Thursday, 28 June 2018

Neuropathy Information That May Clear Up A Lot Of Misconceptions

At first glance, today's post from (see link below) may get you thinking: "can't see the wood for the trees much!" and it's true, there's a mass of information here, not all of which may seem relevant to your particular case. However, although the lay-out may seem a bit jumbled and messy, there's so much valuable general information about nerve damage/neuropathy, that it's worth a read for everybody - however experienced you are with nerve pain. The content is useful enough but it may be in the links that you find the information you're looking for and there are plenty of them - opening up doorways to more detailed info at every click. Maybe a bit much to take in in one go but over a few short sessions, you'll find it less heavy going.

What Is Neuropathy? How to Spot the Signs, Understand the Causes, Get Treatment, Build a Good Diet for Management, Start Exercising, and More
By Sheryl Huggins Salomon Medically Reviewed by Samuel Mackenzie, MD, PhD

Neuropathy, or nerve damage, can result from a wide range of conditions such as diabetes and even treatments like chemotherapy.

In fact, neuropathy, which is sometimes referred to as peripheral neuropathy, is not a single health condition but rather a term used to describe a range of health problems involving damage to the peripheral nerves, as well as the symptoms of those issues.

While the group of conditions is irreversible, you can take steps to help prevent neuropathy or manage it through diet, lifestyle, and treatment.

With the information in this comprehensive article, you can work with your primary care doctor to come up with a plan of attack that works best for you.

What Are the Symptoms of Neuropathy?

Symptoms of neuropathy ultimately depend on the underlying cause and the individual, but they can include temporary or permanent numbness; a tingling, prickling, or burning sensation; increased sensitivity to touch; pain; muscle weakness or wasting; paralysis; dysfunction in organs or glands; and impairment to urination and sexual function. (1,2)

To understand how neuropathy acts in the body, it’s important to know that the nervous system is divided into two parts: the central nervous system — the brain and spinal cord — and the peripheral nervous system, which transmits messages between the central nervous system and the rest of your body. (3)

In turn, the peripheral nervous system is divided into a voluntary — or somatic — nervous system controlling all of the functions we are aware of and can consciously control, such as moving limbs, and an involuntary — or autonomic — nervous system regulating processes we can’t consciously direct, such as heartbeat, breathing, and digestion.

Damage or disruption to both voluntary and involuntary peripheral nerves can be involved in neuropathy. Sensory and motor nerves can be affected. (1)

Learn More About the Symptoms of Neuropathy, Plus How It’s Diagnosed

What Are the Causes of Neuropathy, and How Prevalent Is the Condition?

An estimated 20 million Americans have some form of neuropathy, and the associated risk factors vary from diabetes and chemotherapy to autoimmune conditions. (4)
What Are the Risk Factors or Conditions Associated With Neuropathy?

Within that population, the most common type of neuropathy is diabetic peripheral neuropathy, which affects people managing diabetes with poorly controlled blood sugar and accounts for about 60 percent of the total people with neuropathy. (5)

The second-largest group of neuropathy sufferers are those for which no cause has been identified — 23 percent — and therefore their condition is known as idiopathic peripheral neuropathy. (6)

Chemotherapy-induced peripheral neuropathy afflicts 10 percent of Americans with neuropathy. (7)

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How to Prevent and Treat 10 Diabetes Skin Problems HIV/AIDS is related to 2 percent of total neuropathy cases, which can be due to the effects of the human immunodeficiency virus or the drugs used to treat it. (8)

Other types of neuropathy make up the remaining 5 percent of cases, such as those caused by other metabolic disorders such as hypoglycemia or kidney failure; autoimmune disorders such as celiac disease, rheumatoid arthritis, lupus, sarcoidosis, Sjögren’s syndrome, and Guillain-Barré syndrome; infectious diseases; physical trauma; compression; repetitive stress; toxicity; hereditary disorders such as Charcot-Marie-Tooth disease; hormonal disorders; alcoholism; and nutrient deficiencies. (9,10,11)

What Causes Neuropathy Exactly?

