PERIPHERAL NEUROPATHY

Symptoms depend on the type of nerves affected. Nerves are classified into:

• Sensory nerves – Receive sensation, such as temperature, pain, vibration or touch, from the skin
• Motor nerves – Control muscle movement
• Autonomic nerves – Control functions such as blood pressure, heart rate, digestion and bladder

Signs and symptoms of peripheral neuropathy might include:

• Gradual Onset of Numbness, Prickling or Tingling in Your Feet or Hands, Which Can Spread Upward into Your Legs and Arms
• Sharp, Jabbing, Throbbing, Freezing or Burning Pain
• Extreme Sensitivity to Touch
• Lack of Coordination and Falling
• Muscle Weakness or Paralysis if Motor Nerves are Affected

Signs and symptoms of affected autonomic nerves might include:

• Heat Intolerance and Altered Sweating
• Bowel, Bladder or Digestive Problems
• Changes in Blood Pressure, Causing Dizziness or Lightheadedness

Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.

Diagnosis

Aside from a physical exam, your doctor may require to know your full medical history including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases. Your doctor may also perform a neurological examination to check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

Your doctor may order tests, including:

• Blood Tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy.
• Imaging Tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities.
• Nerve Function Tests. Electromyography records electrical activity in your muscles to detect nerve damage. A probe sends electrical signals to a nerve, and an electrode placed along the nerve’s pathway records the nerve’s response to the signals (nerve conduction studies).
• Other Nerve Function Tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test, and sensory tests that record how you feel touch, vibration, cooling and heat.
• Nerve Biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.
• Skin Biopsy. Your doctor removes a small portion of skin to look for a reduction in nerve endings.

Treatment

Treatment of peripheral neuropathy may include:

• Medications
  • Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. , your doctor might prescribe painkillers for more-severe symptoms.
  • Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain.
  • Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can’t tolerate it.
  • Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
• Therapies
  • Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.
  • Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.
  • Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair.
• Surgery –If you have neuropathies caused by pressure on nerves, such as pressure from tumors,   you might need surgery to reduce the pressure.
• Alternative medicine
  • Acupuncture. Inserting thin needles into various points on your body might reduce peripheral neuropathy symptoms. You might need multiple sessions before you notice improvement.
  • Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years. Discuss using alpha-lipoic acid with your doctor because it can affect blood sugar levels.
  • Herbs. Certain herbs, such as evening primrose oil, might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so discuss herbs you’re considering with your doctor.
  • Amino acids. Amino acids, such as acetyl-L-carnitine, might benefit people who have undergone chemotherapy and people with diabetes.