Peripheral Neuropathies

Peripheral neuropathy is damage to your peripheral nerves which causes weakness, numbness
and pain. The pain usually occurs in your hands and feet which is the most common spot but the
pain can occur in different areas of the body. The peripheral nervous system is part of the central
nervous system which sends information to your brain and spinal cord and to the rest of the body
(Harwell, M and Shamie, Nick, S, 2015). The peripheral nerves extend from the spine. The
nervous system is divided into two specific parts the central nervous system where the brain,
brain stem and the spinal cord are held. The second specific part is the peripheral nervous system
which has the individual cranial, motor and sensory nerves. When the peripheral nerves exit to
either side of the vertebrae can affect the sensory and motor network often severely (Dana C ,
and Rose N, 2015).There are two forms of neuropathies which include only one nerve is called
mononeuropathies and multiple nerves affected all limbs is called polyneuropathy. When two or
more isolated nerves are in separate areas of the body affected are called mononeuritis multiplex
(Dana C, and Rose N, 2015).The damage can be axonal which id damage to the nerve strand or
axon itself. If it is demyelinating is damage to the myelin sheath which is the covering of myelin
sheath. There are more than hundred different types of peripheral neuropathies with its own
characteristic set of symptoms and patterns of development and prognosis (Harwell, M and
Shamie, Nick, S, 2015). Neuropathies can be inherited the causes are inborn mistakes in the
genetic code or by new genetic mutations. Neuropathies also can be acquired the causes are
trauma or physical injury to a nerve, tumors, toxins, autoimmune responses just to name a few.
There are at least 20 million people in the United States affected by peripheral neuropathy. The
autoimmune disorders that have to do with peripheral neuropath are chronic inflammatory
demyelinating polyneuropathy, Guillain- Barre syndrome, rheumatoid arthritis and systemic
lupus erythematous. The common causes of peripheral neuropathies are from traumatic injuries,
infections, metabolic problems and inherited causes and exposure to toxins. The most common
cause of peripheral neuropathies is from diabetes mellitus.

Symptoms
There are many different symptoms of peripheral neuropathies but the main symptoms are
muscle weakness and sensory issues. When an impaired function and symptoms depend on the
nerves there are motor, sensory or non- voluntary for example internal organs that are
damaged(Dana C , and Rose N, 2015).Some people may experience some symptoms such as
temporary numbness, tingling and pricking sensations, sensitivity to touch and muscle weakness.
The more serious symptoms are burning pain especially at night, muscle wasting, paralysis or
organ or gland dysfunction (Dana C, and Rose N, 2015).Often people state that the pain from
peripheral neuropathy describes the pain as stabbing or burning sensation. The signs symptoms

that can occur are painful cramps and fasciculations which is uncontrolled muscle twitching
visible under the skin, muscle loss, bone degeneration, and changes in the skin, hair, and nails.
(Dana C, and Rose N, 2015).The more degenerative changes can be from sensory or autonomic
nerve fiber loss. (Dana C, and Rose N, 2015). There also may be degenerative changes in the
bone and muscle tone and could cause mobility issues and interfere with daily activities. There
are many other reasons to get neuropathies for example bone cancer, environmental influences
and deficiencies in mineral balance or nutrition , spinal infections or spinal injuries just to name
a few. Chronic inflammation and connected tissue damage can cause neuropathies. When are a
sensory nerve is damaged it causes a range of symptoms because sensory nerves have a wider
range of functions (Dana C , and Rose N, 2015).The large sensory fibers have an enclosed
myelin register vibration. The myelin register vibration has a sense of light touch and positon
sense. When a large sensory fiber slows the ability to feel vibrations, touch which involves the
general sense of numbness in the hands and feet (Dana C, and Rose N, 2015).When people have
a large sensory fiber injury they are not able to recognize touch alone the shapes of small objects
or distinguish between different shapes. The damage of the sensory fibers affect the loss of
reflexes (Dana C , and Rose N, 2015).When people lose the position sense it is hard for them to
coordinate complex movements for example walking, fastening buttons and to maintain balance
with their eye closed. When a patient has neuropathic pain is difficult to control and has a huge
effect on emotional well-being and quality of life (Dana C, and Rose N, 2015).The pain is often
worse at night it disrupts sleep and emotional burden. The smaller sensory fibers that do not have
myelin sheaths transmit pain and temperature sensations. When damage is done to these fibers it
can affect the transmission of pain and temperature sensations. The problems that occur are
people may not realize they have been hurt or that the cut is infected, some may not know their
having pain that warn your bodies from heart attacks or other major conditions that may occur.
When there is loss of pain sensation it is a serious problem for diabetes because of lower limb
amputations. Often pain receptors in the skin can become over sensitized. The autonomic nerve
damage affects organ or glands. When the autonomic nerve dysfunction can become life
threatening and often become a medical emergency when symptoms of irregular heart beat or
when breathing becomes difficult. The most common symptoms of autonomic nerve damage are
the inability to sweat normally which can lead to heat intolerance, loss of bladder control which
can cause infection or incontinence (Dana C, and Rose N, 2015). It can also have an effect on
controlling muscles that help expand or contract blood vessels that help maintain safe blood
pressure levels (Dana C, and Rose N, 2015).When you lose control of blood pressure can cause
dizziness, lightheadedness or even syncope. The causes of syncope can be from when a person
moves to fast when theyre in a seated position or standing position which causes them to faint.
The condition is also called orthostatic hypotension or postural hypotension. The gastrointestinal
symptoms that occur often are intestinal muscle contraction often malfunction that lead to
diarrhea, constipation or even incontinence (Dana C , and Rose N, 2015).When certain
autonomic nerves are affected some people can have trouble eating and swallowing when this
occurs.