The nerve damage behind neuropathy can happen in a variety of ways, affecting the nerve axons (along which impulses are conducted to other cells), myelin sheath (which covers and protects the axon), or a combination of both. Doing an electrodiagnostic study can help your doctor determine which kind of damage is involved. (3)

The prevalence of neuropathy in the general population is 2.4 percent. But prevalence increases with age due to an attending increase in chronic disease. Eight percent of people ages 55 and over suffer from polyneuropathy, according to a frequently cited 1997 study in the Journal of Neurology, Neurosurgery and Psychiatry. (12,13)

Learn More About the Causes and Risk Factors of Neuropathy

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What Is Polyneuropathy, and What Are the Other Types of Neuropathy?

When neuropathy involves damage to only one nerve, it is called mononeuropathy. But most often, multiple nerves are affected, and when this happens, doctors refer to the nerve damage as polyneuropathy.

The symptoms of polyneuropathy depend on whether autonomic, sensory, or motor nerves — or a combination of them — are involved. Autonomic nerve damage can affect bodily functions or blood pressure and even create gastrointestinal symptoms. Damage to sensory nerves can affect sensations and sense of balance, while damage to motor nerves can affect movement and reflexes. When both sensory and motor nerves are involved, the condition is known as sensorimotor polyneuropathy, in which damage happens body-wide to nerve cells, fibers (axons), and coverings (myelin sheaths). (14)

More on Neuropathy Symptoms

Numb Feet: Is It MS, or Something Else? Distal symmetric polyneuropathy is a common type of polyneuropathy and the one most prevalent among people with diabetes. In this form of polyneuropathy, the first nerve fibers to malfunction are those most distant from the central nervous system, with symptoms such as pain and numbness felt symmetrically in the feet, then traveling up the legs as the condition progresses. The upper extremities may also become involved eventually. (15)

Learn More About Polyneuropathy and Other Types of Neuropathy

What Is Neuropathic Pain, and What Are Its Symptoms and Causes?

Neuropathic pain can develop when the nerves of the somatic nervous system become damaged and transmit sensory signals to the central nervous system in an altered and disordered fashion. It is estimated to affect 7 to 10 percent of the general population worldwide. (16,17)

Common conditions associated with peripheral neuropathic pain include postherpetic neuralgia (a complication of herpes zoster, also known as shingles), trigeminal neuralgia (pain from a nerve carrying signals from the face to the brain), diabetic neuropathy, HIV-associated peripheral sensory neuropathy, leprosy, and peripheral nerve injury pain. (18,19,15,20,21)

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Potential HIV Complications You Should Know Across a wide range of causes, the symptoms of neuropathic pain tend to be similar, says Vernon Williams, MD, a sports neurologist and director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “The character and quality of neuropathic pain tends to be pain that’s burning or electric in character.” Additionally, he says, the pain will often be associated with other symptoms, such as paresthesia (a lack of normal sensation associated with pain), allodynia (a painful response to a stimulus that wouldn’t normally trigger pain signals), and hyperalgesia (a dramatic or severe pain in response to a stimulus that normally causes mild pain).

Learn More About Neuropathic Pain and How It’s Treated

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What Therapies and Treatment Can Offer Relief From Neuropathy?
Medication can help relieve pain symptoms, as well as improve sleep and quality of life, but it won’t “reverse or cure neuropathy,” Dr. Williams says.

Common over-the-counter medication that people reach for to address mild to moderate neuropathic pain includes Tylenol (acetaminophen), nonsteroidal inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen), and topical treatments such as capsaicin and lidocaine creams. Prescription medication such as COX-2 inhibitors like Celebrex (celecoxib), opioids, and Ultram (tramadol) can be taken as well. (22)

Patients can get a measure of relief from such “traditional, nonspecific” medication, he says. But they are more likely to gain relief from certain categories of medication that have a specific effect on the pain pathways. They act on pain from abnormal nerve firing or nerve signals.

