Peripheral Neuropathy

 

 

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Studies reveal that 1 in 10 people above the age of 55 living in the UK, suffer from peripheral neuropathy.

Peripheral neuropathy (PN) is a medical condition characterised by damage, or destruction of the peripheral nerves i.e. the nerves that are found outside the brain and the spinal cord. These include the nerves of the arms, legs, hands, feet, internal organs, mouth and face.

How Does Peripheral Neuropathy Occur?

To understand how PN develops, you must first get a basic understanding of the anatomy of the nervous system and the functions of its components.

The human body is made up of the nervous system, which is responsible for receiving information about the environment around us and generating responses to that information. For example, when you touch a hot plate, you instinctively withdraw your hand from it. Sensing that the plate is warm is how your body collects information and withdrawing your hand is how your body generates responses to that information.

The nervous system is made up of two subsystems – the peripheral nervous system (PNS) and the central nervous system (CNS). The CNS comprises the brain and the spinal cord. The PNS is the extensive network of nerves that connects the CNS to the peripheries, such as the muscles of the body. Damage of the peripheral nerves is what gives rise to peripheral neuropathy.

Causes And Risk Factors Of Peripheral Neuropathy

Nerve damage in PN can be caused by different factors, such as:

Uncontrolled Diabetes

Uncontrolled diabetes is one of the most common causes of peripheral neuropathy. Experts agree that around 60-70% of patients suffering from diabetes suffer from nerve problems. Researchers suggest that this may be due to the damaging effects that high levels of blood sugar have on the walls of the blood vessels. These vessels bring nutrient-rich blood to the peripheral nerves.

Heavy Alcohol Intake

Alcohol is toxic to nerve tissues. Heavy consumption of alcohol can cause nerve damage. This can be attributed in part to the nutritional deficiencies that come along with drinking too much alcohol, such as deficiencies in the B12 vitamin. B12 is a key ingredient needed by the body for optimal nerve health.

Physical Trauma

Injuries to the peripheral nerves can result in damage and either a decrease in function, or a total loss of function of the nerves. Such injuries include accidents, fractures, falls, or even prolonged sitting in a wheelchair.

Exposure To Toxins

Certain toxins found in organic solvents, insecticides and heavy metals have been identified as potential causes of PN damage.

Infections

Viruses such as HIV, EBV, herpes simplex, VZV and certain bacteria can cause nerve damage.

Autoimmune Conditions

Rheumatoid arthritis and lupus are autoimmune illnesses that can result in serious inflammation of the nerves leading to PN.

Medications

Medications have also been found as potential causative agents in the development of peripheral neuropathy, particularly antibiotics, anticonvulsants, antiretroviral agents and chemotherapeutic drugs.

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Every nerve that makes up the body carries out a different function. Hence, symptoms will vary depending on which nerve is affected. Nerves can be categorised into three different types:

• Sensory nerves which are responsible for detecting sensations, such as pain, temperature and touch.
• Motor nerves that control the movement of muscles.
• Autonomic nerves which are nerves that control automatic functions, such as regulating heart rate, digestion and the bladder.

The most common symptoms of peripheral neuropathy are:

• Numbness, tingling and prickling sensations in the feet, hands, arms, or legs
• Sharp throbbing, or burning pain
• Feeling like you are wearing gloves and socks despite not wearing any
• Increased sensitivity to touch
• Loss of sensation especially in the extremities
• Loss of coordination
• Falls.

Damage to the motor nerves may present with:

• Paralysis
• Muscle weakness, especially in the feet.

Damage to autonomic nerves may present with the following:

• Digestive problems
• Bowel and bladder issues
• Intolerance to heat
• Excessive sweating, or inability to sweat
• Changes in blood pressure.

Diagnosing Peripheral Neuropathy

To diagnose peripheral neuropathy, your doctor will first conduct a thorough physical examination to assess your general health status and the health of your nerves. After the examination, your doctor may request additional tests to rule out other possible diagnoses.

Below are the tests that are usually requested to rule out other conditions and reach a clear diagnosis of PN:

• General blood tests – including red blood cell counts, white blood cell counts and routine glucose levels.
• Additional blood tests – including vitamin levels, particularly B vitamins and advanced glucose tests such as HBA1c.
• Imaging tests – your doctor may find it necessary to request a CT scan, or an MRI of the affected area. Imaging tests help doctors identify significant problems like a disc herniation pressing onto a nerve, or even a tumour.
• Nerve conduction studies to assess the ability of your nerves to carry messages properly through electrodes that are placed onto the skin.
• Nerve biopsy – requesting a nerve biopsy is rare.

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Peripheral neuropathy can interfere with the daily functioning of a person. Fortunately, there are various strategies you can adopt to reduce the symptoms. It is important to note that not all types of neuropathy can be cured. The chances of healing depend on the symptoms, extent and the underlying cause of the neuropathy.

