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Peripheral neuropathy (peripheral neuritis) : Symptoms, Causes, Diagnosis and Treatment

What is Peripheral neuropathy?

Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body.

Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. The peripheral nerves also send sensory information to the central nervous system.

Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes.

People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. Your peripheral nervous system connects the nerves from your brain and spinal cord, or central nervous system, to the rest of your body. This includes your:

  • arms
  • hands
  • feet
  • legs
  • internal organs
  • mouth
  • face

The job of these nerves is to deliver signals about physical sensations back to your brain.

Peripheral neuropathy is a disorder that occurs when these nerves malfunction because they?re damaged or destroyed. This disrupts the nerves? normal functioning. They might send signals of pain when there?s nothing causing pain, or they might not send a pain signal even if something is harming you. This can be due to:

  • an injury
  • systemic illness
  • an infection
  • an inherited disorder

Diabetes is a leading cause of neuropathy in the United States, although there are many other causes too. Some cases of neuropathy can be easily treated and sometimes cured. If neuropathy can?t be cured, treatment is aimed at controlling and managing symptoms and preventing further nerve damage.

Peripheral neuropathy is also known as peripheral neuritis. Peripheral neuropathy belongs under the category of Nerve disorder. Sensory nerves, Motor nerves, Autonomic nerves, etc are some common types of Peripheral neuropathy. Generally Male, Female, Child are the victim of the Peripheral neuropathy. Seriousness of this disease is Medium.

Symptoms of Peripheral neuropathy are :

  • digestive difficulty
  • Low Blood Pressure
  • thinning of the skin
  • tingling or numbness in the feet
  • tingling or numbness in the hands
  • Pain during sex
  • Intercourse pain, or dyspareunia, can cause problems in a couple's sexual relationship. In addition to the physically painful sex occurs just before, during or after intercourse, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

  • a choking sensation
  • pain, numbness in hand and fingure
  • constipation
  • diarrhea
  • Diarrhea is characterized by loose, watery stools or a frequent need to have a bowel movement. It usually lasts a few days and often disappears without any treatment. Diarrhea can be acute or chronic.

    Acute diarrhea occurs when the condition lasts for one to two days. You might experience diarrhea as a result of a viral or bacterial infection. Other times, it could be due to food poisoning.

    There?s even a condition known as traveler?s diarrhea, which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.

    Chronic diarrhea refers to diarrhea that lasts for at least four weeks. It?s usually the result of an intestinal disease or disorder, such as celiac disease or Crohn?s disease.

  • sweating
  • Excessive sweating is when you sweat more than you might expect based on the surrounding temperature or your activity level or stress. Excessive sweating can disrupt daily activities and cause social anxiety or embarrassment.

    Excessive sweating, or hyperhidrosis (hi-pur-hi-DROE-sis), can affect your entire body or just certain areas, particularly your palms, soles, underarms or face. The type that typically affects the hands and feet causes at least one episode a week, during waking hours.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

    Causes

    Peripheral neuropathy can be caused due to:

    Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Health conditions that can cause peripheral neuropathy include:

    • Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
    • Diabetes. More than half the people with diabetes develop some type of neuropathy.
    • Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.
    • Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
    • Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.
    • Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.
    • Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).

    Other causes of neuropathies include:

    • Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
    • Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.
    • Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
    • Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
    • Vitamin deficiencies. B vitamins ? including B-1, B-6 and B-12 ? vitamin E and niacin are crucial to nerve health.

    What kind of precaution should be taken in Peripheral neuropathy?

    Manage underlying conditions

    The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis.

    Make healthy lifestyle choices

    These habits support your nerve health:

    • Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you're vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but talk to your doctor about B-12 supplements.
    • Exercise regularly. With your doctor's OK, try to get at least 30 minutes to one hour of exercise at least three times a week.
    • Avoid factors that may cause nerve damage, including repetitive motions, cramped positions that put pressure on nerves, exposure to toxic chemicals, smoking and overindulging in alcohol.

    How it can be spread?

    Over time it gradually starts to affect shorter nerves, so feels as if it's spreading upwards, and later affects the hands.

    Treatment for the Peripheral neuropathy

    Diagnosis:

    Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:

    • A full medical history. Your doctor will review your medical history, including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases.
    • Neurological examination. Your doctor might check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

    Tests

    Your doctor may order tests, including:

    • Blood tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy.

    • Imaging tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities.

    • Nerve function tests. Electromyography (EMG) records electrical activity in your muscles to detect nerve damage. A thin needle (electrode) is inserted into the muscle to measure electrical activity as you contract the muscle.

      At the same time as an electromyogram, your doctor or an EMG technician typically performs a nerve conduction study. Flat electrodes are placed on the skin and a low electric current stimulates the nerves. Your doctor will record your nerves' responses to the electric current.

    • Other nerve function tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test that measures your body's ability to sweat, and sensory tests that record how you feel touch, vibration, cooling and heat.

    • Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.

    • Skin biopsy. Your doctor removes a small portion of skin to look for a reduction in nerve endings.

    Treatment:

    Treatment begins by identifying and treating any underlying medical problem, such as diabetes or infections.

