Peripheral neuropathy
Definition
Peripheral neuropathy, in its most common form, causes pain and numbness inyour hands and feet. The pain typically is described as tingling or burning, whilethe loss of sensation often is compared to the feeling of wearing a thin stockingor glove.Peripheral neuropathy can result from such problems as traumatic injuries,infections, metabolic problems and exposure to toxins. One of the most commoncauses of the disorder is diabetes.In many cases, peripheral neuropathy symptoms improve with time — especiallyif it's caused by an underlying condition that can be resolved. Medications initiallydesigned to treat other conditions, such as epilepsy and depression, are oftenused to reduce the painful symptoms of peripheral neuropathy.
Symptoms
Your nervous system is divided into two broad categories. Your central nervoussystem consists of your brain and spinal cord. All the other nerves in your bodyare part of your peripheral nervous system, which includes:
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Sensory nerves to receive feelings such as heat, pain or touch
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Motor nerves that control how your muscles move
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Autonomic nerves that control such automatic functions as bloodpressure, heart rate, digestion and bladder functionMost commonly, peripheral neuropathy begins in the longest nerves — the onesthat reach to your toes. Specific symptoms vary, depending on which types ofnerves are affected. Signs and symptoms may include:
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Gradual onset of numbness and tingling in your feet or hands, which mayspread upwards into your legs and arms
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Burning pain
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Sharp, jabbing or electric-like pain
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Extreme sensitivity to touch, even light touch
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Lack of coordination
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Muscle weakness or paralysis if motor nerves are affected
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Bowel or bladder problems if autonomic nerves are affected
Causes
A number of factors can cause neuropathies. These factors include:
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Trauma or pressure on the nerve.
Nerve pressure can result from usinga cast or crutches, spending a long time in an unnatural position,repeating a motion many times — such as typing at a computer keyboard — or having a tumor or abnormal bone growth. When peripheralneuropathy affects a single nerve, trauma or nerve pressure is the mostlikely cause.
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Diabetes.
When damage occurs to several nerves, the cause frequently isdiabetes. At least half of all people with diabetes develop some type ofneuropathy.
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Vitamin deficiencies.
B vitamins are particularly important to nervehealth.
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Alcoholism.
Many alcoholics develop peripheral neuropathy becausethey have poor dietary habits, leading to vitamin deficiencies.
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Autoimmune diseases.
These include lupus, rheumatoid arthritis andGuillain-Barre syndrome.
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Other diseases.
Kidney disease, liver disease and an underactive thyroid(hypothyroidism) also can cause peripheral neuropathy. Patients withHIV/AIDS also are prone to develop peripheral neuropathy.
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Inherited disorders.
Examples include Charcot-Marie-Tooth disease andamyloid polyneuropathy.
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Exposure to poisons.
These may include some toxic substances, suchas heavy metals, and certain medications — especially those used to treatcancer.Unfortunately, it's not always easy to pinpoint the cause of peripheral neuropathy.In fact, if your neuropathy isn't associated with diabetes, it's possible the causemay never be found.
Risk factors
Peripheral neuropathy risk factors include:
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Diabetes, especially if your sugar levels are poorly controlled
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Alcohol abuse
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Vitamin deficiencies, particularly B vitamins
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Immune system suppression, which occurs in people who have receivedorgan transplants and people with AIDS, among others
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Autoimmune diseases, such as rheumatoid arthritis and lupus, in whichthe immune system attacks your own tissues
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Kidney, liver or thyroid disorders
When to seek medical advice
Seek medical care right away if you notice any unusual tingling, weakness, orpain in your hands or feet. Early diagnosis and treatment offers the best chancefor controlling your symptoms and preventing further damage to your peripheralnerves. If your symptoms are interfering with your sleep or you feel depressed,your doctor or pain specialist may be able to suggest treatments that can help.
Tests and diagnosis
Peripheral neuropathy isn't a single disease, but rather a symptom with manypotential causes. For that reason it can be difficult to diagnose. To help in thediagnosis, your doctor will likely take a full medical history and perform a physicaland neurological exam that may include checking your tendon reflexes, yourmuscle strength and tone, your ability to feel certain sensations, and your postureand coordination.Your doctor may also request blood tests to check your level of vitamin B-12, aurinalysis, thyroid function tests and, often, electromyography — a test thatmeasures the electrical discharges produced in your muscles. As a part of thistest, you'll be asked to have a nerve conduction study, which measures howquickly your nerves carry electrical signals. A nerve conduction study is oftenused to diagnose carpal tunnel syndrome and other peripheral nerve disorders.Your doctor may recommend a nerve biopsy, a procedure in which a smallportion of a nerve is removed and examined for abnormalities. But even a nervebiopsy may not always reveal what's damaging your nerves.
Complications
If your feet are numb, you may be less likely to feel when they've become injured.Make sure to check your feet regularly so that you can treat minor injuries beforethey become infected. This is especially important for people with diabetes, whotend to heal more slowly.
Treatments and drugs
The first goal of treatment is to manage the condition causing your neuropathy. Ifthe underlying cause is corrected, the neuropathy often improves on its own. The
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