential vitamins and minerals. Emphasize low-fat meats
and dairy products and include lots of fruits, vegetables and whole grains in
your diet. Drink alcohol in moderation, if at all.
Massage your hands and feet, or have someone massage them
for you. Massage helps improve circulation, stimulates nerves and may
temporarily relieve pain.
Avoid prolonged pressure. Don’t keep your knees crossed or
lean on your elbows for long periods of time. Doing so may cause new nerve
damage.
Alternative Medicine
Some people with peripheral neuropathy try complementary and
alternative treatments for relief of their symptoms. Although these techniques
haven’t been as rigorously studied as most medications, the following therapies
have shown some promise in the treatment of peripheral neuropathy:
Acupuncture. Acupuncture involves the insertion of thin
needles into various points on your body. Acupuncture may reduce symptoms in
about three-quarters of people with peripheral neuropathy. However, you may
need multiple acupuncture sessions before you notice improvement. Acupuncture
is generally considered safe when performed by a certified practitioner using
sterile needles.
Alpha-lipoic acid. Used as a treatment for peripheral
neuropathy in Europe for years, this antioxidant may help reduce the symptoms
of peripheral neuropathy. Discuss the use of alpha-lipoic acid with your doctor
before using it, because alpha-lipoic acid may affect your blood sugar levels.
Other side effects may include stomach upset and skin rash.
Biofeedback. During a biofeedback session, the therapist
applies electrical sensors to different parts of your body to monitor your
body’s physiological response to your peripheral neuropathy symptoms. The
biofeedback device then teaches you how your body responds using cues, such as
a beeping sound or flashing lights. This feedback can help you associate your
body’s response with certain physical functions. Once you begin to recognize
your body’s responses, you can learn ways to lessen the reaction through certain
techniques, such as relaxation or guided imagery.
Prevention
Manage underlying conditionsThe best way to prevent peripheral neuropathy is to carefully manage any medical condition that puts you at risk. That means controlling your blood sugar level if you have diabetes or talking to your doctor about safe and effective treatments if you think you may have a problem with alcohol.
Make healthy lifestyle choices
Whether or not you have a medical condition, eating a healthy diet that’s rich in fruits, vegetables, whole grains and lean protein can help keep your nerves healthy. For example, nerve damage is common if you have a vitamin B-12 deficiency. The best food sources of vitamin B-12 are meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re a strict vegetarian, fortified cereals are a good source of vitamin B-12 for you, but you may also want to talk to your doctor about B-12 supplements. Regular exercise also is important. If possible, try to get at least 30 minutes to one hour of exercise at least three times a week.
Whether or not you have a medical condition, eating a healthy diet that’s rich in fruits, vegetables, whole grains and lean protein can help keep your nerves healthy. For example, nerve damage is common if you have a vitamin B-12 deficiency. The best food sources of vitamin B-12 are meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re a strict vegetarian, fortified cereals are a good source of vitamin B-12 for you, but you may also want to talk to your doctor about B-12 supplements. Regular exercise also is important. If possible, try to get at least 30 minutes to one hour of exercise at least three times a week.
Avoid things that can cause nerve damage as much as
possible. For example:
Repetitive motions
Cramped positions
Toxic chemicals
Tobacco smoke
Excessive alcohol consumption
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