Peripheral Neuropathy 101

Today's post from mollysfund.org (see link below) is more or less a neuropathy 101 guide to the disease and is especially useful to people new to the condition or the symptoms, or those who wish to brush up on their basic knowledge. The information is drawn from various sources but is pretty much entirely accurate, according to current medical opinion. Certainly worth a read, using as a reference, or as a recommendation to others.

What is peripheral neuropathy?
Article by : Karrie Sundbom February 2015 

Peripheral neuropathy is a general term for a series of disorders that result from damage to the body’s peripheral nervous system. The body’s nervous system is made up of two parts; the central nervous system (CNS) and the peripheral nerve system (PNS). The CNS includes the brain and the spinal cord. The PNS connects the nerves that run from the brain and spinal cord to the rest of the body. This includes the legs, arms, hands, feet, joints, eyes, ears, mouth, nose and skin. These neurons transport signals about physical sensations back to your brain.

An estimated 20 million people in the United States have some form of peripheral neuropathy, a disorder that results from damage that occurs to your peripheral nerves. These damaged or destroyed nerves can no longer send out messages, or they send incorrect or distorted information, between the brain and spinal cord and the skin, muscles or other parts of the body. Generally speaking, this often causes unusual sensations, burning, numbness, weakness, loss of balance, and even pain. The symptoms usually occur in your hands and feet, but other areas of your body can also be affected. There are three types of peripheral nerves and all of them can be affected by peripheral neuropathy. Peripheral neuropathy is also categorized by the size of the nerve fibers involved, large or small.

The three types peripheral nerves are:
Sensory Nerves: These connect to your skin
Motor Nerves: These connect to your muscles
Autonomic Nerves: These connect to your internal organs.

It can be scary to get diagnosed with any disease, especially one with a ominous sounding name like peripheral neuropathy. We hope that by providing information in this blog, about the symptoms, diagnosis, treatment, prevention and some potential causes of peripheral neuropathy, you will feel more empowered, and armed with the information that will help you live your best life with this condition. Back to top

What causes peripheral neuropathy?

There are many causes of neuropathy. Approximately 30% of neuropathies are “idiopathic,” meaning that the cause is unknown and in another 30% of cases, diabetes is the cause. According to some studies, nearly 60 percent of diabetics have some sort of nerve damage. This damage is often due to high blood sugar levels, and the risk for neuropathy increases for diabetics who are over the age of 40, have high blood pressure, or are overweight. Having a family history of peripheral neuropathy increases the chances of developing the disorder. However, a variety of factors and underlying conditions may also cause this condition.

Some other causes of peripheral neuropathy may include:
 
Autoimmune disorders: Diseases in which the immune system attacks the body’s own tissues can lead to nerve damage. This can include disorders such as systemic lupus erythematosus, Sjögren’s, rheumatoid arthritis, etc.
Infections: This can include certain bacterial or viral infections such as Lyme disease, shingles, Epstein Barr virus, hepatitis C, leprosy, HIV, and diphtheria.
Heredity: Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
Tumors: Peripheral neuropathy can occur as a result of tumors or growths putting pressure on nerves.
Nutritional imbalances and vitamin deficiencies: B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are crucial to nerve health, imbalances and deficiencies can lead to peripheral neuropathy.
Traumatic injury: Traumatic injury from sports or vehicular accidents can sever or damage peripheral nerves. Pressure on nerves may also result from having a cast, using crutches or repeating a motion many times, such as typing (this is often referred to as carpal tunnel syndrome, a type of peripheral neuropathy).
Exposure to poisons or toxins: This includes those that contain heavy metals or chemicals, lead, mercury, and arsenic. In addition, neuropathies have also been known to have been caused by certain insecticides and solvents.
Certain medications: The medications used to treat cancer (chemotherapy) can cause neuropathy. In addition, anticonvulsant agents (medications used to reduce seizures) and even some medications prescribed to treat heart and blood pressure can cause peripheral neuropathy. In most cases, when these medications are discontinued or dosages are adjusted, the neuropathy resolves.
Disorders of the bone marrow: Peripheral neuropathy may also be caused by lymphoma, disorders that include abnormal protein in the blood, some forms of bone cancer, and amyloidosis (a disorder where amyloid, an abnormal protein that is usually produced in your bone marrow builds up in any tissue or organ).
Other diseases: These could include connective tissue disorders, liver disease, kidney disease, liver disease, and an underactive thyroid (hypothyroidism), vasculitis.
Alcoholism: Heavy alcohol consumption is a common cause of peripheral neuropathy. Chronic alcohol abuse often leads to certain nutritional deficiencies (particularly thiamine, B 12, and folate) that are linked to neuropathy. Damage may not be reversible but if the person stops drinking alcohol, the symptoms may lessen.

