Peripheral neuropathy is a pain disorder characterized by damage to the peripheral nerves—the system of nerves that reside outside of your central nervous system. These tissues extend outward from the brain and spinal cord to innervate your limbs, muscles, organs, etc.
However, these nerves are not invulnerable to damage. Injuries, health conditions, and exposure to toxins may cause harm to these tissues.
Before we delve more fully into the treatment options for peripheral neuropathy, let’s first obtain a better understanding of your peripheral nervous system.
To better understand peripheral neuropathy, it helps to review the basics of your nervous system.
To put it simply, your nervous system enables communication between the brain and all other parts of the body. Specifically, your central nervous system includes your brain and spinal cord. The brain, of course, functions as the command center of your entire body. It controls everything from your breathing and digestion to your movements, consciousness, and much, much more.
Relatedly, your spinal cord serves as the superhighway that connects the brain to those faraway muscles and organs. It’s the main thoroughfare where vital messages conveying sensation and intention speed to and from other areas of the body. Consider the peripheral nerves, then, the side streets that exit from the spinal cord. These nerves enable the electrical impulses from the brain and spinal cord to reach nearly all areas of the body.
More specifically, peripheral nerves can be divided into one of three categories:
Now that you’ve witnessed the crucial role that your peripheral nervous system plays in conducting your everyday activities, let’s discuss peripheral neuropathy.
Peripheral neuropathy refers to damage to your peripheral nervous system, the complex network of nerves discussed above. In fact, over 100 types of peripheral neuropathy have been identified, each with its own unique prognoses and symptoms.
As such, symptoms of peripheral neuropathy can range from mild to disabling. Moreover, the kind of symptoms experienced will depend on which nerves are most affected.
As we mentioned earlier, the peripheral nervous system contains three main types of nerves. Damage to each of the following nerves types may result in the following symptoms:
There are several different conditions that can cause peripheral neuropathy, diabetes being one of the most common. In fact, over half of all individuals with diabetes will develop some form of peripheral neuropathy.
Other underlying causes of peripheral neuropathy include:
The first step toward diagnosing peripheral neuropathy is to receive a comprehensive physical exam from your doctor. Because peripheral neuropathy has several causes, your doctor will want to pinpoint the precise underlying issue producing your symptoms.
Your doctor will inquire about any past or present medical conditions, as well as the symptoms that you’re currently experiencing. In addition, your doctor will inquire about your lifestyle, type of employment, and family history of neurological diseases.
The actual physical exam involves assessing your muscle strength, reflexes, and reactions to sensations. Testing can also include evaluating your coordination, posture, balance, and more.
Depending on what the doctor finds during his/her initial examination, he/she may order certain tests to confirm a diagnosis.
Testing can include blood tests to detect diabetes, kidney or liver issues, or other metabolic disorders. Additionally, certain blood tests can alert your doctor to any hidden infections, vitamin deficiencies, or autoimmune disorders.
Doctors may also use nerve function tests, like electromyography (EMG), to detect nerve damage. In some cases, a nerve or skin biopsy will be ordered to search for abnormalities in the nerves.
So, the condition causing your neuropathy has been determined. What’s next?
The primary goal of peripheral neuropathy treatment is to address the underlying cause of the condition while also providing symptom relief. Effective treatment options for peripheral neuropathy include the following:
Some over-the-counter medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), can alleviate mild pain and discomfort. Furthermore, topical medications, like lidocaine patches or creams, may be effective if the pain is limited to a small area. Capsaicin cream—derived from a substance found in hot peppers—may relieve some neuropathic pain and itching.
In more severe cases, your doctor may prescribe narcotic medications. These can be habit-forming, so it is very important to use these powerful medications only as prescribed.
Some antidepressants and anti-seizure medications may also be helpful in treating nerve pain symptoms. Ask your doctor if you’d be an ideal candidate for these medications.
Finally, some doctors may also prescribe medications to address the underlying condition that’s causing your neuropathy. This tactic may include using medications to resolve infections or mitigate the effects of diabetes, high blood pressure, or autoimmune conditions.