Statistics
In the United States there are 1.15 million people that have peripheral neuropathies. Diabetes is
the most common cause of peripheral neuropathies in the United States. The disease occurs in
women, men, children and adults. There is no predisposition on race or ethnicity .

Risk FactorsThe risk factors of peripheral neuropathy are diabetes controlling the sugar levels are poorly
controlled (Dana C, and Rose N, 2015). The other risk factors are alcohol abuse, vitamin
deficiencies, particularly B vitamins, infections such as Lyme disease, shingles, Epstein- Barr,
hepatitis C and HIV and AIDS. Autoimmune diseases such as rheumatoid arthritis and lupus,
kidney, liver or thyroid disorders, exposure to toxins and repetitive physical stress can also be
risk factors for peripheral neuropathies. There is no prevention possible for autoimmune but you
can carefully manage the risk related to help slow nerve damage (Dana C , and Rose N, 2015).A
healthy lifestyle can help prevent non- diseased caused neuropathies. When reducing or by
avoiding things that cause nerve damage , reducing repetitive motions, cramped positions, toxic
chemicals, tobacco smoke and by reducing excessive alcohol consumption.

TreatmentTo rule out a medical condition blood tests need to be done to prove it and other tests can be
done such as biopsy, electromyogram, and nerve conduction study or nerve function test maybe
used to determine the cause of neuropathies. When diagnosing peripheral neuropathy can be
difficult to diagnosis. There are many tests to use for diagnosing peripheral neuropathies on them
is neurological exam which usually includes the patients symptoms, work environment, patients
history, social habits, exposure to any toxins, history of alcoholism and any other infectious
disease. The tests are done to see the extent of nerve damage and the type of damage. A physical
examination and other test can determine the disease that is causing nerve damage (Dana C, and
Rose N, 2015).A blood test is another test that can show diabetes, vitamin deficiencies, liver or
kidney problems and other signs of immune problems. Another test that can be performed is a
cerebrospinal fluid that surrounds the brain and spinal cord can show the signs of abnormal
antibodies. There are many other tests that can show signs like test of muscle strength, the ability
to register vibration. Light touch, body position, temperature and pain can show signs of nerve
damage. This may show that it is a small or large sensory nerve that is affected. The tests that can
be done to determine if a patient has peripheral neuropathies are CT scan, MRI, EMG, nerve
conduction velocity, nerve and a skin biopsy. A CT scan shows x-rays that are passed through