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What are the symptoms of peripheral neuropathy?

Symptoms of peripheral neuropathy may be experienced over a period of days, weeks, or years. They can be acute or chronic. In acute neuropathies, the symptoms will appear suddenly, rapidly progress, and resolve slowly as damaged nerves heal. In chronic forms of neuropathy, the symptoms often begin subtly and progress slowly. Some people may have periods of little symptomatic activity (remissions) followed by periods of increased symptoms (flares). Others may reach a stage where symptoms stay the same for many months or even years. Many chronic neuropathies worsen over time. Although peripheral neuropathy may be potentially debilitating, very few forms are fatal.

The specific symptoms of peripheral neuropathy will vary depending on whether motor, sensory, or autonomic nerves are damaged. These are some of the most common symptoms:
Tingling in hands and/or feet
Pain described as sharp, stabbing or burning
Loss of balance
Numbness in hands and/or feet
Heavy feeling in the arms and/or legs, sometimes described as feeling like your legs or arms “lock” in place
The feeling of wearing tight gloves or socks when you are not
Buzzing, vibrating or shocking sensation in muscles

Often the symptoms are symmetrical involving both hands and/or both feet. Because these symptoms occur in areas covered by gloves or stockings, peripheral neuropathy is often described as having a ‘glove and stocking’ symptom distribution. In many cases these symptoms improve with treatment especially if the underlying cause or condition is treatable.
Here are the symptoms that might be experienced when the different types of nerves are involved:

Motor nerve damage symptoms: The motor nerves control voluntary movement of muscles such as those used for walking, grasping things or talking. If these motor nerves are damaged, the following symptoms might occur:
Muscle weakness
Cramping
Decreased motor skills
Atrophy (shrinking) of the muscles
Twitching
Cramping
Slower reflexes

Sensory nerve damage symptoms: The sensory nerves have a broad range of sensory functions. Any damage to these nerves might cause a person to experience these symptoms:
Decreased sensations of touch. This can lead to not experiencing the pain from a cut or injury, or the feeling of wearing gloves or stocking when they are not.
A loss of ‘sense of position’ which can make coordinating complex movements like walking or buttoning a shirt very difficult. Balance might also be affected.
Difficulty in transmitting temperature sensations which could lead to burns. This loss of pain sensation can be a very serious problem for those suffering from diabetes and may contribute to a high rate of lower limb amputations among this group.
Increased sensation of pain is often a debilitating symptom of neuropathy. Instead of numbness, it can produce the opposite effect of an increased sensation of pain or feeling severe pain from stimuli that would normally be painless. It can severely affect quality of life, ability to sleep, emotional well-being, and the ability to work.

Autonomic nerve damage symptoms: If the autonomic nerves are involved, nearly every organ can be affected. The autonomic nerves control the functions of the body that happen automatically. Autonomic neuropathy can have symptoms that affect the loss of control of some of these functions. Symptoms may include:
Problems with heart rate
Difficulty with the body’s ability to regulate blood pressure which may cause dizziness or light-headedness
Problems with digestion (this may include diarrhea, or constipation)
Loss of bladder control
Inability to sweat normally which could lead to heat intolerance or overheating
Difficulty eating or swallowing

Seek medical care right away if you notice unusual pain, weakness or tingling in your hands or feet. Early diagnosis and treatment offer the best chance for preventing further damage to your peripheral nerves and controlling your symptoms. Back to top


How is it diagnosed?