TENS therapy uses a gentle electrical current to ease pain and other neuropathy symptoms. Small electrodes are placed on the skin near the injured nerve. Once applied, the electrodes deliver a gentle electrical current. Specifically, TENS therapy works by blocking or changing the nerves’ perception of pain.
Some TENS units are small and portable. They can be used at home, work, or anytime pain relief is needed.
Physical therapy uses focused exercises, routines, massage, and other treatments to enhance coordination, posture, and strength. Physical therapy can address the muscular weakness associated with motor nerve damage. Physical therapists can also suggest changes to how you perform daily activities—such as sitting or walking—that may be contributing to your pain.
Relatedly, occupational therapy addresses how to regain or adapt to functional changes brought on by nerve damage. An occupational therapist can suggest adaptive equipment, additional exercises, and new ways to perform the activities of daily living.
Vitamin deficiencies (such as B-12 deficiency) can contribute to peripheral neuropathy. A balanced diet with whole grains, fruits, vegetables, and lean proteins can prevent further nerve damage from occurring. And don’t forget…a healthy diet helps the body to function better overall.
Regular exercise is also excellent for maintaining a healthy weight, regulating blood sugar, and maintaining muscle strength. However, be sure to consult your doctor before starting a new exercise routine—especially if you are struggling with peripheral neuropathy.
Tobacco products and excessive alcohol consumption may also play a role in nerve damage. While smoking cessation isn’t easy, there are numerous programs and medications to help manage withdrawal symptoms. Ideally, limit your alcohol intake to 1-2 drinks a day at the most.
Your doctor may choose one of several treatments if your peripheral neuropathy results from autoimmune issues. Treatments can include oral medications or IV infusion treatments. For example, azathioprine and prednisone are common medications that your doctor may prescribe.
Another immunosuppressive treatment is plasmapheresis. During this procedure, a portion of the blood is removed from your body. Then, immune cells and antibodies are cleansed from the blood. The “cleaned” blood is then returned to the body.
Sometimes mechanical aids like foot or hand braces may help to reduce pain or the effects of neuropathy. For example, splints can be used for those with carpal tunnel syndrome. These splints allow for better positioning of the wrist to give the compressed nerve more room to heal.
Diabetic shoes can assist in reducing the risk of skin breakdown in the feet and provide added support. Those with muscle weakness may also require the aid of a cane or other supportive equipment to get around.
Acupuncture is a classic Chinese method that promotes natural healing and improves function. Needles are inserted at very precise points into the body depending on where you are experiencing pain or other symptoms.
Acupuncture is believed to unblock energy channels, known as meridians, that flow through the body. A more modern explanation: Accurately placed needles can stimulate the nervous system. This, in turn, releases chemicals (or a chain reaction of chemicals and hormones) to alter the experience of pain or other symptoms.
If you don’t like needles, some acupuncture practitioners can actually use electrical stimulation instead. Acupressure is another variation of this practice.
Acupuncture generally has little to no side effects. In fact, it can be performed despite certain medications the patient may be taking. Make sure to check with your doctor to learn if you’d be an ideal candidate for acupuncture.
Mind/body techniques like deep breathing, meditation, yoga, and tai chi are also treatment options for those struggling with peripheral neuropathy. Typically, these practices are used in conjunction with more conventional medicine.
In particular, these practices can lead to a more mindful experience of what is going on with you physically, mentally, and emotionally. This, in turn, can reduce stress and pain, promote relaxation, and improve your quality of life.
Some of the more physical mind/body practices, like yoga or tai chi, can also assist with flexibility and muscle tone.
For some more serious cases of peripheral neuropathy, surgery may be the best option. Certain surgeries can take the pressure off a damaged nerve. Surgery may be an option for those with tumors, a herniated disc in the neck or back, or nerve entrapment (such as carpal tunnel syndrome).
As surgical technology continues to improve, many surgical procedures related to peripheral neuropathy are minimally invasive. Minimally invasive surgery uses smaller incisions and tiny, precise equipment. As a result, one could expect less scarring, pain, and a quicker recovery time.
Those with disabilities and/or chronic health conditions may benefit from talking to a therapist about their condition. It is not always easy to cope with being unable to do the things you enjoy. A psychotherapist can equip you with the skills and support to explore and manage your thoughts and emotions.
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