Peripheral neuropathy: Damage to nerves causing pain and weakness

Peripheral neuropathy is a nerve disorder in which all nerves other than those of the brain and spinal cord may be affected. Patients with this condition experience various sensory changes, such as tingling, numbness, weakness, or burning pain in the affected area, usually the hands and/or feet. Many conditions such as diabetes mellitus and vitamin deficiencies lead to the disease. In addition, environmental factors are also involved in the development of peripheral neuropathy, such as excessive alcohol consumption. The doctor treats the underlying problem and, if necessary, uses additional medication. A number of lifestyle recommendations reduce some risk factors for nerve damage.

  • Causes of nerve damage
  • Diseases
  • Environmental factors
  • Types of nerve disorder that affects peripheral nerves
  • One or more nerves
  • Nerve types
  • Symptoms: Pain, weakness, numbness and tingling
  • Diagnosis and examinations
  • Treatment of peripheral neuropathy
  • Diseases
  • Medication
  • Other treatments
  • Prognosis
  • Complications
  • Prevention of nerve damage

 

Causes of nerve damage

Peripheral neuropathy is damage to the peripheral nerves caused by a condition or an environmental factor. A doctor is not always able to determine the cause of peripheral neuropathy; In medical terms this is called idiopathic peripheral neuropathy.

Diseases

Neuropathy is a common complication of a number of different medical conditions such as:

  • autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis (inflammation of joints and organs) or Guillain-Barre syndrome (weakness and pain due to nerve damage)
  • diabetes mellitus (diabetic neuropathy)
  • pressure on a nerve, for example due to carpal tunnel syndrome
  • a chronic liver disease
  • a repeated injury
  • a trauma, such as a broken bone, a cast that is too tight, etc.
  • hereditary conditions, such as amyloid polyneuropathy or Charcot-Marie-Tooth disease (peripheral nerve damage)
  • hereditary amyloidosis (rare) (amyloid deposits in tissues and organs)
  • hereditary sensory autonomic neuropathy (rare)
  • infections such as HIV/AIDS, shingles (after postherpetic neuralgia), syphilis (bacterial infection caused by sexual contact), Lyme disease (bacterial infection caused by a tick bite)
  • neurofibromatosis (rare) (skin and eye abnormalities)
  • kidney failure
  • some types of cancer, including lymphoma and multiple myeloma (Kahler’s disease)
  • vitamin deficiencies, especially vitamin B12 deficiency and folic acid deficiency
  • Fabry disease (rare) (storage disease with fat build-up)
  • Tangier disease (rare)

 Excessive alcohol consumption may lead to peripheral neuropathy / Source: Jarmoluk, Pixabay

Environmental factors

Damage to the peripheral nerves may result from environmental factors

  • exposure to toxins, such as heavy metals, gold compounds, lead, arsenic, mercury, and organophosphate pesticides
  • medication
    • antibiotics such as metronidazole (Flagyl) and isoniazid
    • chemotherapy (certain cancer medicines).
    • Statins: Statin drugs have been linked to peripheral neuropathy, although neuropathy caused by statins only rarely causes symptoms.
  • excessive alcohol consumption (alcoholic neuropathy)

 

Types of nerve disorder that affects peripheral nerves

Peripheral neuropathy can be classified according to the size of the nerve fibers involved (large or small).

One or more nerves

Sometimes multiple nerves are affected. Peripheral neuropathy also sometimes affects one specific nerve, causing only symptoms limited to the distribution of that nerve. This is known in medical terms as mononeuropathy. Examples include:

  • Bell’s palsy: a neuropathy of the nervous system affecting the face (sudden facial paralysis)
  • carpal tunnel syndrome: damage to the median nerve at the wrist with tingling and/or weakness in the hand
  • meralgia paraesthetica: compression of the lateral sciatic nerve in the waist with numbness and pain in the thigh
  • peroneal nerve palsy (peroneal nerve syndrome): compression of the fibular nerve
  • postherpetic neuralgia: complication of shingles; the sensory neuropathy sometimes persists for months after the rash has disappeared
  • pudendal neuralgia: damage to the pudendal nerve with pain in the genitals and perineum
  • Ulnar nerve palsy: Compression of the ulnar nerve

 

Nerve types

Peripheral neuropathy affects several possible nerve types, such as motor, sensory and autonomic nerves.Autonomic Nerves These nerves control body systems such as the digestive or cardiovascular systems. Autonomic neuropathy causes problems with, among other things, heart rate and blood pressure.Motor Nerves These nerves allow force and movement. Damage causes weakness in the feet and hands.Sensory nerves These nerves control sensation. Due to nerve damage, the patient experiences tingling, pain, numbness or weakness in the feet and hands.

