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Peripheral Neuropathy

Overview

Peripheral neuropathy occurs when one or more nerves are damaged or dysfunctional, causing numbness, burning, muscular weakness, and discomfort in the area. It mostly affects the hands, but it can also impact other parts of the body, including processes such as digestion, urination, and the circulatory system. The pain caused by peripheral neuropathy is often experienced as stabbing, scorching, or tingling.

Your brain and spinal cord deliver information to your peripheral nervous system, which then sends it to the remainder of the body. Sensory information is also sent to the nervous system via peripheral nerves. Traumatic injuries, infectious diseases, metabolic issues, hereditary factors, and toxic exposure can all cause peripheral neuropathy. Diabetes is among the most frequent causes. Symptoms often improve, especially if they are induced by a curable disorder.

Causes

·         Diabetes mellitus is the most common cause of neuropathy. Around 60 to 70 percent of diabetic patients are affected by peripheral neuropathy. Small fiber neuropathy, a disorder that produces intense burning pain in the feet and hands, is most commonly caused by diabetes.

·         Neuropathy can be caused by falls, automobile accidents, fractures, or sports events. Other reasons include nerve compression.

·         Autoimmune disorders: Neuropathy can be caused by autoimmune illnesses such as Guillain-Barré disorder, lupus, rheumatoid arthritis, Sjogren's syndrome.

·         Neuropathy can also be caused by infections such as chickenpox, shingles, HIV, herpes simplex, STD, leprosy, West Nile virus, Epstein-Barr virus, and hepatitis C.

·         Kidney disease, liver disease, hypothyroidism, and tumors pressing on nerves, such as myeloma and lymphoma, can all cause neuropathy.

·         Neuropathy can also be caused by antibiotics, anti-seizure drugs, and HIV treatments.  Some cancer therapies, such as chemo and radiotherapy, can cause peripheral nerve damage. Nerve function can be affected by hazardous substances such as toxic metals (including mercury and lead) and chemical products, particularly solvents.

·         Neuropathy can develop when blood flow to the legs and arms is reduced or slowed due to inflammation or other blood vessel diseases. Vasculitis, smoking, and diabetes can all cause vascular issues.

·         Vitamin deficiency and alcoholism: Chronic alcoholism depletes the blood levels of thiamine and other vital nutrients required for nerve function, usually due to a poor diet.

·         Inherited disorders: Charcot-Marie-Tooth (CMT) illness is the most prevalent hereditary neuropathy.

Types

Peripheral neuropathy comes in various forms, each with its unique set of symptoms and outcomes. They are frequently divided into the following groups to assist clinicians in identifying them:

Motor neuropathy

Damage to the nerves that govern muscles and mobility in the body, such as raising your forearms, is referred to as motor neuropathy.

Sensory neuropathy

Pain, warmth, and light touch are all controlled by sensory nerves. These nerve groups are affected by sensory neuropathy.

Autonomic Neuropathy

Autonomic nerves are responsible for processes you aren't aware of, such as heart rate and breathing.

Mononeuropathy

Mononeuropathy refers to damage to a single nerve. The most prevalent cause is injury or trauma. Prolonged inactivity or continuous, repetitive actions can both cause nerve pressure.

Carpal tunnel syndrome is a kind of mononeuropathy that affects many people. It's known as an overuse strain injury. It happens when the nerve that runs through the forearm is squeezed. Numbness, burning, strange feelings, and discomfort in the first three fingers on the thumb side of the hand might be caused by nerve injury. The person may wake up with tingling in their hand or realize that the tingling is more obvious when they conduct certain tasks.

Other Neuropathies

A sensory-motor neuropathy, for example, is a combination of two or three of these different forms of neuropathy.

Signs And Symptoms

Peripheral neuropathy can cause the following signs and symptoms:

·         Numbness, pins, and needles, or burning in your feet or hands that gradually spreads upwards into your legs and arms.

·         Pain that is sharp, stinging, throbbing, or scorching.

·         Touch sensitivity is high.

·         Trouble in your feet when you put weight on them or while they're under a blanket

·         You may feel like wearing socks or gloves even when you are not wearing them.

·         Falling and poor coordination

·         Muscle degradation

·         Bladder problems

Diagnosis

Your doctor will take a complete history and examine your reflexes, balance and coordination, muscle tone, and power and sensations during a neurologic exam.

Blood tests

Vitamin and mineral deficiencies, electrolyte imbalances due to kidney problems, diabetes, thyroid disorders, poisonous chemicals, antibodies to specific viruses, and autoimmune illnesses can all be discovered by blood tests.

Magnetic resonance imaging

Tumors, strained nerves, and nerve compression can all be detected with magnetic resonance imaging (MRI) of the affected region.

Electromyography

It can reveal issues with the transmission of nerve impulses from your body to the muscles. A tiny syringe will be inserted into your muscle for this test. Your doctor will next instruct you to you’re your muscles gradually. The quantity of electricity traveling through your muscles will be measured by sensors in the needle. After the procedure, the region may be uncomfortable for a few days.

Nerve conduction study

Your doctor will insert sensors on your skin during a nerve conduction study. They then send small electrical pulses through your nerves to test if they deliver signals appropriately. This procedure is a little unpleasant while it's being performed, but it shouldn't ache once it's through.

 Genetic testing

A genetic test may be conducted if your doctor feels a hereditary disease is causing your neuropathy.

Treatment

Peripheral neuropathy management may include addressing any underlying causes or symptoms.

·         Diabetes may be managed by lifestyle modifications such as quitting smoking, limiting alcohol use, keeping a healthy diet, and exercising.

·         Vitamin B12 injections are used to treat vitamin B12 insufficiency.

·         If you quit using a drug, peripheral neuropathy induced by that medicine may resolve.

Medications

The following are some of the most frequently prescribed medicines for neuropathic pain:

·         Amitriptyline

·         Duloxetine

·         Gabapentin and pregabalin

You can also take certain extra drugs to ease pain in a particular location of your body or to treat extremely severe pain for a limited time.

Prognosis

Peripheral neuropathy has a variety of outcomes based on the underlying issue and which nerves have already been injured. If the underlying cause is addressed, some instances may improve over time. However, the damage may be irreversible in others or worsen over time.

Lifestyle Modifications

·         Regular physical activity can help you stay active while also improving your mood, reducing discomfort, and improving your general health. It aids in the rise in blood flow to our limbs, reducing stress and nerve damage.

·         In addition to a balanced diet, vitamins B and D may help alleviate neuropathy pain. Vitamin B is necessary for nerve function, while vitamin D aids in the prevention of nerve irritation.

·         Quitting smoking will be a great step towards improvement.

·         Relaxation practices such as yoga and meditation can help people manage their pain.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 26, 2023.

References

Peripheral Neuropathy | National Institute of Neurological Disorders and Stroke (nih.gov)

https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy#:~:text=Peripheral%20neuropathy%20refers%20to%20the,other%20parts%20of%20the%20body.

Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID | Neurology Neuroimmunology & Neuroinflammation

https://nn.neurology.org/content/9/3/e1146?fbclid=IwAR01s2EzMg3BmwHP3nsVEYLiXoTGMEGPDb75N4YJ1PZMpEJ8kY6koPO85QQ

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