Peripheral neuropathy is a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, and an inability to control muscles.
The symptoms depend on which type of nerve is affected. The three main types of nerves are:
Neuropathy can affect any one or a combination of all three types of nerves. Symptoms also depend on whether the condition affects the whole body or just one nerve (as from an injury).
Longer nerves are more easily injured than shorter ones, so it is common for you to have worst symptoms in the legs and feet than in the hands and arms.
Damage to sensory fibers results in changes in sensation, burning sensations,Nerve paintingling,numbness or an inability to determine joint position, which causes incoordination.
For many neuropathies, sensation changes often begin in the feet and progress toward the center of the body with involvement of other areas as the condition worsens. Diabetes is a common cause for sensory neuropathy.
Damage to the motor fibers interferes with muscle control and can cause weakness, loss of muscle bulk, and loss of dexterity. Sometimes, cramps are a sign of motor nerve involvement.
Other muscle-related symptoms include:
The autonomic nerves control involuntary or semi-voluntary functions, such as control of internal organs and blood pressure. Damage to autonomic nerves can cause:
Exams and Tests
A detailed history will be needed to determine the cause of the neuropathy. A neurological exam may reveal problems with movement, sensation, or organ function. Changes in reflexes and muscle bulk may also be present.
Blood tests may be done to screen for medical conditions such as diabetes and vitamin deficiencies.
Tests that reveal neuropathy may include:
Tests for neuropathy are guided by the suspected cause of the disorder, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, scans, or other tests and procedures
Physical therapy, occupational therapy, and orthopedic interventions may be recommended. For example, exercises and retraining may be used to increase muscle strength and control. Wheelchairs, braces, and splints may improve mobility or the ability to use an affected arm or leg.
Safety is an important consideration for people with neuropathy. Lack of muscle control and reduced sensation increase the risk of falls and other injuries. The person may not notice a potential source of injury because he or she can’t feel it. For example, one may not notice if water in a bathtub is too hot. For this reason, people with decreased sensation should check their feet or other affected areas frequently for bruises, open skin areas, or other injuries, which may go unnoticed and become severely infected. Often, a podiatrist can determine if special orthotic devices are needed.
Safety measures for people experiencing difficulty with movement may include:
Safety measures for people having difficulty with sensation:
Shoes should be checked often for grit or rough spots that may cause injury to the feet.
Persons with neuropaties are prone to new nerve injury at pressure points such as knees and elbows. They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or assuming similar positions.
Prescription pain medications may be needed to control nerve pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin, and pregabalin), tricyclic antidepressants (duloxetine), or other medications may be used to reduce the stabbing pains. Use the lowest dose possible to avoid side effects.
Adjusting position, using frames to keep bedclothes off tender body parts, or other measures may also be helpful to reduce pain.
The symptoms of autonomic changes may be difficult to treat or respond poorly to treatment.
Use of elastic stockings and sleeping with the head elevated may help treat low blood pressure that occurs when standing up (postural hypotension). Fludrocortisone or similar medications may also be helpful.