Peripheral Neuropathy

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According to the Neuropathy Association, an estimated 10-20 million Americans suffer from peripheral neuropathy.
Peripheral neuropathy is a common neurological disorder characterized by sensory loss, pain, muscle weakness and a loss of muscle mass in the hands or legs and feet. It may be inherited, caused by other diseases such as diabetes, or be the result of injury. Regardless of the cause, the end result is that the peripheral nerve no longer is able to conduct its messages in a normal manner.
Diabetes is the most commonly known cause of peripheral neuropathy. In fact, approximately 30% of all cases are diabetes-related. Other causes include autoimmune disorders, tumors, heredity, nutritional deficiencies, infections, metabolic abnormalities, trauma, and drugs or toxins. In about one third of all cases, a cause is simply unknown.

Peripheral Neuropathy: Symptoms

Some neuropathies come on suddenly, while others appear gradually over time. Symptoms vary depending upon which nerve fibers are affected and where they are located:

  • Sensory nerve fibers affect sensation.
  • Autonomic nerve fibers affect organ functions.
  • Motor nerve fibers affect motion.

Most types of neuropathy affect all three nerve fiber types, but some affect only one or two. Common neuropathy symptoms include:

  • Weakness in the arms or legs
  • Numbness, tingling, and pain
  • Unsteadiness and a lack of coordination when walking
  • A “glove and stocking” sensation
  • Dizziness when standing up

Peripheral Neuropathy: Diagnosis

With neuropathy, like many neurological diseases, early detection is critical. The longer neuropathy goes undiagnosed, the more difficult it becomes to treat. Although nerve damage can be mild initially, it can spread and become much more serious, even irreversible, if left untreated.

Your doctor may perform nerve conduction studies and electromyography (EMG) to determine if nerve damage has occurred and to what extent. EMG can also help to distinguish whether symptoms are related to a neuropathy or to a muscle disorder.

Lumbar puncture is sometimes useful to rule out infectious diseases such as meningitis, diagnose high or low levels of cerebrospinal fluid, and detect abnormal protein levels.

Peripheral Neuropathy: Treatment

The main goals of treatment are to reduce pain, improve the patient’s ability to cope with any remaining pain, and improve the patient’s quality of life. Pain symptoms are typically managed using drugs, physical therapy , injection therapy, or some combination of these treatments.
There are many medications available that may be used to provide neuropathy sufferers some relief from symptoms.

These include:

  • Selective serotonin and norepinephrine reuptake inhibitors (e.g., duloxetine hydrochloride [Cymbalta®])
  • Anticonvulsants (e.g., carbamazepine [Tegretol®], lamotrigine [Lamictal®])
  • Antidepressants (e.g., amitriptyline [Elavil®])
  • Local anesthetics (e.g., lidocaine [Xylocaine®])
  • Antiarrhythmics (e.g., mexiletine [Mexitil®])
  • Topical drugs (e.g., capsaicin cream [Zostrix®])

If necessary, your doctor will develop a medication regimen appropriate for managing your pain.

Your neurologist may also suggest injecting a nerve-blocking agent (like lidocaine) into the area surrounding the affected nerves. This will prevent the nerves from carrying impulses to the brain and will temporarily reduce your symptoms. Often just by blocking the affected nerves for a few hours with local anesthetics, the pain can be reduced for several days or even weeks before returning to its baseline severity. Remember, however, that nerve blocks are not a cure. They are often combined with other treatments and therapies to promote a more speedy resolution to the problem.

Many patients find relief through simple physical therapies. The therapist assigned to your patient care team will develop a series of exercises tailored specifically to your needs. He or she may also suggest massage therapy, heat, or acupuncture as part of your complete treatment plan.

Your multidisciplinary patient care team will work together to develop a comprehensive treatment program to reduce your pain and improve your quality of life.

Peripheral Neuropathy: Resources

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
ACPA@pacbell.net
Tel: 916-632-0922 or 800-533-3231
Fax: 916-632-3208

National Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro, VA 24460
Tel: 540-862-9437
Fax: 540-862-9485

Neuropathy Association
60 East 42nd Street
Suite 942
New York, NY 10165-0999
info@neuropathy.org
Tel: 212-692-0662
Fax: 212-692-0668

American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, MD 21201-4111
info@painfoundation.org
Tel: 888-615-PAIN (7246)
Fax: 410-385-1832

Muscular Dystrophy Association
3300 East Sunrise Drive
Tucson, AZ 85718-3208
mda@mdausa.org
Tel: 520-529-2000 or 800-572-1717
Fax: 520-529-5300

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
askada@diabetes.org
Tel: 800-DIABETES (800-342-2383) or 703-549-1500

National Diabetes Information Clearinghouse (NDIC)
1 Information Way
Bethesda, MD 20892-3560
ndic@info.niddk.nih.gov
Tel: 301-654-3327 or 800-860-8747

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