Peripheral Neuropathy: Diagnosis & Treatments
January 17, 2020
Peripheral neuropathy is the term used for disorders that are caused by damage to the body’s peripheral nervous system.
The peripheral nervous system connects nerves from the brain and spinal cord to the rest of the body. Including, but not limited to, the arms, legs and feet, joints, eyes, nose, and even the skin. Peripheral neuropathy is when nerves are damaged and are unable to send messages from the brain to other parts of the body. This damage can cause numbness or pain in these affected areas.
Peripheral neuropathy can be separated into two categories: polyneuropathy and mononeuropathy. People most commonly suffer from polyneuropathy.
- Polyneuropathy is when multiple nerves are affected
Mononeuropathy occurs when only one nerve is affected
How is Peripheral Neuropathy Diagnosed?
There are many symptoms of peripheral neuropathy, such as numbness and tingling, severe sensitivity to touch, lack of coordination, and weakness, to name a few. Because the variety of symptoms is so vast, it can be difficult to diagnose this condition.
A diagnosis program typically includes a review of your medical history, a physical and neurological exam, and blood work and diagnostic testing.
- Medical History. Your doctor will review your medical history and ask questions regarding your symptoms, severity of pain, and what helps relieve the pain. Other factors may include your work environment, anything that triggers an onset of pain, social habits, exposure to toxins, alcohol and tobacco use, and family history of neurological diseases.
- Physical & Neurological Exam. Your doctor will perform a physical exam to look for any diseases that cause nerve damage, such as diabetes or celiac disease. A neurological exam will determine the cause of a neurological disorder and severity of nerve damage.
- Blood Work. Blood tests are able to test for vitamin deficiencies, organ dysfunction, infections, and any abnormal bodily system activities. These tests can assist the doctor in determining diseases or disorders that cause neuropathic diseases.
Other tests that can be used to test for peripheral neuropathic diseases are imaging tests, nerve and skin biopsies, and nerve function tests.
Types of Treatments Available
Your doctor will recommend a treatment type based on the type of nerve damage, symptoms you display, and the area that is affected. With the guidance of a pain management specialist, you may be able to manage your neuropathic pain and reduce medications. As long as the nerve cell has not died, consistent and definitive treatment allows for a function recovery over time.
Treating Underlying Causes
By correcting the underlying cause of your neuropathy, it can many times heal itself and the nerves can recover and regrow. Simple lifestyle changes such as maintaining a healthy weight, eating a nutritious diet, and taking vitamin supplements can improve nerve health. Exercise delivers more blood, oxygen, and nutrients to nerve endings, therefore improving muscle strength and preventing muscular atrophy. Controlling glucose levels has also been shown to reduce neuropathic symptoms and help people with diabetes avoid nerve damage.
If your peripheral neuropathy is caused by an autoimmune disease or inflammation, symptoms can be controlled by using medications like prednisone. A procedure that involves stripping your blood of immune system cells and antibodies, called plasmapheresis, helps reduce inflammation or subdue immune system activity.
When your peripheral neuropathy is not caused by an underlying disease, medications can be used to minimize symptoms.
- Over-the-Counter Pain Relievers. Medications such as NSAIDs like naproxen, ibuprofen, and aspirin can relieve minor symptoms.
- Topical Treatments. Ointments that contain a substance found in hot peppers has been proven to reduce neuropathic symptoms. Lidocaine patches also provide pain relief, although side effects may include drowsiness, dizziness, or numbness.
- Antidepressants. Antidepressants interfere with the chemical processes in your brain that cause pain. Tricyclic antidepressants like amitriptyline help relieve pain. Drugs like Cymbalta (inhibitor duloxetine) may also ease neuropathic pain. Antidepressants have been known to cause side effects such as nausea, drowsiness, or constipation.
Spinal Cord Stimulation
Spinal cord stimulators (SCS) have been used to treat pain for over 50 years. The implanted device transmits therapeutic electrical signals to provide a therapeutic effect. Neuropathic pain is caused by damaged tissue and nerves. Spinal cord stimulators are surgically placed under the skin. They send mild electrical signals to the spinal cord and nerve fibers. These signals mask pain signals before they are able to reach the brain.
Therapies to Treat Peripheral Neuropathy
Therapy that helps ease the pain of peripheral neuropathy include:
- Physical Therapy. Muscle weakness and physical disabilities caused by peripheral neuropathic diseases can be reversed under the supervision of a physical therapist and a specialized exercise program. Braces, canes, and walkers many be used to aid treatments.
- TENS. Transcutaneous electrical nerve stimulation delivers a gentle electrical current at various frequencies. Electrodes are placed on the skin over the affected area.
- Plasma exchange. Plasma therapy means your blood is removed, then processed to remove antibodies, and then returned to your body. This helps suppress the immune system activity that causes inflammation.
Surgery for Peripheral Neuropathy
For some types of neuropathies, surgery is the recommended treatment option. Pinched nerves or conditions that compress nerve roots are generally treated with surgery in order to free the damaged nerve and allow for proper healing. Mononeuropathy that is caused by compression or infections often require surgery to release pressure on the nerve.
Polyneuropathies such as diabetic neuropathy is not treated with surgery. In fact, if you suffer from polyneuropathy, surgery could potentially make your pain worse. Surgery that involves cutting or injuring the nerve can cause damage to the central nervous system. This has been known to cause phantom pain.
With the evolution of technology, less damaging procedures such as electrical stimulation has replaced surgery to treat peripheral neuropathy.
January 17, 2020