Peripheral Neuropathy: What it is, Symptoms & Treatment

Peripheral Neuropathy

Peripheral neuropathy is damage or dysfunction of the peripheral nerves, that is, the nerves outside the brain and spinal cord. It may affect:

• Sensory nerves (sensation)
• Motor nerves (movement)
• Autonomic nerves (uncontrolled body functions)

Peripheral Neuropathy Symptoms

These are the typical symptoms of peripheral neuropathy, listed by the type of nerve involved:

Sensory Nerve Symptoms (most frequent)

• Numbness or decreased sense of feeling (particularly in hands or feet)
• Tingling or "pins and needles" feeling
• Burning, stabbing, or shooting pain
• Heightened sensitivity to touch (even slight touch may hurt)
• Loss of coordination or balance
• Feeling like you're wearing gloves or socks when you're not

Motor Nerve Symptoms

• Weakness of muscles
• Cramping or spasms
• Paralysis (in extreme cases)
• Difficulty with fine motor tasks (e.g., dressing)

Autonomic Nerve Symptoms

• Dizziness or fainting (particularly when rising from a lying down position)
• Abnormal sweating (excessive or insufficient)
• Digestive problems (bloating, nausea, diarrhea, or constipation)
• Bladder difficulties (incontinence or retention)
• Heat intolerance

Peripheral Neuropathy Treatment

Treatment for peripheral neuropathy is aimed at symptom management, addressing the underlying cause, and preventing additional nerve damage. Below is a summary of options available:

Medical Treatments

Addressing Underlying Causes:

• Diabetes Management: Blood sugar control can prevent additional nerve damage and potentially improve symptoms.
• Vitamin Deficiencies: B vitamin (particularly B12), vitamin E, and others as appropriate supplementation.
• Autoimmune Conditions: Treatment may involve immunosuppressive therapies.

Medications for Symptom Relief:

Pain Relievers:

• Over-the-counter (OTC): Mild pain may be eased with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
• Prescription: For greater pain, more potent drugs such as tramadol might be dispensed.
• Anti-seizure Medications: Gabapentin and pregabalin are prescribed to relieve pain due to the nerves.
• Antidepressants: Tricyclic antidepressants (amitriptyline) and serotonin-norepinephrine reuptake inhibitors (duloxetine) will ease neuropathic pain.
• Topical Treatments: Topical lidocaine patches or capsaicin cream will ease local pain.

Therapies and Procedures

• Physical Therapy: Enhances strength, coordination, and balance of muscles.
• Transcutaneous Electrical Nerve Stimulation (TENS): Could alleviate pain by providing mild electrical impulses to nerves.
• Surgical Intervention: When there is nerve compression, interventions such as nerve decompression surgery may be advised.

Peripheral Neuropathy Causes

Peripheral neuropathy has numerous potential causes. It results when peripheral nerves are disrupted or damaged, causing weakness, numbness, and pain. The following is a listed and categorized array of the most significant and common causes:

Medical Conditions

• Diabetes mellitus (most frequent cause globally)
• Chronic kidney disease (uremia)
• Liver disease
• Hypothyroidism
• Autoimmune disorders (e.g., lupus, rheumatoid arthritis, Sjögren's syndrome)

Infections:

• HIV/AIDS
• Hepatitis B and C
• Lyme disease
• Shingles (post-herpetic neuralgia)
• Leprosy

Nutritional Deficiencies

• Vitamin B12 deficiency
• Vitamin B1 (thiamine) deficiency – often associated with alcoholism
• Vitamin B6 toxicity or deficiency
• Vitamin E and niacin deficiencies

Toxins and Medications

• Chemotherapy medications (e.g., vincristine, cisplatin)
• Antibiotics (e.g., metronidazole, fluoroquinolones)
• Excessive alcohol consumption
• Heavy metals (lead, mercury, arsenic)
• Industrial toxins (e.g., solvents)

Inherited Disorders

• Charcot-Marie-Tooth disease
• Hereditary sensory and autonomic neuropathies (HSANs)

Trauma or Nerve Compression

• Carpal tunnel syndrome
• Herniated disc
• Sustained pressure on a nerve (e.g., during surgery, cast, or immobilization)
• Accidents or injuries

Other Causes

• Cancer or tumors compressing nerves
• Paraneoplastic syndromes (immune responses to tumors)
• Idiopathic neuropathy – no known cause (most common in older adults)

Peripheral Neuropathy Diagnosis

Diagnosing peripheral neuropathy includes determining the type, cause, and extent of nerve injury. This is how physicians normally proceed:

Medical History and Physical Exam

• Review of symptoms: Time of onset, location (hands, feet), character of pain, numbness, etc.
• Family history: Presence of inherited conditions such as Charcot-Marie-Tooth
• Lifestyle factors: Alcohol consumption, exposure to toxins, medications
• Underlying medical conditions: Diabetes, autoimmune conditions, infections

Blood Tests

Used to test for:

• Diabetes (HbA1c, fasting glucose)
• Vitamin deficiencies (B12, B6, E)
• Thyroid function (TSH)
• Kidney and liver function
• Autoimmune markers (ANA, RF)
• Infections (HIV, Hepatitis B/C, Lyme disease)

Nerve Function Tests

a. Nerve Conduction Study (NCS)

• Measures how quickly electrical impulses travel through your nerves.
• Helps detect damage in large myelinated fibers.

b. Electromyography (EMG)

• Tests electrical activity in muscles.
• Identifies muscle weakness due to nerve damage.

Imaging Tests

• MRI/CT scan: Eliminate herniated discs, tumors, or nerve compression.
• Ultrasound: Occasionally used to see swelling of nerves.

Nerve or Skin Biopsy (Rare)

• A tiny sample of nerve or skin is removed for microscopic examination.
• Assists in the diagnosis of small fiber neuropathy or vasculitis.

Lumbar Puncture (Spinal Tap) (Occasionally)

• Tests cerebrospinal fluid for infection or inflammation.

Peripheral Neuropathy Supplements

Some supplements can help control peripheral neuropathy, particularly when the condition is due to vitamin deficiencies, diabetes, or oxidative stress. Nevertheless, always see a healthcare professional before taking supplements since improper use can exacerbate symptoms (e.g., excessive vitamin B6).

Best Supplements for Peripheral Neuropathy

• Vitamin B12 (Methylcobalamin): Nerve regeneration support; deficiency is a frequent cause of neuropathy
• Alpha-Lipoic Acid (ALA): Antioxidant; alleviates nerve pain and enhances glucose metabolism
• Acetyl-L-Carnitine: Enhances nerve function and pain relief
• Vitamin B1 (Benfotiamine): Enhances glucose metabolism; can decrease neuropathic pain
• Vitamin B6 (Pyridoxine): Enhances nerve function
• Vitamin D: Deficiency associated with nerve pain and inflammation
• Magnesium: Can relax nerves and decrease cramping
• Omega-3 Fatty Acids (Fish Oil/Algal oil): Anti-inflammatory; can aid in nerve repair
• Curcumin (Turmeric extract): Anti-inflammatory and antioxidant

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