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Peripheral NeuropathyDefinitionPeripheral neuropathy is damage to the peripheral nerves. These are the nerves that connect your spinal cord to the rest of your body. Peripheral Nerves of the Foot  © 2009 Nucleus Medical Media, Inc. CausesMany diseases and conditions can cause peripheral neuropathy. The damage may occur due to: Diseases that can damage peripheral nerves include:
Compression commonly occurs when nerves are pinched or trapped somewhere along their course, such as:
Toxins that can damage the peripheral nerves include:
Many medications can lead to peripheral neuropathy. A partial list includes:
Other causes of peripheral nerve damage include:
Risk FactorsThese factors increase your chance of developing this condition. Tell your doctor if you have any of these risk factors:
SymptomsDamage to the peripheral nerves often results in sensory (feeling) and motor (strength) symptoms in the:
Other parts of the body can also be affected. Symptoms depend on which nerves are involved. They can range from mild to severe and may seem worse at night. Sensations and pain may occur in the upper or lower limbs and move toward the trunk (eg, from the feet to the calves). Symptoms include:
If untreated, peripheral neuropathy can lead to:
DiagnosisThe doctor will ask about your symptoms and medical history. She will also do a physical exam, which may include:
Additional tests may also include:
TreatmentTreatment may include: Treatment for the Underlying Illness or ExposureTreating the underlying illness can decrease or eliminate symptoms. For instance, if it is caused by diabetes, controlling blood sugar levels may help. In some cases, neuropathy caused by medications or toxins is completely reversed when these substances are stopped or avoided. Correction of vitamin B12 deficiency often improves symptoms. Physical TherapyCertain exercises may help stretch shortened or contracted muscles and increase joint flexibility. In long-standing cases, splinting the joint may be required to protect and rest it, while maintaining proper alignment. Orthotics (supports and braces) may help with:
Maintaining physical activity is also key. MedicationsPrescription and over-the-counter (OTC) pain medications are often used to ease discomfort. Drugs to treat depression and prevent convulsions sometimes relieve neuropathy symptoms. These medications are often given at lower dosages. Commonly used antidepressants include:
Commonly used anticonvulsants may include:
For severe and potentially life-threatening cases (such as Guillain-Barre syndrome ), treatment includes:
Other TherapiesThese therapies are aimed at reducing symptoms and may include:
SurgerySurgery can relieve the pressure on nerves. For example, surgeons commonly release fibrous bands in the wrist to treat carpal tunnel syndrome . Prevention
RESOURCES: American Chronic Pain Association The Neuropathy Association CANADIAN RESOURCES: Canadian Diabetes Association Health Canada References: Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health website. Available at: http://www.niddk.nih.gov/ . Dyck PJ, Thomas PK, Dyck PJ, Thomas PK, eds. Peripheral Neuropathy . 4th ed. Philadelphia, PA: Saunders; 2004. Fermaglich J. Merritt's Neurology . 11th ed. Chicago, IL: Lippincott Williams & Wilkins; 2005. NINDS peripheral neuropathy information page. National Institute of Neurological Disorders and Stroke, National Institutes of Health website. Available at: http://www.ninds.nih.gov/ . Peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed May 12, 2008. Samuels MA, Feske SK. Office Practice of Neurology . Philadelphia, PA: Churchill Livingstone; 2003. Williams O. Introduction to and clinical evaluation of peripheral neuropathies. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. ¹12/20/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine . ²10/5/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Feng Y, Schlösser FJ, Sumpio BE. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50:675-682,682. Last reviewed January 2009 by Rimas Lukas, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Copyright © 2009 EBSCO Publishing All rights reserved.
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