Peripheral Neuropathy - Symptoms, Diagnosis & Treatments

The term peripheral neuropathy describes any particular group of disorders, such as damage and disease – affecting the sensory and/or motor nerves in the peripheral nervous system.

The Nervous System

peripheral neuropathyThis is comprised of two parts – the central nervous system and the peripheral nervous system.

The central nervous system (CNS) consists of the brain and spinal cord.

The peripheral nervous system (PNS) is a network of nerves threaded throughout the rest of the body, carrying messages from the CNS to the rest of the body.

Different Types of Nerves

Nerves carry impulses to and from the CNS to the rest of the body.

Sensory Nerves

These nerves carry messages from the body to the brain – relaying information from outlying receptors towards the CNS, conveying sensations such as pain, touch, taste, temperature etc.

Motor Nerves

Nerves that carry information from the CNS to bring about activity in a muscle or gland.

Autonomic Nerves

Part of the PNS, autonomic nerves regulate automatic bodily functions and are responsible for controlling involuntary muscular functions such as the heart, bladder and bowels.

Damage to the nerves relaying messages between the CNS and the rest of the body is described as Peripheral neuropathy. Various different conditions can cause peripheral neuropathy – according to the NHS, it is estimated that as many as 1 in 10 people over the age of 55 will be affected by some form of peripheral neuropathy.

The condition most commonly affects all the nerves in the body, typically the longest nerves first – hence why symptoms usually manifest in the feet primarily, this is known as polyneuropathy. It may however, only affect one nerve (mononeuropthy) or several nerves (mononeuritis).

Symptoms

Symptoms can vary and very much depend on which nerves are affected, and where they are located in the body. However, peripheral neuropathy commonly affects the hands, arms, feet and legs. The longer the nerve, the more prone it is to damage.

Common symptoms include:

  • Pain – sharp stabbing pains/ feelings of electric shock
  • Increased sensitivity to pain
  • Tingling
  • Loss of sensation/numbness
  • Loss of balance (stumbling or tripping when walking)
  • Lack of coordination (tasks such as buttoning clothes etc. become difficult to perform)
  • Constipation and a feeling of being bloated when autonomic nerves are affected
  • A cut or ulcer on the foot that isn’t getting better

Note: If you are suffering from diabetes or are at risk of peripheral neuropathy for any other reason, it is important to have regular check ups and take good care of your feet.

Causes

Diabetes

Both type 1 and type 2 diabetes can cause peripheral neuropathy. It is believed that the high blood sugar levels associated with diabetes, can damage the tiny blood vessels which supply the nerves – this is known as polyneuropathy. The longer the individual has suffered from diabetes, the more likely it is they will develop peripheral neuropathy.

Physical Injury

This may be caused by an accident or as a side effect of surgery. Surgery for breast cancer, as an example, may damage the nerves.

Cancer

Certain types of cancer, typically lymphoma and multiple myeloma.

Infections

Some infections and viruses can cause peripheral neuropathy, these include:

  • HIV
  • Shingles
  • Diphtheria
  • Lyme Disease
  • Botulism

Alcoholism

Regular heavy drinking for many years

Vitamin B12 Deficiency

Certain conditions

Conditions caused by an over active immune system

  • Rheumatoid arthritis
  • Lupus
  • Sjorgren's syndrome

Charcot-Marie-Tooth CMT

Hereditary motor sensory neuropathy

Medication and other treatments

Some types of medication can on occasions cause peripheral neuropathy:

  • Chemotherapy – used in the treatment of cancer
  • Certain antibiotics – when taken for extended periods of time
  • Radiotherapy – some forms of radiotherapy can cause damage to the nerves in the area treated

Complications of peripheral neuropathy

Diabetes related complications

Any wounds or lesions in the foot such as an ulcer may take longer to heal and lead to further complications such as gangrene, which if left to spread can result in amputation.

Cardiovascular autonomic neuropathy

In some cases, peripheral neuropathy may affect the autonomic nerves controlling the functions of the heart and circulation system.

Treatment

This will largely depend on the underlying cause of the peripheral neuropathy and the area of the body affected.

Treating nerve pain

Nerve pain can range in severity from feelings of discomfort to excruciating pain – unfortunately neuropathic pain is not relieved by common over the counter medications such as paracetamol and ibuprofen.

  • Chemotherapy – used in the treatment of cancer
  • Certain antibiotics – when taken for extended periods of time
  • Radiotherapy – some forms of radiotherapy can cause damage to the nerves in the area treated

Medication

Medication used in the treatment of peripheral neuropathy:

  • Anti-depressants – Amitryptiline, Duloxetine
  • Anti-convulsants – Pregabalin and Gabapentin
  • Opioids such as Tramadol, Oromorph

Capsaicin cream

This effective pain killer, comes in the form of a topical ointment – it is believed to work by preventing the nerves from sending pain messages to the brain. The cream itself consists of a substance found in hot chilli peppers.

Lidocaine plaster

Lidocaine is a local anaesthetic and works by helping prevent nerves from transmitting painful impulses to the brain.

The Pain Management Clinic

The pain management clinic comprises of a multi-disciplinary team of pain management consultants, surgeons, physiotherapists and psychologists. A specialist in this area will be able to advise on all aspects of pain management and devise an individual plan for the management of your symptoms, prescribing the most suitable treatments. This may include treating the underlying cause of the condition as well as particular medication and physiotherapy in cases of muscle weakness. Specific exercises may be needed to help improve muscle strength.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment