Peripheral Neuropathy Treatment

An estimated 30 million people nationwide suffer from some form of peripheral neuropathy, according to the Foundation for Peripheral Neuropathy. Fortunately, quality of life may be improved with treatment by a skillful team of medical professionals.

The Department of Neurosurgery at Rutgers Health and RWJBarnanbas Health uses a multidisciplinary approach for peripheral neuropathy treatment. Our board-certified neurologists and neurosurgeons examine each patient carefully to determine their customized treatment plan to ensure the best possible outcome.

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What Are the Central and Peripheral Nervous Systems?

To understand peripheral neuropathy, you must first learn the function of the central and peripheral nerves. The central nervous system includes the brain and spinal cord, which connect to the peripheral nervous system by sending signals from the brain through the spinal cord to the rest of the body. This communication from the central nervous system to the peripheral nervous system is what tells the body to contract the muscles to move, it helps you feel sensation, and it also controls the body’s involuntary functions such as heart rate and digestion, among many others.

What Is Peripheral Neuropathy?

Peripheral neuropathy is not a single disorder. It is a general term for numerous disorders that result from nerve damage to the body’s peripheral nervous system. The peripheral nerves are responsible for controlling functions such as sensation, motor coordination, involuntary bodily functions, and more. There are three categories of peripheral nerves: motor nerves, sensory nerves, and autonomic nerves.

Peripheral Nerve Types

  • Motor nerves: These control muscle contractions, as the brain and spinal cord send impulses to the body’s muscles. This makes it possible for you to do activities such as walking, grasping objects, catching a baseball, and other functions involving movement.Motor nerve damagecan cause muscle weakness, cramps, uncontrollable muscle twitching, and muscle shrinkage, even difficulty grasping and picking up objects. People with motor nerve damage may have difficulty walking or moving their arms.
  • Sensory nerves: These nerves are responsible for detecting sensation, such as feeling temperature, identifying texture of an object, and sensitivity to touch. Sensory nerve damagecommonly affects the body’s extremities, particularly the hands or feet, but it can also develop in the legs and arms. Symptoms include numbness, tingling, burning sensations, and sharp/stabbing pains that are strongest at night.
  • Autonomic nerves: The central nervous system (brain and spinal cord) send signals to these nerves to control involuntary bodily functions, including heart rate, digestion, sexual function, and sweating, among others. Autonomic nerve damagecan cause dizziness in the process of standing up, excessive sweating, difficulty swallowing, gastrointestinal distress, and sexual dysfunction.

Most neuropathies affect all three types of peripheral nerves – motor, sensory, and autonomic – to some degree, but some only affect one or two types. One example of “mononeuropathy,” which is a type of peripheral neuropathy only affecting one nerve, is carpal tunnel syndrome, a condition where the median nerve is compressed in the wrist, causing numbness and pain in the hand(s). “Polyneuropathy,” by contrast, means at least two types of peripheral nerves are affected.

Symptoms of Peripheral Neuropathy

Depending on which nerves in the peripheral system are affected, symptoms of peripheral neuropathy vary. Most people who experience peripheral neuropathy first notice sensory problems, like numbness or tingling sensations in the toes or fingers.

Common symptoms of peripheral neuropathy include:

  • Burning or freezing sensations or pain
  • Sharp, stabbing or electric-like pain
  • Sensitivity to touch
  • Pain that wakes you up at night
  • Problems with balance and coordination
  • Sweating excessively or inability to sweat normally
  • Abnormalities in heart rate or blood pressure
  • Muscle weakness, such as not being able to grasp or pick up objects

What Causes Peripheral Neuropathy?

There are a number of risk factors for developing peripheral neuropathy, but the most well-established is diabetes mellitus, also known as Type 2 diabetes. Peripheral neuropathy can be caused by numerous other diseases or disorders, too, including hereditary disorders, autoimmune diseases, protein abnormalities, toxic chemical exposure, kidney failure, alcoholism, and poor nutrition. Medications that treat cancer, including chemotherapy, may also be to blame for peripheral neuropathy. Some people have no known cause for their peripheral neuropathy, which is called idiopathic neuropathy.

The following can induce peripheral neuropathy:

  • Diabetes: Diabetes, particularly Type 2 diabetes, is a pandemic affecting hundreds of millions of people worldwide. This disease can seriously impact quality of life due to the complications that may result. Diabetic neuropathy (DN) is caused by chronically high blood sugar levels, and it is the most common complication in diabetics. In fact, it is so common in diabetics that at least half of all diabetics eventually develop peripheral neuropathy, according to research conducted by the National Institutes of Health. Other independent research estimates that as many as 70% of diabetics will develop diabetic neuropathy.