Peripheral neuropathy is not a single disease, but rather describes damage to the nerves that produces varying symptoms. Because there are many potential causes for peripheral neuropathy, your doctor will need to examine where the nerve damage is in your body and attempt to determine what may be causing it. A neurologist is typically the type of doctor who will diagnose and treat neuropathy.

A diagnosis of peripheral neuropathy usually requires: 
 
Complete medical history: Your physician will first review your medical history, this will include discussions of any current or past medical conditions, your lifestyle, any exposure to toxins, your drinking habits, and any family history of nervous symptom diseases.
Physical exam
Neurological exam: Your physician will check your reflexes, muscle tone and strength, ability to feel sensations, coordination and posture.

Blood tests: Blood tests can detect vitamin deficiencies, liver or kidney dysfunction, diabetes, other metabolic disorders, and/or any signs of abnormal immune system activity
Diagnostic and imaging tests: This may include CT or MRI scans to show muscle quality and size, look for tumors, herniated discs or any other abnormality that might be causing your symptoms. Electromyography involves inserting a fine needle into a muscle to record electrical activity when muscles are at rest and when they contract. This can determine if your symptoms are being caused by muscle or nerve damage.
Nerve biopsy: This is where a small portion of a nerve is examined to determine the cause of your specific nerve damage.
Skin biopsy: A skin biopsy would be taken to observe the number of nerve endings in the skin. A reduction of nerve endings can signal neuropathy.
Other tests to analyze nerve function: Sweat tests to record how your body sweats, autonomic reflex screen test that will record how the autonomic nerve fibers are functioning, and other sensory tests to indicate how you feel touch, temperature changes, and vibrations.

If your lab and other diagnostic tests do not indicate any underlying condition, your doctor may recommend ‘watchful’ waiting to see if your neuropathy symptoms improve. If either exposure to toxins or alcohol consumption are the suspected causes of your condition, your doctor will recommend avoiding those substances to see if your symptoms improve before prescribing any medications or developing a treatment protocol. Back to top

How is it treated?

Peripheral neuropathy can be very uncomfortable and debilitating. Fortunately, treatment can be very helpful in the management of neuropathy symptoms. But before any treatment can begin, the most important step is to determine the underlying cause of the neuropathy to plan the correct course of treatment.

Some of the treatments for peripheral neuropathy may include:
Medications
Over-the-counter or non-prescription pain relievers: Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including acetaminophen, ibuprofen, aspirin, etc. can be very helpful in relieving mild or moderate symptoms. For more-severe symptoms, your doctor may recommend prescription painkillers. Because these drugs can affect your liver or stomach function, it is very important to avoid using them for an extended period of time, especially if you regularly drink alcohol.
Prescription medications: Medications containing opioids can lead to dependence and addiction and are therefore generally prescribed only when other treatments fail. These drugs can include tramadol, oxycodone, conzip and others, COX-2 inhibitors, etc.
Steroid Injections: Corticosteroid injections can help with pain and inflammation
Anti-seizure medications: Medications developed to treat epilepsy may also relieve nerve pain. These medications can may cause side effects that include drowsiness and dizziness.
Capsaicin: Capsaicin is a substance naturally in hot peppers and can cause modest improvements in peripheral neuropathy symptoms. Doctors may suggest you use this cream with other treatments. However, some people can’t tolerate it and side effects such as skin burning and irritation may occur (these often lessen over time). Topical lidocaine, an anesthetic agent might also be prescribed for localized chronic neuropathic pain such as pain from the shingles virus. Their helpfulness in the treatment of diffuse chronic diabetic neuropathy is limited.
Antidepressants: Certain antidepressants have been shown to interfere with the chemical processes in the brain and spinal cord that cause the body to feel pain. These medications may include tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor).
Immunosuppressant medications: Medications to reduce the immune system’s reaction, such as prednisone, cyclosporine (Neoral, Sandimmune, others), mycophenolate mofetil (CellCept) and azathioprine (Azasan, Imuran), may also help people with peripheral neuropathy associated with autoimmune conditions such as [lupus] and [RA].
Other medications: Pregabalin (Lyrica) is a medication that is used for the treatment of postherpetic neuralgia (postherpetic neuralgia is a complication of shingles) and diabetic peripheral neuropathy. Duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy. 