organ, bones and tissues to see if there are any irregularities throughout the body. A MRI
examines the body by creating a magnetic field using radio waves to provide three- dimensional
pictures. An electromyography or another words EMG is a test that involves sticking a needle
into a muscle to see how much electrical activity is in the muscles at rest and when the contract.
This test can help sort whether its a muscle or nerve problem. The nerve conduction velocity
test measures the damage of nerves by electrically stimulating the nerve which makes it respond
to its own electrical impulse (Dana C, and Rose N, 2015).A nerve biopsy is another test that can
be performed, this tests involves removing and examining a sample of a nerve tissue taken from
the lower leg (Dana C, and Rose N, 2015).When a skin biopsy is done they take a sample of skin
and exam the nerve endings. The test are helpful to determine if they have peripheral
neuropathies but there is no medical treatment that can cure it (cite 2nd). Therapy can play a big
role with treating and managing the symptoms. Nerves have the ability to regrow as long as the
nerve cell hasnt been killed (Dana C, and Rose N, 2015).The positive outlook for the disease is
that symptoms can be controlled and prevent new damage. A way of controlling the symptoms
are maintaining a healthy weight, avoid exposure to toxins, have an exercise program, eating a
balanced diet and avoiding alcohol consumption can help reduce emotional effects. When
incorporating exercise into the program it can reduce cramps. Improve muscle strength prevent
muscle wasting. A Dietary plan can improve gastrointestinal problems. It is also important when
getting an injury to treat it right away so you can prevent damage. Quitting smoking has a huge
importance because smoking constricts the blood vessels that carry nutrients to the nerves.
Educating diabetes patients on self-care skills like foot and wound care can help alleviate
symptoms and improve the quality of life of the patient. When completing these changes it can
create and encourage nerve regeneration although you wont regain all of the nerve back.
Inflammatory and autoimmune can be control by immunosuppressive drugs can be beneficial.
When it comes to neuropathic pain is hard to control but mild pain can be alieved by analgesic
over the counter medications (Dana C, and Rose N, 2015). Injections is also another option or
topical patches containing lidocaine that relieve intractable pain (Dana C, and Rose N, 2015).The
most severe cases a doctor can surgically destroy nerves but the results are not permanent and the
surgery can lead to complications (Dana C, and Rose N, 2015).There are mechanical aids can
help reduce pain and lessen the impact of the physical disability (Dana C, and Rose N, 2015).
Braces also can be used to alleviate nerve compression. Orthopedic shoes also will help improve
gait and help prevent foot injuries with patients with loss of pain sensation. When there is a nerve
entrapment often can be released by surgical release of ligaments and tendons (Dana C, and Rose
N, 2015). The outcome of peripheral neuropathies depends on the cause in some cases a
condition that can be identified and treated the outlook may be positive. In a severe case of
peripheral neuropathies the nerve damage can be permanent even if it is treated right (Dana C,
and Rose N, 2015).
. Most of these conditions are harmless but some can progress more rapid and can lead to severe
complications. In some conditions such as Guillain Barre Syndrome the suddenly progress
rapidly and slowly damages nerves. In cases of chronic forms symptoms begin subtly and slowly

progresses (Dana C, and Rose N, 2015). Depending on person and the condition they have they
may have periods of relief followed by relapse and others may plateau where symptoms stay for
a long period of time or short period of time.

Occupational therapy treatmentOccupational therapy can help with self-cares by adapting them to make them easier by using
adaptive equipment and techniques to make self-cares successful and independent. Ots can also
work in areas of a specific need to the patient such as ADLS,IDAL, rehabilitation, work,
education, positioning, balance, pain management, maintain healthy weight, compressions and
braces and also do nerve tests such as sensation. We can also help by doing sensory activities to
see if they can feel different textures due to the nerve issue. Occupational therapists can educate
patients, families, health care professionals and many other people about peripheral neuropathies
and what it is and ways to help patients with this disorder. When working compressions and
braces we can educate the patient the proper way to wear them and clean them. We can also
complete tests to see what they can feel by using different objects to see what extend the nerve
damage is. Occupational therapy can also improve gait, balance, fine motor skills, dexterity, and
coordination. If the occupational therapist is trained we can also complete acupuncture, manual
lymph drainage to relieve the symptoms. The main focus of neuropathies is focused on
decreasing the risk of falls and injuries that can result from peripheral neuropathies and also
educating the patients on how save on joints and nerves and bones by making sure the patient is
positioned the right way and decreasing the use of repetitive motions.

References-

Harwell, M and Shamie, Nick, S. peripheral neuropathy, "Health Reference Center. Facts on
File, Inc. Web. 14 Feb. 2015<http://www.fofweb.com/activelink2.asp?
ItemID=WE48&SID=5&iPin=EBSSD0166&SingleRecord=True>.

Dana C and Rose N. "peripheral neuropathy." Health Reference Center. Facts on File, Inc. Web.
14 Feb. 2015. <http://www.fofweb.com/activelink2.asp?
ItemID=WE48&SID=5&iPin=EAID0259&SingleRecord=True>. (

Rare clinical diseases research network by national institutes of health.

https://www.rarediseasesnetwork.org/INC/patients/learnmore/CMT/

Barrett, Julia. "Peripheral Neuropathy." Gale Encyclopedia of Medicine, 3rd Ed... 2006.
Retrieved February 14, 2015 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G23451601234.html
Komaroff, A. L. (2015). ASK THE DOCTOR. Harvard Health Letter, 40(4), 2