Williams says antidepressant, antiseizure, and antiepileptic medications are “the types of categories we’re likely to turn to and can be most helpful.”

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10 Questions About Antidepressants, Answered “Antidepressants have an effect on some of the neurotransmitters like norepinephrine and serotonin, which can have an effect on pain,” he explains. Among the options in this category of treatment are selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Zoloft (sertraline), which restore the chemical balance in the nerve cells of the brain; serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine; norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine; and serotonin receptor modulators, such as Oleptro (trazodone), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves.

Williams says the effectiveness of anticonvulsants is still being investigated, but “we believe the mechanism of effect is on calcium channels, and that can reduce transmission of those abnormal nerve signals, often within the peripheral nerve or the spinal cord.” Gabapentin is an example of an anticonvulsant that’s used to relieve nerve pain in people who have had shingles or have diabetes. (23,24)

There are other treatments that act more directly on nerves, such as neuromodulation or surgery. Neuromodulation can involve placing an electrode along a peripheral nerve. “These are helpful by essentially turning off pain signals,” explains Williams. “You can do that very selectively with individual peripheral nerves or you can take a more regional approach with spinal cord stimulation.”

Surgery can be useful to release pressure on a nerve, says Peter Highlander, DPM, a podiatrist based in Sandusky, Ohio. It’s a technique more commonly used to treat the pain of carpal tunnel syndrome, but it can also be used to treat diabetic neuropathy. (25,26)

Learn More About Neuropathy Treatment Options

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What Are the Possible Complications of Neuropathy?

A number of the complications associated with neuropathy stem from loss of sensation. The issue with losing sensation from neuropathy isn’t necessarily the initial injury, which may be as minor as a blister from a new pair of shoes. Rather, it’s the resulting infection — a particular issue among people with diabetes. “If it’s where there’s diminished sensation in the feet, there can be areas of increased pressure that can cause sores or ulcers,” says Matthew Villani, DPM, a podiatrist at Central Florida Regional Hospital in Sanford, Florida. “The ulcers can become infected because there are open wounds, which can also progress into bone infection. Unfortunately, commonly, it requires amputations if it does progress to that point.”

More on Neuropathy Complications

How to Manage Chronic Nonhealing Wounds From Diabetes Neuropathy can lead to complications during surgery as well, explains Dr. Highlander. That is because of a condition called Charcot neuropathic osteoarthropathy (or Charcot, for short), in which inflammation and unaddressed injuries subject bones, joints, and soft tissues (especially those in the feet) to microfractures and deformity. “A neuropathic ankle fracture is [at a] much higher risk for complications, and so it should be treated differently. If a patient knows they have neuropathy, that should be brought up before surgery,” says Highlander. (27)

Learn More About Potential Neuropathy Complications and How They’re Treated

What Are the Best and Worst Foods for Managing Neuropathy?

Malnutrition — whether caused by disease-related malabsorption, alcoholism, or an unbalanced diet — can also lead to neuropathy.

Vitamin B12 deficiency, which is prevalent in 10 to 15 percent of people over age 60, has been linked to neuropathy. The deficiency causes damage to the myelin sheath that surrounds and protects nerves. The nerves won’t function properly without this protection. Sources of vitamin B12 include fish, meat, poultry, eggs, and milk and other dairy products. Getting more B12 in your diet is important if your doctor determines you’re deficient through a blood test, but taking B12 supplements or getting injections is also an option. The recommended daily allowance (RDA) of the nutrient for most people ages 14 and older is 24 micrograms (mcg), though women who are pregnant or lactating should get 26 mcg and 28 mcg, respectively. Taking Glucophage (metformin), which people with type 2 diabetes commonly use to control their blood sugar, may increase your risk of vitamin B12 deficiency, so if you are taking the medication, be sure to inform your physician so he or she can look out for a possible deficiency and recommend supplementation or dietary advice. (28,29,30)

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Nutrient Deficiencies can lead to weaker bones, a slower metabolism, an increased risk of neuropathy, and other health issues. Here are a handful of the most prevalent types and how you can help avoid them.