Therapies

Various therapies and procedures may help ease symptoms of peripheral neuropathy.
Intravenous immunoglobulin and plasma exchange: This treatment is also very common in the treatment of chronic inflammatory demyelinating polyneuropathy (a disorder characterized by progressive weakness and impaired sensory function in the legs and arms) and other inflammatory neuropathy. In immune globulin therapy, you receive high levels of proteins that work as antibodies. This helps to suppress immune system activity. Plasma exchange (called plasmapherisis) involves removing your blood and then removing antibodies and other proteins from the blood. The blood is then returned to your body.
Transcutaneous electrical nerve stimulation (TENS): TENS is a non-invasive intervention used for pain relief for a range of conditions, and a number of studies have described its use for neuropathic pain. In TENS, varying currents of gentle electrical current is delivered through adhesive electrodes placed on the skin. It is recommended that TENS should be applied for 30 minutes daily for about one month.
Physical therapy: Physical therapy can help improve your movements and counteract muscle weakness. Assistive medical devices such as canes, walkers, hand/foot braces might also be needed and helpful for those with mobility issues related to neuropathy.
Surgery: If pressure on the nerves is being caused by tumors for example, surgical intervention might be required and recommended to reduce the pressure. In carpal tunnel, where there is typically injury to a single nerve, surgery may be an effective solution. Some surgical procedures reduce pain by destroying the nerve when other treatments have failed to provide relief. Typically, diabetic neuropathy is not treated with surgical intervention.
Nerve block: A nerve block is an injection of anesthetics directly into the nerves.

Many treatments can bring relief to neuropathic symptoms and can help you to return to your regular activities. Often, a combination of lifestyle adjustments, treatments and therapies may work best. Back to top

Alternative treatments and self-care options

Complementary and alternative treatments have been shown to provide relief of peripheral neuropathy symptoms. The following therapies have shown some promise despite the fact that researchers have not studied these techniques as thoroughly as they have most traditional pharmaceutical medications. Some of these complementary and alternative treatments may include:
Fish oil supplements:These supplements, which contain omega-3 fatty acids, may reduce inflammation, improve blood flow and improve neuropathy symptoms in people with diabetes. Check with your doctor before taking fish oil supplements if you’re taking anti-clotting medications.
Herbs: Certain herbs, such as evening primrose oil, may help reduce neuropathy pain in people with diabetes. Some herbs may interact with medications or make some medications less effective, so please discuss any herbs or supplements that you are considering adding to your diet with your doctor.
Acupuncture: Acupuncture, which involves inserting thin needles into various points on your body, may reduce peripheral neuropathy symptoms. Multiple sessions might be required before any significant symptom improvement is noticed. Always be sure find a certified acupuncture specialist using sterile needles.
Chiropractic care: This can include massage, muscle stimulation, ultrasound therapy and manipulation.
Massage
Alpha-lipoic acid: This antioxidant has been used as a treatment to help reduce symptoms of peripheral neuropathy in Europe for years. Blood sugar levels may be affected by this antioxidant, so please discuss using alpha-lipoic acid with your physician. Other side effects could include skin rash and stomach upset.
Amino acids: In people who have undergone chemotherapy and in people with diabetes, amino acids, such as acetyl-L-carnitine, may help improve peripheral neuropathy. Side effects may include nausea and/or vomiting. 