Here are some doctor-approved tips on how to manage peripheral neuropathy:

Control Your Blood Sugar Levels

If you suffer from diabetes, one of the most effective methods to prevent the progression of peripheral neuropathy is to keep your blood glucose level under control. You should adopt new healthy lifestyle habits, such as consuming a low glycaemic index diet, cut down on sugary foods and refined carbohydrates, increase your intake of fibre, and control your stress levels. The NHS provides detailed information about what to eat and what not to if you suffer from diabetes mellitus.

Take Care Of Your Feet

Taking care of your feet can bring tremendous benefits if you have diabetic neuropathy. Start by checking your feet daily for cracks, blisters, sores, dry skin, and redness. With neuropathy, some people may not experience pain, itching, or any discomfort even if they have foot injuries. Leaving foot injuries untreated can have drastic consequences, such as serious foot infections, foot ulcers, and at worst, gangrene.

Also, try getting into the habit of checking in between your toes, as the interdigital spaces are places for fungi. If you notice a white film and cracks that itch between your toes, it may be a sign of fungal infection. Put talcum powder in between your toes to keep the spaces dry and consult a physician if the cracks enlarge, and itching becomes persistent.

Trim your nails daily, wear socks and shoes that fit correctly. You may also find it helpful to go for regular foot care check-ups at a podiatric centre. Podiatrists are medical professionals who have been trained to provide foot care treatments.

Eat Vitamin-rich Meals

Peripheral neuropathy that occurs due to nutritional deficiencies can be managed by replenishing the body with the nutrients it lacks.

The B vitamins are a group of essential vitamins that play a significant role in the maintenance of a healthy brain and nervous system.

B6 helps in maintaining the protective covering of nerve fibres and also promotes cognitive development. Vitamin B1 helps in the healthy functioning of the nerves. Vitamin B12, also known as cobalamin, plays a crucial role in the formation of healthy nerve cells. Leaving vitamin B12 deficiency untreated can lead to permanent damage of the nerves.

You can replenish your levels of vitamin B by consuming more vitamin-rich foods. Vitamin B1 can be found in whole-grain cereals, beans, sunflower seeds, pork, and beef. Vitamin B12 can be found in trout, mackerel, almonds, shiitake mushrooms, milk, and dairy products. Rich sources of vitamin B6 include sunflower seeds, milk, fish, chicken, beef liver, sweet potatoes, pistachios, and spinach. Your doctor may also recommend taking supplements if he suspects that nutritional deficiencies are at the core of your condition.

Avoid Prolonged Pressure

Peripheral neuropathy triggered by prolonged sitting, bending and slouching can be resolved if you change your posture and avoid any of the activities that put pressure on your nerves.

Use Supports, Braces And Splints

Ergonomic leg, wrist, or arm supports, such as splints and casts, can help you in case neuropathy affects the function of your legs, arms and wrists. Using splints can help you cope with muscle weaknesses. If you have been diagnosed with neuropathy due to carpal tunnel syndrome, you may benefit greatly from a cast, or splint, that holds your wrist in place to reduce compression on the median nerve.

Manage Neuropathic Ppain

If you experience neuropathic pain that occurs in a specific area, you can find some relief by applying capsaicin cream. Capsaicin works by inhibiting the nerves from transmitting pain messages to the brain. A recent analysis published in Clinical Therapeutics concluded that the application of a capsaicin 8% patch brings similar benefits to that of oral medications used in the management of neuropathic pain, but with fewer side effects.

Seek Professional Medical Help

It is of utmost importance to seek medical assistance early, as a delay may lead to the complete loss in function of the damaged nerve. The medical treatment of peripheral neuropathy depends greatly on its cause.

For structural causes, such as nerve compression due to tumours, your general practitioner will refer you to a qualified surgeon for removal of the mass.

For metabolic causes, such as uncontrolled diabetes mellitus, your physician will prescribe medications to keep your glucose levels under control.

Since nerve-related pain does not usually get better with mainstream painkillers, such as paracetamol, doctors often prescribe particular painkillers known as neuropathic agents. Neuropathic painkillers include amitriptyline, duloxetine, pregabalin and gabapentin. 

 

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The Pain Relief Foundation was founded in 1979 and is a registered charity run by a dedicated, hard-working team of healthcare professionals that promote research about the causes and treatment of chronic pain in humans. Click here to visit the Pain Relief Foundation website.

Diabetes UK is a registered charity in England, Wales, and Scotland that provides support, hope, and evidence-based information to patients suffering from diabetes and its complications, including peripheral neuropathy. Visit Diabetes UK here.

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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.

Autoimmune – autoimmune conditions are those in which the body’s immune system produces autoantibodies that attack normal body tissues.

Carpal tunnel syndrome – is a medical condition that occurs secondary to the compression of the median nerve found within the area of the wrist. It usually occurs in people whose work-related tasks involve repetitive wrist movements, such as the daily tasks of cashiers and hairdressers.

HBA1C – also known as glycated haemoglobin test, is a particular test that determines the average blood glucose level of a patient over the past 3 months.