Peripheral Neuropathy – Symptoms, Types and Causes

More than twenty million people suffer from some sort of peripheral neuropathy. It is an uncomfortable burning or numbness sensation in the feet and legs. Neuropathies mean the dysfunction of the nerves and peripheral neuropathy means that anything wrong from nervous like coming out of the small cord and the nerves coming down going to the limbs or the same in the arms. That is a degeneration of the nerve fibers which usually starts in the distal part which is the longest portion of the nerves in the toes and starts to climb up gradually over time.

Overview

It tends to start in the toes of the feet and is usually the beginning port initial is intermittent then becomes more constant and moves up to the ankle and stays below the knees. When it starts in the hands and the fingertips come to the wrist and that is known as gloves. It starts in the legs more because the nerves are longer and the smaller caliber like they have been pulled a little bit longer.

People with peripheral neuropathy are more susceptible to injuries or dysfunction.

What are the types of peripheral neuropathy?

There are over a hundred types of peripheral neuropathy exist. Your physician decides your course of action based on the type of neuropathy you are suffering. These neuropathies occur mainly to sensory nerves, motor nerves, and an autonomic nerve. People suffer from this condition due to the dysfunction of the nerves. As per health professionals, peripheral neuropathy is mainly classified into two types. It includes

• Mononeuropathy
• Polyneuropathies

Mononeuropathy

When damage occurs to only one nerve is known as mononeuropathy.

Polyneuropathies

When damage occurs to multiple nerves or more than one nerve is known as polyneuropathies.

What are the indicators of peripheral neuropathy?

Patients with peripheral neuropathy can present with the number of different symptoms and commonly they present with tingling in the hands, low blood pressure, stabbing pains, thinning of the skin, tingling in the feet, buzzing sensations, numbness in the hands, shocking sensations, sharp pains, numbness in the feet, and a heavy feeling in the arms and legs.

When to see a doctor

Consult your healthcare provider or a physician immediately if you are experiencing any of the symptoms described above. Your doctor should evaluate you for other possible causes of your symptoms before treating peripheral neuropathy. Together, you and your doctor can determine the best way to manage your symptoms.

What are the causes of peripheral neuropathy?

Diabetes, hyperglycemia, or pre-diabetic state are the most common causes of neuropathy. People who have high blood sugar are more likely to develop this condition as their blood sugars are high all the time but there is some kind of it damages a nerve. Blood sugar is a precursor to developing neuropathy or developing diabetes event.

In the United States, diabetes is the most common cause followed by alcohol. People end up in a hospital and ER is called Guillain-Barre syndrome and that’s what climbing acute onset of numbness, weakness in the legs. The reason alcohol causes neuropathies is it has a toxic for the nerve killers and the neurons. A glass of wine probably won’t do it but too much of that will do. People who drink heavily experience or tell another person that their feet are tingling or burning. Most of them feel it if they are not drinking that night.

Smoking doesn’t have any direct effect but it causes poor circulation and it can affect the nerves as well. B12 deficiencies, diabetes, exposure to toxins, malignancies, lung cancer, lymphoma, or multiple myeloma are the underlying causes of peripheral neuropathy.

What are the risk factors of peripheral neuropathy?

Several well-established risk factors developing the condition such as addiction to alcohol, repetitive motion, family history of peripheral neuropathy, vitamin deficiencies, autoimmune diseases, and infections like

• Lyme disease
• Shingles
• Human immunodeficiency virus
• Epstein-Barr virus
• Hepatitis B and c

What are the complications of peripheral neuropathy?

The complications of peripheral neuropathy include

• Burns and skin trauma
• Infection
• Falls

Let’s discuss the above complications in detail

Burns and skin trauma

Some of your body parts affected by neuropathy may become numb and as a result, you may not feel temperature changes and pains in your body.

Infection

As your body affected by neuropathy, there are high chances of getting infection to the parts that lack sensation. Due to this reason, it is advised to have a word with your physician and treat minor injuries. It is especially important when you are suffering from diabetes. You can prevent further infections to your body by treating minor injuries.

Falls

Muscle wasting or muscle weakness may lead to a lack of coordination and falling.

How do physicians diagnose peripheral neuropathy?

The following are the tests and procedures to confirm the diagnosis of peripheral neuropathy. It includes

• Medical history
• Neurological examination
• Blood tests
• Nerve function tests
• Nerve biopsy
• Skin biopsy

Let’s discuss the above diagnostic tests in detail:

Medical history

Your physician may ask detailed information about the symptoms you are experiencing in the past few days and review your and your family’s full medical history.