    Some cases of neuropathy can be easily treated and sometimes cured. Not all neuropathies can be cured, however. In these cases, treatment is aimed at controlling and managing symptoms and preventing further nerve damage. Treatment options include the following:

    • Medicines can be used to control pain. A number of different medications contain chemicals that help control pain by adjusting pain signaling pathways within the central and peripheral nervous system. These medications include:
      • Antidepressants such as duloxetine or nortripyline.
      • Antiseizure medicines such as gabapentin (Neurontin®, Gralise®) and pregabalin (Lyrica®).
      • Topical (on the skin) patches and creams containing lidocaine (Lidoderm®, Xylocaine®) or capsaicin (Capsin®, Zostrix®).
      • Narcotic medications are not usually used for neuropathy pain due to limited evidence that they are helpful for this condition.
    • Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
    • Occupational therapy can help you cope with the pain and loss of function, and teach you skills to make up for that loss.
    • Surgery is available for patients with compression-related neuropathy caused by such things as herniated disc in back or neck, tumors, infections, or nerve entrapment disorders, such as carpal tunnel syndrome.
    • Mechanical aids, such as braces and specially designed shoes, casts and splints can help reduce pain by providing support or keeping the affected nerves in proper alignment.
    • Proper nutrition involves eating a healthier diet and making sure to get the right balance of vitamins and other nutrients.
    • Adopting healthy living habits, including exercising to improve muscle strength, quitting smoking, maintaining a healthy weight, and limiting alcohol intake.

    Other treatments

    • Transcutaneous electrical nerve stimulation (TENS): This treatment involves placing electrodes on the skin at or near the nerves causing your pain. A gentle, low-level electrical current is delivered through the electrodes to your skin. Treatment schedule (how many minutes and how often) is determined by your therapist. The goal of TENS therapy is to disrupt pain signals so they don?t reach the brain
    • Immune suppressing or immune modulating treatments: Various treatments are used for individuals whose neuropathy is due to an autoimmune disease. These include oral medications, IV infusion treatments, or even procedures like plasmapheresis where antibodies and other immune system cells are removed from your blood and the blood is then returned to your body. The goal of these therapies is to stop the immune system from attacking the nerves.
    • Complementary treatments: Acupuncture, massage, alpha-lipoic acid, herbal products, meditation/yoga, behavioral therapy and psychotherapy are other methods that could be tried to help relieve neuropathic pain. Ask your doctor if any of these therapies might be helpful for treating the cause of your neuropathy.

    Possible complication with Peripheral neuropathy

    Complications of peripheral neuropathy can include:

    • Burns and skin trauma. You might not feel temperature changes or pain on parts of your body that are numb.
    • Infection. Your feet and other areas lacking sensation can become injured without your knowing. Check these areas regularly and treat minor injuries before they become infected, especially if you have diabetes.
    • Falls. Weakness and loss of sensation may be associated with lack of balance and falling. Other complications with neuropathy are :

    Diabetic foot ulcer

    A diabetic foot ulcer is an open wound or sore on the skin that's slow to heal. These are common in people with diabetic polyneuropathy.

    If you have numb feet, it's easy to cut your foot by stepping on something sharp.

    An ulcer can also come on if you unknowingly develop a blister caused by badly fitting shoes.

    If you do not feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer.

    High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted.

    A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene.

    Gangrene

    If you get a wound infection in one of your feet as a result of peripheral neuropathy, there's a risk this could lead to gangrene.

    If gangrene does develop, you may need surgery to remove the damaged tissue and antibiotics to treat any underlying infection.

    In severe cases, your toe or foot may need to be amputated.

    If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist, a medical professional (also known as a chiropodist) who specialises in foot care.

    Read more about preventing gangrene and taking care of your feet if you have diabetes.

    Heart and blood circulation problems

    Cardiovascular autonomic neuropathy (CAN) is a potentially serious heart and blood circulation problem that's common in people with diabetic polyneuropathy.

    CAN happens when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat.

    The 2 main noticeable symptoms of CAN are:

    • an inability to exercise for more than a very short period of time
    • low blood pressure that can make you feel dizzy or faint when you stand up

    Treating CAN

    You may be able to control the symptoms of low blood pressure by:

    • standing or sitting up slowly and gradually
    • drinking plenty of fluids to increase the volume of your blood and raise your blood pressure
    • wearing compression stockings to help prevent blood falling back down into your legs
    • tilting your bed by raising it at the head end

    In some cases, you may need to take medicine for low blood pressure. These are most likely to be:

    • fludrocortisone, which works by increasing the volume of your blood
    • midodrine, which works by tightening your blood vessels

    A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest, where your heart stops beating altogether.

    You may be prescribed medicine to help regulate the beating of your heart, such as flecainide, beta blockers or amiodarone, to prevent this.

    If you have CAN, you'll probably need to have regular check-ups so your heart function can be monitored.

    References:

    1 https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 2 https://www.healthline.com/health/peripheral-neuropathy#treatments 3 https://www.medicalnewstoday.com/articles/147963#treatment 4 https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics##1 5 https://my.clevelandclinic.org/health/diseases/14737-neuropathy/management-and-treatment 6 https://www.nhs.uk/conditions/peripheral-neuropathy/complications/ 7 https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/peripheral-neuropathy#complications-of-peripheral-neuropathy

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