Peripheral neuropathy results from damage to the peripheral nerves (nerves outside the brain and spinal cord). It usually presents as pain, numbness and weakness. It most commonly involves the hands and feet, although it could affect any other parts of the body including digestion and circulation.
Peripheral neuropathy can be caused by different reasons including metabolic abnormalities, trauma, infection or autoimmune causes.
Peripheral Neuropathy Symptoms
Peripheral neuropathy can affect a single nerve (mononeuropathy, such as carpal tunnel) or multiple nerves (polyneuropathy, such as diabetes). Signs and symptoms of peripheral neuropathy include:
- Sharp, burning, or throbbing pain
- Numbness and tingling, usually in hands/feet that start distally and spread up
- Sensitivity to touch or pain with activities that are not normally pain (pain with wearing shoes)
- Lack of coordination or falls
- Wounds in feet due to loss of sensation
- Bowel, bladder or digestive problems
Peripheral Neuropathy Causes
Peripheral neuropathy can be used by different conditions including:
- Diabetes Mellitus: This is the most common cause of neuropathy and usually develops in advanced disease or in patients who had diabetes for a while.
- Autoimmune disease: These include Guillain-Barre Syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
- Medications: certain medications such as chemotherapy can lead to peripheral neuropathy (PN)
- Toxins: toxic substances or metal poisoning
- Vitamin deficiencies: such as vitamin B, Niacin or vitamin E
- Inherited conditions: such as Charcot-Marie-Tooth disease
Peripheral Neuropathy Diagnosis
Your doctor will start by obtaining a history and physical exam. Blood work, nerve function test (electromyography), nerve biopsy or skin biopsy can help confirm the diagnosis.
Pain Management for Peripheral Neuropathy
In addition to treating the underlying cause of peripheral neuropathy (i.e. controlling blood sugars in case of diabetic neuropathy), you may be referred to pain physicians to manage your pain symptoms.
Pain related to PN can be debilitating and may affect your daily function. Treatment options include medications, interventions and alternative approaches.
Medications include “neuropathy agents” which particularly help with nerve-related pain as well as numbness/burning associated with PN. These agents include gabapentin, pregabalin, tricyclic antidepressants or duloxetine. Other second-line agents may include topiramate.
Interventional options depend on the location of the pain. Your doctor may start with a sympathetic block. A sympathetic block targets the sympathetic nervous system, a series of nerves that spread out from your spine to your body to help control several body functions including temperature and sweating. This is a safe procedure, and you can normally return to your normal activities after a day of rest. Other options include spinal cord stimulation (SCS). This includes the implantation of a small device outside your spinal cord to “modulate” the nerve signal coming from the periphery (feet or hands) to your brain. Before implantation of the device, there is a “trial” period where the device is tested out for 7 days before permanent implantation.
Other treatment options include acupuncture, physical therapy or transcutaneous electrical nerve stimulation (TENS). A “multimodal” approach including a combination of different therapies will provide the best results.