One of every 12 people over age 55 suffers from this very painful disorder
Peripheral neuropathy refers to damage, disease or dysfunction of nerves outside the brain and spinal cord. The condition, which affects an estimated 20 million Americans, has more than 100 known causes, including diabetes, autoimmune disorders, tumors, heredity, nutritional imbalances and infections.
Until recently, there were no specific criteria for doctors to use when diagnosing the nerve disorder known as peripheral neuropathy. As a result, a patient might go for months or even years without getting a proper diagnosis for symptoms (such as numbness, tingling, burning or stabbing pain, a feeling of pins and needles or weakness) that typically occur in the hands and/or feet.
Latest development: New guidelines by the American Academy of Neurology can help patients get a prompt diagnosis and effective treatment that reduces their risk for permanent nerve damage.
Peripheral neuropathy can have various symptoms because there are many possible causes. If you suffer any of the symptoms mentioned above, see your primary care physician and describe them in as much detail as possible. Your doctor may refer you to a neurologist.
Your doctor will want to know…
Do you have weakness or feel clumsy at times? Because nerves stimulate muscles, some neuropathies result in a loss of strength, causing patients to lose balance, trip and/or feel clumsy.
Where did you first notice the symptoms? Peripheral neuropathy typically starts in the areas of the body farthest from the spinal cord, usually the feet and/or hands.
Did the symptoms occur simultaneously on both sides of the body — for example, in both feet — or on only one side? Peripheral neuropathy symptoms usually occur simultaneously on both sides of the body. If you experience symptoms on only one side, other possible causes, such as multiple sclerosis or a stroke, must be considered.
Be sure to tell your doctor about: All medications you have taken in the last year or are currently taking. Among the drugs that can cause peripheral neuropathy…
Chemotherapy drugs, such as vincristine (Oncovin) or cisplatin (Platinol).
Antibiotics, including metronidazole (Flagyl) or nitrofurantoin (Macrodantin).
Anticonvulsants, such as phenytoin (Dilantin).
In addition, excessive doses of vitamin B-6 (pyridoxine) can cause peripheral neuropathy.
IDENTIFYING THE CAUSE
To find the cause of peripheral neuropathy, you should receive blood tests for…
High blood sugar (glucose). This could indicate diabetes or glucose intolerance (impaired ability to convert glucose to energy). When prolonged, glucose elevation damages small blood vessels, leading to slow nerve death.
To prevent further nerve damage: Control blood glucose through diet and/or the use of insulin and, if necessary, other diabetes medication.
Vitamin deficiency. As many as one in three adults over age 50 does not efficiently absorb vitamin B-12, a nutrient required for proper nerve function. Vitamin B-12 deficiency also can result from heavy drinking or a poor diet. Because vitamin B-12 is found only in animal foods, such as meat, poultry and dairy products, some vegetarians are at increased risk for a deficiency unless they take a supplement.
To prevent further nerve damage: Ask your doctor about monthly vitamin B-12 injections and/or daily B-12 oral supplements.
Infection and/or inflammation. A complete blood count (CBC) and a test for the inflammation marker C-reactive protein (CRP) can help identify infections that can cause neuropathy, such as Lyme disease… HIV… hepatitis… and syphilis.
To prevent further nerve damage: Begin treatment immediately with an antibiotic or other medication.
WHAT OTHER TESTS CAN TELL
The blood tests described above can usually identify the general cause of neuropathy, but other tests that may be needed include…
Nerve conduction study (NCS). With this noninvasive test, electrodes are placed on the surface of the skin — on the hands and feet, for example — and mild electric shocks are delivered to help measure the speed of nerve signals. Some types of neuropathy, such as Charcot-Marie-Tooth disease (a hereditary disorder), strip the nerves of their protective coating (myelin), causing nerve impulses to travel more slowly.
Electromyography (EMG). Often performed with NCS, this test helps evaluate the health of nerves that control muscles. A needle-thin electrode is inserted through the skin and into a muscle to track electrical activity that gives clues to the causes of muscle weakness.
Skin and nerve biopsies. By taking a skin sample, doctors can examine the small nerve fibers that cause pain or numbness. A nerve biopsy can find less common causes of inflammation, including deposits of abnormal proteins, or unusual infections, such as leprosy.
THE BEST TREATMENT
If you identify neuropathy early, symptoms may disappear with proper treatment, such as improved blood sugar control or medication to treat infection or inflammation. By stopping the disease process, you often can avoid additional nerve damage.
Too often, however, nerve damage is permanent — and pain and numbness continue indefinitely.
In these cases, you should…
Get some exercise. Physical activity helps maintain your physical abilities and prevent disabilities, such as muscle contractures (shortening of muscles). Exercise also triggers the release of natural painkilling compounds called endorphins.
For minor neuropathy, the best exercises include low-impact activities, such as walking and bicycling. Water exercises, which can build strength without risk for injury from falling, are especially good for people who have balance problems. Aim to exercise for 30 minutes three to four times weekly — as tolerated.
Avoid neuropathy-related injury. If the body’s pain signals are blunted, cuts and blisters are easily ignored and may become infected. To prevent injury: Don’t go barefoot… wash and examine your feet daily… and moisturize with a lotion or cream, when necessary, to avoid cracking skin.
Relieve the pain. Pain can reduce your quality of life, limit your activities and may even “rewire” your brain so that your discomfort becomes more difficult to treat. Best to try…
Topical pain relievers. When applied to the hands or feet, topical analgesics can relieve pain intensity in some people by reducing nerve sensation. Example: Prescription lidocaine creams and patches. Common side effects: Temporary tenderness at the application site.
Antidepressant medications. Relatively new antidepressants called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) can increase levels of the brain chemicals serotonin and norepinephrine, both of which help regulate mood. The drugs inhibit pain impulses so that they don’t “register” in awareness. Examples: Venlafaxine (Effexor) and duloxetine (Cymbalta). Common side effects: Nausea, dry mouth and insomnia.
Anti-epileptic medications. Developed to control seizures, these drugs can intercept the transmission of pain signals. Examples: Pregabalin (Lyrica)… and gabapentin (Neurontin). Common side effects: Sleepiness and dizziness.
Centrally acting analgesics. These drugs bind to specific receptors in the brain to block pain and alter the patient’s emotional response to the sensations. There is a risk for dependency with these drugs, so they are used only as a last resort. Examples: Oxycodone (OxyContin)… and hydrocodone and acetaminophen (Vicodin, Lortab). Common side effects: Sleepiness, dizziness and gastrointestinal upset.
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