Neurological examination

In this test, your doctor will check your

• Muscle strength
• Tendon reflexes
• Body response to sensations
• Posture
• Body coordination

Blood tests

Your physician may recommend blood tests to detect the various health problems and it is due to a lot of underlying medical conditions contributes to peripheral neuropathy. Blood tests provide the necessary information to your physician regarding

• Vitamin deficiencies
• Diabetes
• Abnormal immune function

Imaging tests

Computed tomography or Magnetic resonance imaging scans can reveal abnormalities like tumors and herniated disks.

Nerve function tests

This test is used to detect nerve damage by measuring electrical activity in your muscles. It requires inserting a thin needle into the muscle through your veins and it records the electrical activity when the patient contracts his or her muscle.

Nerve biopsy

Your physician may remove a small portion of a nerve and send it to the laboratory for analysis.

Skin biopsy

This test reveals the important information about the nerve endings and it requires removing a small portion of the skin to perform this test.

What are the treatment options available for peripheral neuropathy?

There are treatments for peripheral neuropathy which includes lifestyle alternations, therapies as well as prescription medications. The treatment options of peripheral neuropathy include

• Pain relievers
• Anti-seizure medications
• Topical treatments
• Antidepressants
• TENS
• Plasma exchange and intravenous immune globulin
• Physical therapy
• Surgery
• Lifestyle alterations

Let’s discuss the above treatment options in detail:

Pain relievers

Your physician may prescribe pain reliever medications if you are experiencing severe pain due to peripheral neuropathy. Examples of pain reliever medications include

• Tramadol (Conzip, Ultram)
• Oxycodone (Oxycontin, Roxicodone)

People may become addicted to the above medications with overuse. Due to this reason, doctors prescribe the above drugs only when other treatment options failed to manage the symptoms.

Anti-seizure medications

These anti-seizure medications are used in the management of epilepsy and can give you relief from pains in the nerve. Gabapentin and pregabalin are examples of anti-seizure drugs. The following are the possible side effects of this medication. It includes

• Feeling sleepy all the time
• Dizziness
• Swelling of the hands
• Sudden changes in weight
• Difficulty in concentrating or unable to concentrate
• Swelling of the feet

The above side effects can occur at any time during medication use. It is advised to consult a physician when you are experiencing the side effects of this medication. Your physician may change the dosage of the medication or switch you to another one.

Topical treatments

You can use capsaicin cream to get relief from the symptoms of peripheral neuropathy. When you apply this cream to the affected area, you may experience burning and irritation of the skin. It is not easy for some people to tolerate. The following are the possible side effects of topical treatment. It includes

• Feeling sleepy all the time
• Dizziness
• Numbness at the site of the patch

Antidepressants

If the neuropathy condition affecting your brain and spinal cord, then your physician may recommend antidepressants to reduce those effects. Examples of antidepressant medications include

• Amitriptyline
• Doxepin (Silenor, Zonalon)
• Nortriptyline (Pamelor)
• Duloxetine (Cymbalta)
• Venlafaxine (Effexor XR)

The above medications are recommended to relieve pain caused by peripheral neuropathy by interfering with the brain and spinal cord. The following are the possible side effects of antidepressants. It includes

• Dry mouth
• Nausea
• Feeling sleepy all the time
• Dizziness
• Loss of appetite
• Hard bowel movements

TENS

The full form of TENS is transcutaneous electrical nerve stimulation. Your physician may place electrodes on the skin and send an electric current to your body at different frequencies.

Plasma exchange and intravenous immune globulin

This procedure is used to offer relief in people with certain inflammatory diseases. It requires you to removing your blood, and then they will replace the same blood by removing the antibodies and proteins that are present in the blood.

Physical therapy

The main objective of this therapy is to remove the improve your body movements. You might require

• Hand braces
• Foot braces
• Cane
• Walker
• Wheelchair

Surgery

Your physician may recommend surgery if the peripheral neuropathy is causing you a lot of pain and pressure on nerves. Your surgeon can reduce the pressure on the nerve by performing surgery or through surgery.

Lifestyle alterations

A well-balanced diet, exercise, and maintaining a healthy body weight can reduce the chances of experiencing these adverse conditions associated with peripheral neuropathies. Bad habits like smoking and drinking excessive alcohol can increase the severity of the symptoms.

How do you prevent peripheral neuropathy?

There are things that people can do to prevent neuropathy by getting their blood sugar’s down, quitting smoking, reducing the consumption of alcohol, exercising regularly, and taking care of your feet especially if you have diabetes.

Conclusion

Peripheral neuropathy conditions can have a serious effect on the mental health of anyone. It is important to identify the symptoms of this condition and then with your physician about your symptoms. Your doctor can complete a physical exam and review your medical history to determine which treatment option would be best for you.

References

1. https://jamanetwork.com/journals/jama/fullarticle/1674238
2. https://www.atsjournals.org/doi/full/10.1164/rccm.201112-2135oc
3. https://pubmed.ncbi.nlm.nih.gov/18399710/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471666/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988942/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287277/