Symptoms: Pain, weakness, numbness and tingling

The cause of peripheral neuropathy determines the type of complaints that are constant or occur intermittently, and are very mild or very severe in nature. Symptoms usually occur symmetrically on both the hands and feet. The patient has pain that is often worse at night (hand pain, foot pain). Numbness, weakness, tingling, prickling and a burning sensation (burning hands, burning feet) are also common symptoms. Sometimes the patient is no longer able to detect changes in heat and cold. Due to the complaints, the patient sometimes also experiences a loss of balance and coordination (ataxia). Finally, the patient has slow reflexes.A blood test is needed / Source: Frolicsomepl, Pixabay

Diagnosis and examinations

The doctor reviews the patient’s medical history and performs a physical examination, which is very important because peripheral neuropathy has many causes and presentations. The doctor performs a vibration and monofilament test, which can be used to diagnose large fiber peripheral neuropathy, such as diabetes mellitus. Furthermore, a blood test is required to detect toxins, for example. Electrodiagnostic studies, such as nerve conduction studies and electromyelography (EMG: measurement of electrical muscle activity) are also very useful, although these tests cannot be used in the diagnosis of small fiber neuropathy. To detect a hernia, tumor or other abnormalities, the doctor sometimes uses imaging tests such as a CT scan or MRI scan. Sometimes a skin biopsy is required (removing a piece of tissue from the skin and examining it microscopically) for peripheral small fiber neuropathy.

Treatment of peripheral neuropathy

The treatment of peripheral neuropathy depends on the cause.

Diseases

Autoimmune Disease Neuropathies associated with autoimmune diseases usually improve with treating the autoimmune disease.Diabetes mellitus The patient must manage diabetes mellitus properly so that elevated blood sugar levels (hyperglycemia) do not develop. Hyperglycemia leads to further nerve damage. It is important to keep the condition under control and to undergo medical follow-up. In this way it is possible to prevent or possibly detect diabetic neuropathy in a timely manner, so that treatment can be started quickly. In this way, the patient prevents permanent damage to the nerves because the symptoms of diabetic neuropathy cannot always be reversed.Shingles Prompt treatment with sympathetic injections reduces the risk of developing postherpetic neuralgia, a complication of shingles. Neuralgia is the medical term for nerve pain.Pinched Nerve Neuropathy caused by a pinched nerve or pressure on the nerve can be treated with physiotherapy, injections or surgery.A balanced diet is necessary / Source: Jill111, PixabayVitamin deficiencies The patient consumes a sufficient healthy and balanced diet, otherwise vitamin supplements are available.

Medication

Over-the-counter medication Sometimes there is no specific treatment available for the nerve disorder. The doctor then combats the pain with medication. First, the doctor starts treatment with over-the-counter medications such as ibuprofen or aspirin. These over-the-counter painkillers are known as nonsteroidal anti-inflammatory drugs (NSAIDs). Capsaicin, the chemical responsible for hot chili peppers, is available over-the-counter as a topical (applied to the skin) cream to relieve the pain of peripheral neuropathy. Both vitamin B6 and alpha-lipoic acid are available for relieving the peripheral neuropathy associated with the use of chemotherapy.Medication prescribed by the doctor Tricyclic antidepressants and anti-epileptic drugs may be prescribed by the doctor to relieve the pain of neuropathy. Some patients require opioids (powerful painkilling medicines) to control pain. Doctors sometimes prescribe medicated skin patches to provide temporary, local pain relief. These patches contain local anesthetic medication (lidocaine). The plasters are also available as bandages and can be cut to size.Accupuncture relieves symptoms in some patients / Source: Fusiontherapy, Pixabay

Other treatments

The doctor may use other treatments to relieve the symptoms of peripheral neuropathy, such as:

  • acupuncture
  • chiropractic adjustments
  • surgery (especially necessary if there is pressure on the nerves)
  • physiotherapy
  • hydrotherapy
  • cold laser therapy
  • plasmapheresis (removal and replacement of plasma in blood) and intravenous (given through a vein) immunoglobulin
  • transcutaneous electrical nerve stimulation
  • trigger point injections (TPI)

 

Prognosis

Many diseases and other medical problems that cause peripheral neuropathy can be successfully treated or prevented. The peripheral neuropathy is temporary and reversible, but in some cases it is permanent or progressive. This also depends on the underlying cause, the damaged nerve(s) and the effectiveness of the treatment(s).

Complications

Peripheral neuropathy can lead to foot ulcers, leg ulcers, infection and gangrene (tissue death with changes to the skin).

Prevention of nerve damage

Certain forms of peripheral neuropathy are preventable. For example, a patient should not drink too much alcohol. He must also be vaccinated against shingles. The patient also limits exposure to heavy metals. Finally, good control of diabetes is essential to prevent diabetic neuropathy.

read more

  • Autonomic neuropathy: Damage to autonomic nerves
  • Diabetic neuropathy: Nerve damage from diabetes with pain

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