Take Action in the Fight Against Peripheral neuropathy
Peripheral neuropathy, a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in the hands and feet. It can also affect other areas and body functions including digestion, urination and circulation.
If you have neuropathy, the most commonly described feelings are sensations of numbness, tingling (“pins and needles”), and weakness in the area of the body affected. Other sensations include sharp, lightening-like pain; or a burning, throbbing or stabbing pain.
Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.
See your healthcare provider immediately as soon as you notice symptoms. Neuropathy can also be a symptom of a serious disorder. If left untreated, peripheral neuropathy can lead to permanent nerve damage.
Signs and symptoms of peripheral neuropathy might include:
- Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
- Sharp, jabbing, throbbing or burning pain
- Extreme sensitivity to touch
- Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
- Lack of coordination and falling
- Muscle weakness
- Feeling as if you’re wearing gloves or socks when you’re not
- Paralysis if motor nerves are affected
How is neuropathy diagnosed?
History and physical exam
First, your doctor will conduct a thorough history and physical exam.
A genetic test may be ordered if your doctor suspects a genetic condition is causing your neuropathy.
During a neurologic exam, your doctor will check your reflexes, your coordination and balance, your muscle strength and tone, and your ability to feel sensations (such as light touch or cold).
Blood work and imaging tests
Your doctor may also order blood work and imaging tests. Blood work can reveal vitamin and mineral imbalances, electrolyte imbalances (indicator of kidney problems, diabetes, other health issues), thyroid problems, toxic substances, antibodies to certain viruses or autoimmune diseases. Magnetic resonance imaging (MRI) can detect tumors, pinched nerves and nerve compression.
In some cases, a nerve, muscle or skin biopsy is needed to confirm the diagnosis. During a biopsy, a small sample of your tissue is removed for examination under a microscope.
Other tests include a test to measure your body’s ability to sweat (called a QSART test) and other tests to check the sensitivity of your senses (touch, heat/cold, pain, vibration).
How is neuropathy treated?
Treatment begins by identifying and treating any underlying medical problem, such as diabetes or infections.
Some cases of neuropathy can be easily treated and sometimes cured. Not all neuropathies can be cured, however. In these cases, treatment is aimed at controlling and managing symptoms and preventing further nerve damage. Treatment options include the following:
- Medicines can be used to control pain. A number of different medications contain chemicals that help control pain by adjusting pain signaling pathways within the central and peripheral nervous system.
These medications include:
- Antidepressants such as duloxetine or nortripyline.
- Antiseizure medicines such as gabapentin (Neurontin®, Gralise®) and pregabalin (Lyrica®).
- Topical (on the skin) patches and creams containing lidocaine (Lidoderm®, Xylocaine®) or capsaicin (Capsin®, Zostrix®).
- Narcotic medications are not usually used for neuropathy pain due to limited evidence that they are helpful for this condition.
- Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
- Occupational therapy can help you cope with the pain and loss of function, and teach you skills to make up for that loss.
- Surgery is available for patients with compression-related neuropathy caused by such things as herniated disc in back or neck, tumors, infections, or nerve entrapment disorders, such as carpal tunnel syndrome.
- Mechanical aids, such as braces and specially designed shoes, casts and splints can help reduce pain by providing support or keeping the affected nerves in proper alignment.
- Proper nutrition involves eating a healthier diet and making sure to get the right balance of vitamins and other nutrients.
- Adopting healthy living habits, including exercising to improve muscle strength, quitting smoking, maintaining a healthy weight, and limiting alcohol intake.
- Transcutaneous electrical nerve stimulation (TENS): This treatment involves placing electrodes on the skin at or near the nerves causing your pain. A gentle, low-level electrical current is delivered through the electrodes to your skin. Treatment schedule (how many minutes and how often) is determined by your therapist. The goal of TENS therapy is to disrupt pain signals so they don’t reach the brain
- Immune suppressing or immune modulating treatments: Various treatments are used for individuals whose neuropathy is due to an autoimmune disease. These include oral medications, IV infusion treatments, or even procedures like plasmapheresis where antibodies and other immune system cells are removed from your blood and the blood is then returned to your body. The goal of these therapies is to stop the immune system from attacking the nerves.
- Complementary treatments: Acupuncture, massage, alpha-lipoic acid, herbal products, meditation/yoga, behavioral therapy and psychotherapy are other methods that could be tried to help relieve neuropathic pain. Ask your doctor if any of these therapies might be helpful for treating the cause of your neuropathy.
Living with neuropathy
Can neuropathy be stopped?
Your long-term outcome depends on what is causing your neuropathy. If your neuropathy is caused by a treatable condition, managing the condition might result in stopping the neuropathy or preventing it from getting worse. If the underlying cause of the neuropathy can’t be treated, then the goal is to manage the symptoms of neuropathy and improve your quality of life.
Neuropathy rarely leads to death if the cause is determined and controlled. The sooner the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or repaired. Recovery, if it’s possible, usually takes a very long time — from months to even years. Some people live with a degree of neuropathy for the rest of their lives.
Can neuropathy be reversed?
If the underlying cause of the neuropathy can be treated and cured (such as neuropathy caused by a vitamin deficiency), it’s possible that the neuropathy can be reversed too. However, frequently by the time individuals are diagnosed with a neuropathy, there is some degree of permanent damage that can’t be fixed.
Even though this is the general belief of today, it’s not the hope of tomorrow. Nerve damage may be reversible someday. Researchers are already seeing positive results – the regrowth of nerve fibers – in a drug study in mice with diabetes. Ongoing research combined with living a healthy lifestyle so the body can repair itself will likely be needed. Stay tuned.
Can neuropathy lead to amputation?
Yes, neuropathy – especially diabetes-related neuropathy – can lead to limb amputation. Each year about 86,000 Americans with diabetes lose a limb. The sequence of events leading up to amputation is typically this: the high glucose levels seen in diabetes cause nerve damage. The nerve damage reduces sensation in the limbs (usually the feet), which can lead to unnoticed injuries turning into skin ulcers or infections. Reduced blood flow to the feet, another effect of diabetes, prevents the wound from healing properly. The wounds cause the tissue in the foot or leg to break down, requiring amputation.