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Peripheral Neuropathy

 

Medical Author: Standiford Helm II, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

What is a peripheral neuropathy?

Peripheral neuropathy is disorder of nerve(s) apart from the brain and spinal cord. Patients with peripheral neuropathy may have tingling, numbness, unusual sensations, weakness, or burning pain.

What causes a peripheral neuropathy?

There are many possible causes of peripheral neuropathy, including:

1.     Diabetes Mellitus

2.     Shingles (post herpetic neuralgia)

3.     Vitamin deficiency, particularly B12 and folate

4.     Alcohol

5.     Autoimmune diseases, including lupus, rheumatoid arthritis or Guillain-Barre syndrome

6.     AIDS, whether from the disease or its treatment, syphilis, and kidney failure

7.     Inherited disorders, such as amyloid polyneuropathy or Charcot-Marie-Tooth disease

8.     Exposure to toxins, such as heavy metals, gold compounds, lead, arsenic, mercury, and organophosphate pesticides

9.     Cancer therapy drugs such as vincristine (Oncovin, Vincasar), and other medications [for example antibiotics such as metronidazole (Flagyl), and isoniazid (Nydrazid, Laniazid)]

While diabetes and post herpetic neuralgia are the most common causes of peripheral neuropathy, often times no cause is found. In these situations, it is referred to as idiopathic peripheral neuropathy.

Sometimes, peripheral nerve entrapments, such as carpal tunnel syndrome, are considered peripheral neuropathies. In these cases, pressure on the nerve rather than a disease state leads to nerve malfunction.

 

Is there any treatment for peripheral neuropathy?

The treatment for peripheral neuropathy depends on its cause. The first step in treatment is, therefore, to look for the cause.

  • Vitamin deficiencies can be corrected.
  • Diabetes can be controlled, although control may not reverse the neuropathy. The goal with diabetes is early detection to prevent the occurrence of neuropathy.
  • Neuropathies that are associated with immune diseases can improve with treatment of the autoimmune disease.
  • Neuropathy caused by nerve entrapment can be treated by physical therapy, injections or surgery.
  • Prompt treatment with sympathetic injections can minimize the chance of shingles progressing to post herpetic neuralgia.

If a specific treatment isn't available, the pain of the neuropathy can usually be controlled with medications. The simplest treatment is acetaminophen, ibuprofen, or aspirin. Tricyclic antidepressants such as amitriptyline (Elavil) and anti-seizure medications, such as carbamazepine (Tegretol) have been used to relieve the pain of neuropathy. Capsaicin, the chemical responsible for chili peppers being hot, is used as a cream to help relieve the pain of a peripheral neuropathy. Pregabalin (Lyrica) has recently been approved by the FDA for the treatment of post herpetic neuralgia and diabetic peripheral neuropathy, while duloxetine (Cymbalta) has been approved for diabetic peripheral neuropathy. The addition of these drugs to our set of tools to treat peripheral neuropathy is very exciting and indicates the interest in this area.

If you believe you have a peripheral neuropathy, you should contact your healthcare practitioner since many causes of peripheral neuropathy can be successfully treated.

Peripheral Neuropathy At A Glance

 

I am disabled with peripheral neuropathy; I am on the highest doses of a series of medicine. We started at the lowest dose and each would work for a time and the pain would come back worse. Not just in my feet and legs although this is where it started. Mine is idiopathic neuropathy. For the last 2 months my feet swelled, mostly on the left side. Now they aren't swelling as much but the pain is unbearable and it is difficult to walk. The ankle on the left still swells, a lot of the time it feels like I have wide straps wrapped around the middle of the foot and pain shoots up and down the inside of toes and legs. I am under the care of a neurosurgeon and my family doctor. I just thought you might have some advice, since we seemed to be at the end of the rope. Published: July 15 ::

I have peripheral neuropathy as the result of a nerve being compressed during a spinal fusion surgery. It has been a year now, and I still have the pins and needles, bee sting, electric shock and shooting pain sensations in my leg and foot as well as the loss of sensation and hyper sensation of the skin. I currently take 100 mgs of Lyrica three times a day. I will be undergoing a trial using a spinal stimulator that will hopefully lower the level of pain that I have. Then, if it helps, it will be permanently implanted in my spine. Published: July 07 ::

I have peripheral neuropathy and have been taking Lyrica (75 mg, three times a day) for three years. I am always tired and depressed because it is not going away. It is most prevalent in the months when I have to wear closed shoes. My family does not understand the pain and anxiety I go through every day. They cannot see it, so they don't believe it. I am currently going to a chiropractor and am hoping that he will align my spine and neck to bring me back to what I was before. He uses manual adjustments with the neck and spine. Published: July 16 ::

It began to have problems about 5 years ago, my hands and feet tingling and muscle spasms, they came and went but never stayed long, then a year ago I had problems with my right leg going numb from the thigh down and not being able to stand or walk on it. That lessened and moved to my hands, then to my feet working its way up my legs all the way to my lower back, not in the joints mid muscle with loss of feeling and sensations. Then it went to my hands with weakness and cramping. At times the pain is overwhelming and I get no relief from any of the medications prescribed so far. I want it to end one way or the other. Published: July 15 ::

I have pain mostly on my left side of body. It's sharp pain although it has an accompanied sensation which is very disturbing and hard to tolerate. This sensation is like the feeling you get when you scratch your finger nails on a black board. I also get pins and needles along my arms and burning sensation mostly on my palms but at times it is all over including my tongue. When I am depressed, stressed or worried the symptoms seems to increase. This is a problem because I am fatigued from the feeling. I am booked in to see a pain specialist and neurologist in the future but I need something now. Has anybody had same experience symptoms and what helped? Published: July 14 ::

I began to have problems about 5 years ago, my hands and feet tingling and muscle spasms, they came and went but never stayed long, then a year ago I had problems with my right leg going numb from the thigh down and not being able to stand or walk on it. That lessened and moved to my hands, then to my feet working its way up my legs all the way to my lower back, not in the joints mid muscle with loss of feeling and sensations. Then to my hands again with weakness and cramping. At times the pain is overwhelming and I get no relief from any of the medications prescribed so far. I want it to end one way or the other. Published: July 14 ::

Four years ago I started getting burning feet and lower legs which occurs daily with varying degrees of intensity and is worse at night, often waking me up. I have had extensive tests and no cause could be established. I take Vitamin B complex but this does not seem to help. I am reluctant to take painkillers as I was told they need to be taken continuously. At the time it started I was taking Ciprofloxacin for Prostatitis. Does anyone have similar burning pains and have the found any way to emliminate the symptoms? Published: July 09 ::

I have severe pains in my hands with numbness and tingling. Three doctors have said they don't know what is causing it. A diabetic relative told me to look up peripheral neuropathy on the web and sure enough it looks like what I have. I am not diabetic. I am seeing my internal medical doctor tomorrow about this. I recently had cancer and was taking chemo. It looks like the chemo might have been the cause of this. Published: June 26 ::

I’m a 41 year old male and have been diagnosed with Bilateral Peripheral Neuropathy since 2007 & had both the NCV and EMG tests. I also had been diagnosed with Diabetes Mellitus since 2000. I find that I get pain during and after exertion and weight applied. This resembles extreme sharp pain & cramping in my lower ankles and feet, to the point of not being able to continue walking or standing. I was told by physician to keep hydrated, get off my feet and keep them elevated, and he prescribed a drug called Lyrica. This does help somewhat even though the nerve damage is irreversible. However, with Diabetics its also about getting those High glucose readings below 120, so no further damage occurs.