Some suggestions to help you self-manage peripheral neuropathy

Quit smoking: Cigarette smoking can affect circulation by constricting the vessels that supply nutrients to the peripheral nerves, increasing the risk of foot problems and other neuropathy complications.
Exercise: Ask your doctor about starting an exercise routine. Regular gentle exercise, such as walking, or swimming may reduce neuropathy pain, control cramping, improve your muscle strength, prevent the muscles from atrophy, and help control blood sugar levels. Yoga and tai chi might also help.
Eat a balanced diet: 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. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but also talk to your doctor about B-12 supplements. Speak with your doctor about using various dietary strategies to improve gastrointestinal symptoms from neuropathy.
Avoid excessive alcohol: Alcohol may worsen peripheral neuropathy.
Meditation
Monitor your blood glucose levels: Monitoring your blood glucose levels, if you have diabetes, will help keep your blood glucose under control and may even help improve your symptoms of neuropathy.
Take good care of your feet, especially if you have diabetes: Wash and inspect your feet daily for any injuries, blisters, cuts or calluses. Help to keep the skin moist with lotion. Timely treatment of injuries can help prevent permanent damage. Wearing soft, loose cotton socks and shoes with padded inserts may also help. To keep bedcovers off of hot or sensitive feet and provide a better night’s sleep, you may wish to use a semicircular hoop. These can be found in medical supply stores. 

Making Your Home Safe

If you have peripheral neuropathy, you are potentially at greater risk for accidents in the home due to muscle weakness, loss of balance, decreased sensitivity to sensations of pain, etc. Here are few things to keep in mind to make yourself safer in your home and decrease your chances of injury:
Protect your feet by always wearing shoes.
Things laying around on the floor can be a tripping hazard, so try to keep your floor clear.
Use your elbow, not your hand or foot to check the temperature of your bath or dishwater.
Installing handrails in your bathtub or shower, as well as anti-slip bath mats can reduce the odds of falling or slipping and injuring yourself.
For those whose work involves sitting for long periods of time, make the effort to get up and move around a few times each hour to improve circulation. It is important to not stay in one position for too long.

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In Conclusion

Peripheral neuropathy, while it cannot be cured, can most likely be well-managed if it is caused by a treatable underlying condition. The best way to prevent peripheral neuropathy is to manage those conditions that may put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. Even if you have a family history of this disorder, you may be able to prevent its onset by taking the following precautions to lower your risk:
Being aware of any toxins that you might be exposed to at work or at school
Protecting your feet during sports, especially those that involve kicking
Never inhaling toxins like glue to get high
Managing your alcohol intake
Avoiding tobacco and smoking
Maintaining a healthy weight and lifestyle
Avoiding factors that may cause nerve damage such as repetitive motions, staying in one position for long periods of time, staying in cramped positions

The goal of treatment and therapy for peripheral neuropathy is targeted at treating the underlying disease and improving the symptoms with the right combinations of medications and therapies. Finding a knowledgeable and experienced neurologist who listens and supports you, and makes you feel more comfortable can greatly improve your quality of life. It is very important to find a neurologist as soon as you notice any of the above-listed symptoms. This will provide the opportunity for you to receive the necessary treatment that can stop the disease before it has a chance to cause permanent damage help to ensure your best possible health.

Neuropathy, fibromyalgia, lupus, rheumatoid arthritis and many other conditions are considered invisible illnesses meaning they cannot be seen, but they exist. Being misunderstood and judged are two of the most common frustrations with those suffering from invisible illnesses. In addition to educating yourself about peripheral neuropathy, you might find it helpful to provide your family, friends and co-workers with information as well. Sharing this blog might be a good start! We want you to know that you are not alone as you learn to navigate living with a chronic and invisible illness. Our Facebook community is a great place to share and get great support from others who know exactly what you are experiencing and our online support groups are also a great way to get connected. We are here for you.
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Article by : Karrie Sundbom Karrie is the Digital Marketing Manager at Molly's Fund and responsible for innovating content for all of Molly's Funds online communications, creating memes and graphics, writing the MFFL Newsletter and main lupus blogs, as well as developing and managing the content for all of our social media platforms. Connect with Karrie on LinkedIn and Google+ .

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