Peripheral neuropathy: the pain inside
Peripheral neuropathy is a condition that results in pain, numbness, and weakness in the body. It is often caused by peripheral nerve damage. In this article, a consultant neurologist explains how peripheral neuropathy occurs, the types and symptoms of peripheral neuropathy, and options for treatment.
What is peripheral neuropathy?
The peripheral nerves are connected to the central nervous system, which is located in the spinal cord. These nerves send information to and from the central nervous system to the limbs, muscles, organs, and glands.
There are many types of peripheral neuropathy – over one hundred. They are categorised under four labels:
- Motor neuropathy, where the damaged nerves are those that control movement and muscles. This affects the arms, hands, legs, feet, and jaw, for example.
- Sensory neuropathy, where the damage is to the nerves that control feeling, such as tactile sensations, pain, and temperature.
- Automatic nerve neuropathy, where the nerves that facilitate unconscious bodily operations like breathing and heartbeat. This is a very serious category of peripheral neuropathy.
- Combination neuropathy, where two or more neuropathies are present.
What causes peripheral neuropathy, and what are the symptoms?
Peripheral neuropathy can arise due to a variety of preexisting conditions that are afflicting the patient, such as diabetes, genetics, physical trauma, autoimmune diseases and infections, tumours, substance abuse, and vitamin deficiencies. There is no one clear reason as to why someone may develop peripheral neuropathy, so it is important for patients and their doctors to do a thorough investigation when symptoms arise.
The symptoms of peripheral neuropathy can vary based on the type that the patient has and where in the body it is occurring, such as:
- Numbness and loss of sensation (which can be as extreme as not noticing major injuries or when other things are wrong in the body)
- Tingling
- Muscular weakness or paralysis
- Cramping and twitching
- Pain like burning
- Loss of muscle or bone density
- Changes in the skin, hair, or nails
- Imbalance
- Disrupted sleep
- Disrupted perspiration mechanisms
- Changes in bowel and urinary habits
- Dizziness, light-headedness, or nausea
- Trouble eating or swallowing (dysphagia)
How is peripheral neuropathy diagnosed?
Because the symptoms of peripheral neuropathy can also occur within other illnesses and ailments, it can complicate the diagnostic process. If a doctor suspects peripheral neuropathy in their patient, they will begin a thorough process of neurological testing to ascertain the location and extent of the nerve damage, which can include testing:
- Blood
- Spinal fluid
- Muscle strength
- Vibration detection
Scans are also often employed to investigate further, such as CT scans, MRI scans, biopsies, and electromyography and nerve conduction studies.
How is peripheral neuropathy treated?
Painkillers and other such medications may be used to help with regaining control over muscles, alleviating pain, and correcting irregular heartbeats. Patients are recommended to improve their diets and their strength with exercise to better support their bodies.
Therapies that can be explored include transcutaneous electrical nerve stimulation (TENS), plasma exchange, intravenous immune globulin, and physical therapy. In rare cases, surgery can be utilised to repair or destroy nerves that are impeding on the patient’s function and comfort.
Peripheral neuropathy, being itself a symptom of an underlying condition, cannot be cured. Treatment will focus on preventing its advancement and addressing the root cause. For some patients, this can take the form of diabetes management, for others it may involve sobriety, and others benefit from a surgery to remove their tumour.