Copper deficiency is another, though rarer, cause of neuropathy, says Norman Latov, MD, PhD, a neurologist and Weill Cornell Medical Center, and the director of the peripheral neuropathy clinical and research center at Weill Cornell Medical College in New York City. Beef, nuts, and legumes offer dietary copper, although Dr. Latov says the deficiency is usually a result of an individual’s metabolism or malabsorption, rather than an unbalanced diet. Injectable and oral supplements can help treat the condition. (31,32)

For diabetic neuropathy, Dr. Villani says he often recommends the multivitamin Metanx and eating a diabetes-friendly diet to help keep blood sugar controlled. (33)

For those people with alcoholism-related neuropathy, it goes without saying that the best advice is to abstain from drinking to help control your symptoms.

In terms of diet, getting too much of a nutrient can also lead to neuropathy as well, Latov cautions. For instance, “too much B6 can be toxic to the nerves. The normal requirement is less than 2 milligrams a day, yet many B6 supplements are 100 milligrams or more. B6 is also an additive to all sorts of packaged foods,” Latov says. “Susceptibility [to absorbing the nutrient] varies, so if you take B6 supplements, you really should have your blood levels checked to make sure they’re not in excess.” (34)

Toxins contained in foods we tend to think of as healthy, such as seafood, can also lead to neuropathy, he adds. “In our center we see people with very high levels of mercury, which can cause neuropathy. Brown rice can have high arsenic levels, and that can cause neuropathy too.” (35,36,37)

Learn More About the Relationship Between Nutrition and Neuropathy

Conditions Related to Neuropathy

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What’s the Best Way to Exercise When You Have Neuropathy?

More on How to Exercise if You Have Neuropathy

How Can I Stay Active With Neuropathy? Making fitness a part of your routine can help to address the muscle weakness that some people experience with neuropathy, as well as reduce pain. In people with diabetic neuropathy, regular exercise can also help to lower high blood sugar (hyperglycemia). But be sure you talk to your healthcare team before beginning a new exercise regimen because neuropathy can affect how you respond (or don’t respond) to injury or activities that risk injury. Before one of his patients begins exercising, Highlander typically assesses the patient’s feet, neuropathy, blood flow to the extremities, and their risk for deformities and foot ulcers.

Villani adds it’s important to start slowly and only gradually increase the length and severity of your exercise. “If you are walking, go for a quarter of a mile, then go home and take a look at your feet,” he explains. “If there [are] any areas of concern, consult a professional to make sure that your shoes are wide enough and large enough.” (38)

Furthermore, he says, “do a daily inspection before and after you do exercise to make sure there are no areas of increased redness [or] skin breakdown. We recommend that people wear white socks so that if there’s any sort of drainage or bleeding, it can be seen.”

More on Checking Your Feet With Neuropathy

How to Protect Your Feet and Legs if You Have Diabetes Highlander recommends purchasing a plastic mirror to keep at your bedside to check the bottoms of your feet. Or, he says, you could have a loved one check them.

Remember that if you’re suffering from any loss of sensation, you may not know when you are overdoing it with exercise. On the other hand, get as much exercise as your condition will allow. The Foundation for Peripheral Neuropathy has a guide to getting started.

Learn More About How to Exercise Safely if You Have Neuropathy

The Foundation for Peripheral Neuropathy Hereditary Neuropathy Foundation Livestrong Medline Plus National Institute of Neurological Disorders and Stroke NHS Inform U.S. Department of Veterans Affairs Weill Cornell Medicine

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Last Updated: 5/29/2018

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