Chronic (long-term) high blood sugar causes nerve damage that can take the form of sensory problems. Diabetics are at an increased risk for not being able to feel their feet when DN sets in, meaning a simple cut could lead to a rampant infection resulting in a life-threatening condition that could necessitate amputation of a foot or leg if the infection spreads. In extreme cases, it can lead to death. Diabetics must diligently monitor their blood sugar levels daily, and carefully inspect their feet daily, to check for any cuts or open sores.

  • Alcoholism: Alcohol abuse can cause peripheral neuropathy, because alcohol is a toxin. Consumed frequently and in great quantities, alcohol slowly destroys nerve tissues, resulting in burning, tingling sensations that can persist for years. Nerve damage caused by alcoholism is permanent; however, those who stop drinking may prevent further nerve damage.
  • Autoimmune (AI) diseases: If you have an autoimmune disease such as lupus, rheumatoid arthritis, vasculitis, sarcoidosis, celiac disease, or any other AI disease, you are at an increased risk of peripheral neuropathy. This is because AI disease, by definition, means your immune system is actively attacking and damaging healthy tissues, including the nerves.
  • Kidney failure: Renal failure, also called uremia, is when the kidneys fail to function properly and begin to shut down. Because the kidneys flush waste from the body, when they fail, fluids and waste products begin to accumulate. Signs of nerve damage include pain or numbness in the feet or legs, and reduced sensation. Uremic neuropathy may be treated by dialysis or a kidney transplant to prevent further nerve damage.
  • Exposure to toxins: Toxins are poisonous substances that can cause peripheral neuropathy. Toxic neuropathy may result from limited or long-term exposure to any number of toxic substances, such as arsenic, lead, mercury, or nitrous oxide.
  • Poor nutrition: Malnutrition or vitamin deficiency, especially a vitamin B12 deficiency, is established as a cause of peripheral neuropathy. B12 can be increased by taking a multivitamin, getting B12 injections, as well as eating foods rich in B12, such as red meat, dairy, fish, and poultry and eggs.
  • Chemo-induced: As a primary treatment for many forms of cancer, chemotherapy is also a poison that doesn’t discriminate between cancerous and healthy cells, which can result in nerve damage. Fortunately, chemo-induced peripheral neuropathy often goes away once chemotherapy doses are reduced or discontinued. In some cases, however, nerve damage is permanent.
  • Inherited disorders: Charcot-Marie Tooth disease, a rare disorder that affects approximately 150,000 people nationwide, is the most common inherited disorder associated with peripheral neuropathy.

Diagnosis of Peripheral Neuropathy

A neurologist, or a physician who specializes in the treatment of disorders of the central and peripheral nervous systems, is the best physician to treat neuropathies. Although many patients initially have a consultation with their primary care physician, those with chronic neuropathies are often referred to specialists. A neurologist has extensive training in treating diseases affecting the various nerves of the body.

The following diagnostic tools are used by neurologists to diagnose peripheral neuropathy:

  • Medical and physical examination: When you meet your neurologist, they will begin by taking a detailed medical history and documenting any medication(s) you are taking, as well as ask you about any symptoms you are experiencing. Your doctor will also ask about your alcohol intake. A physical exam will include checking for signs of muscle weakness and numbness, as well as signs of impaired reflexes. Your neurologist will likely order a test to check if you have Type 2 diabetes, vitamin deficiencies, and test for any other underlying disease or defect that could be altering your nerve function.
  • Electrodiagnostic tests: These measure the electrical activity of your nerves and muscles, which can help uncover the extent of any nerve damage.
  • Blood tests: These check for vitamin deficiencies, including vitamin B12 and folate levels. A blood test can also be useful to diagnose any kidney malfunction, vasculitis, Lyme disease, HIV/AIDS, and hepatitis B or C.
  • Imaging tests: CT scans, electromyography, and MRI scans may be helpful in revealing the extent of nerve damage.

Peripheral Neuropathy Treatment

Treatment depends on the underlying cause of the disorder, but in most cases peripheral neuropathy cannot be cured. However, your quality of life can still be improved with treatment to alleviate acute or chronic pain.

All types of peripheral neuropathies call for a multidisciplinary approach to treat pain and to maintain strength and flexibility. For example, if a patient has diabetes, then diabetes management is the first line of treatment. If there is no known cause, some patients may reduce symptoms by taking over-the-counter or prescription painkillers, applying topical medications, and in some cases, antidepressants can help with chronic pain relief and improve sleep quality.

Treatment may also focus on anti-inflammatory drugs, such as corticosteroids to relieve pain associated with nerve irritation. Other medications that successfully treat the symptoms of peripheral neuropathy include intravenous immunoglobulin, mexiletine, nerve blocks, plasmapheresis, and tramadol.

Alternative therapies may also complement medical treatment, such as acupuncture or relaxation techniques such as meditation. Patients with peripheral neuropathy should always tell their neurologist or medical team about any holistic medicine techniques they are using to help treat their peripheral neuropathy symptoms.

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