Understanding Peripheral Neuropathy

    Brittney Fulcher, NP-CDeaconess Comprehensive Pain Center

    Peripheral neuropathy affects an estimated 20 million people. It is often very painful and difficult to treat, and the symptoms can range from mild to more severe. This is a diagnosis that we evaluate and treat on a daily basis at our pain centers, yet some patients have dealt with this condition for years without helpful treatment. For some, this condition is nothing more than an annoyance and is easily treated by their primary care provider; for patients we treat, it is usually much more severe.
     
    What is peripheral neuropathy?
     
    The peripheral nervous system sends information from your brain and spinal cord to the rest of your body. Peripheral neuropathy is a result of damage to those peripheral nerves. Patients with peripheral neuropathy will describe their pain as numbness, tingling, burning or stabbing. Others may describe it as “pins and needles” or a prickly sensation. This condition usually begins gradually and will start in the hands and/or feet and can spread into the arms and legs.
     
    Peripheral neuropathy is often worse at night and can affect the patient’s sleeping pattern. Patients can experience a decrease in sensation and may describe feeling as though they are wearing gloves or socks even when they are not. It can also result in an over-sensitization of pain receptors, causing patients to feel discomfort from something that would normally not be painful, such as the severe pain described from having the sheet draped across the feet at night or pain with wearing socks and shoes.
     
    Neuropathy can affect one nerve, two or more nerves, or multiple nerves (polyneuropathy). Most patients with peripheral neuropathy have polyneuropathy.

    What causes peripheral neuropathy?
     
    Peripheral neuropathy is nerve damage caused by a number of conditions or factors, including:
    • Diabetes- more than half of patients with diabetes will develop some type of neuropathy.  Learn more in Diabetes 101
    • Heavy alcohol consumption
    • Medications – certain medications, especially those used to treat cancer (chemotherapy)
    • Exposure to heavy metals, poisons or toxins (lead, mercury, arsenic, certain solvents, Agent Orange, etc.)
    • Autoimmune diseases such as rheumatoid arthritis, Sjogren’s syndrome, and lupus
    • Infections such as Lyme disease, HIV, Hepatitis C, shingles
    • Vitamin deficiencies such as low vitamin B1, B6 or B12
    • Trauma/injury, such as from a motor vehicle accident 

    In many cases no cause can be identified and this is called idiopathic peripheral neuropathy.
     
    What is the treatment for peripheral neuropathy?
     
    Treating neuropathy may be as simple as treating the underlying cause, but early diagnosis is critical. The peripheral nerves have a limited ability to regenerate, so treatment may only slow or stop the progression – not reverse the damage.
     
    Medications

    There are several different classes of medications that can be helpful in managing the symptoms of peripheral neuropathy. These include:
    • Anti-seizure medications (also referred to as “nerve stabilizers”) like gabapentin (Gralise, Neurontin) or pregabalin (Lyrica).
    • Pain relievers –over-the-counter medication such as naproxen or Ibuprofen may relieve mild pain but for more severe pain this may require prescription pain medication from your health care provider.
    • Some antidepressants have been found to help relieve pain by interfering with the chemical processes in your brain and spinal cord that allow you to feel pain. These drugs would include duloxetine (Cymbalta), venlafaxine (Effexor XR), and amitriptyline.
    • Topical treatments – lidocaine patches, lidocaine ointment and capsaicin cream. 

    Other treatments for neuropathy
    • Smoking cessation. Smoking constricts the blood vessels that supply the nutrients to the peripheral nerves, which worsens peripheral neuropathy and can increase pain.  Learn more about our online smoking cessation program, Breath of Fresh Air (www.deaconess.com/breath)
    • Physical therapy, which can address any muscular weakness that may have developed related to the neuropathy. You may also benefit from a cane or walker to help with walking.
    • Interventional procedures or nerve blocks may be done for diagnostic and therapeutic purposes. These procedures reduce the symptoms of neuropathy and temporarily improve the circulation to the painful areas.
    • Spinal cord stimulation has also been shown to be beneficial for neuropathic pain. With this permanent implantable device, the burning and painful sensations are replaced with the sensation generated by the stimulator. 

    It is also important to adopt a healthy lifestyle: maintaining a healthy weight, engaging in routine physical exercise and limiting alcohol consumption should be priorities. Smoking cessation is a must. In diabetic patients, strict control of blood sugar levels is critical.
     
    If you believe you are suffering from peripheral neuropathy contact your health care provider or request a referral to the Deaconess Comprehensive Pain Centers. Early diagnosis and treatment can help ensure the best possible outcome.
     
    More Information
     
    My colleague, Deaconess Clinic podiatrist and wound care specialist Dr. Brandt Dodson, further explains peripheral neuropathy as it relates to foot care
    Posted: May 11, 2017 by Kate Reibel

    Tags: nerves, neuropathy, Pain, peripheral

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