DefinitionPeripheral neuropathy is damage to the peripheral nerves. These are the nerves that connect your spinal cord to the rest of your body.
|Peripheral Nerves of the Foot|
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CausesMany health conditions can cause peripheral neuropathy. The damage may occur due to:
- Trauma from nerve compression or inflammation
- Certain medications, such as chemotherapy treatments for cancer
- Vitamin deficiencies
- Hereditary syndromes
- Exposure to toxins and heavy metals, such as lead , mercury , or pesticides
- Exposure to cold or radiation
- Prolonged treatment in the intensive care unit
- Type 1 or type 2 diabetes
- Infections, such as Lyme disease , HIV , tuberculosis , or leprosy
- Chronic kidney failure
- Autoimmune disorders, such as rheumatoid arthritis
- Acute or chronic demyelinating polyneuropathy
- Paraneoplastic syndromes
Risk FactorsHaving certain health conditions may increase your chance of getting peripheral neuropathy.
SymptomsDamage to the peripheral nerves often results in sensory and motor symptoms in the:
- Numbness or reduced sensation
- Pain, often a burning or sharp, cutting sensation
- Sensitivity to touch
- Muscle twitches
- Muscle weakness
- Difficulty with walking
- Loss of coordination or balance
- Loss of reflexes and muscle control
- Muscle atrophy—loss of muscle bulk
- Foot deformities
- Injuries to the feet that go unnoticed and become infected
- Problems regulating blood pressure
- Erectile dysfunction
- Difficulty breathing
DiagnosisThe doctor will ask about your symptoms and medical history. A physical exam will be done. It may include examining:
- Muscle strength
- Ability to feel vibration, temperature, and light touch
- Sensation in the feet using a fine flexible wire—Semmes-Weinstein monofilaments test
- Tests of your bodily fluids and tissues:
- Evaluation of your nerves and muscles:
- Imaging tests to evaluate nerves and other structures:
- Your doctor may need to evaluate other family members for this condition.
TreatmentTalk with your doctor about the best treatment plan for you. Options may include:
Treatment for the Underlying Illness or ExposureTreating the underlying illness can decrease symptoms or make them go away. For instance, if it is caused by diabetes, controlling blood sugar levels may help. In some cases, neuropathy caused by medications or toxins is completely reversed when these substances are stopped or avoided. Correction of vitamin B12 deficiency often improves symptoms.
Physical TherapyCertain exercises may help stretch shortened or contracted muscles and increase joint flexibility. In long-standing cases, splinting the joint may be required to protect and rest it, while maintaining proper alignment.Orthotics, such as supports and braces, may help with:
- Balance issues
- Muscle weakness
MedicationsPrescription and over-the-counter pain medications are often used to ease discomfort. Medications used to treat depression and prevent convulsions can relieve neuropathy symptoms. For severe and potentially life-threatening cases, such as Guillain-Barre syndrome , treatment includes:
- IV immunoglobulins
- Plasma exchange of the blood— plasmapheresis
Other TherapiesThese therapies are aimed at reducing symptoms:
- Relaxation training
- Walking and other exercise
- Warm baths
- Transcutaneous electronic nerve stimulation (TENS)
SurgerySurgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat carpal tunnel syndrome .
PreventionTo help reduce your chance of peripheral neuropathy:
- Manage chronic medical conditions with the help of your doctor. If you have diabetes, make sure you have regular foot exams.
- Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Limit your alcohol intake to a moderate level. This means 2 or fewer drinks per day for men and 1 or fewer for women.
- Avoid toxic chemicals.
American Chronic Pain Association
The Neuropathy Association
Canadian Diabetes Association
Baron R, Binder A, et al. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807-819.
Diabetic neuropathies: The nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.aspx. Updated November 26, 2013. Accessed May 30, 2014.
Karlsson P, et al. Epidermal nerve fiber length density estimation using global spatial sampling in healthy subjects and neuropathy patients. J Neuropathol Exp Neurol. 2013 Mar;72(3):186-93.
Peripheral neuropathy. EBSCO DynaMed website. Available at: Available at: http://www.ebscohost.com/dynamed. Updated April 15, 2014. Accessed May 30, 2014.
12/20/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine.
10/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Feng Y, Schlösser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50:675-682,682.
- Reviewer: Rimas Lukas, MD
- Review Date: 05/2014
- Update Date: 05/30/2014
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