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The most common cause of peripheral neuropathy worldwide is diabetes. And because the obesity crisis has led to increased rates of diabetes, peripheral neuropathy has become more common as well. In fact, it’s estimated that in the United States alone, around 20 million people have some form of neuropathy.

Shanna K. Patterson, MD, director of the Electromyography (EMG) Laboratory at Mount Sinai West & St. Luke’s Hospital, explains just how commonplace the disorder has become: “Before the global epidemic of obesity and diabetes, the most common cause of neuropathy worldwide was leprosy.”

Of course, peripheral neuropathy can have other origins. In fact, there are hundreds of potential causes, says Dr. Patterson. They include:

COMMON

Vitamin deficiencies, such as a deficiency of B1 or B12

Hypothyroidism

RARE

Infections, such as HIV or hepatitis C

Autoimmune conditions like CIDP [CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY]

Toxic effects of chronic alcoholism

Heavy metal poisoning [SUCHAS LEAD]

Certain medications [SUCH AS SOME CHEMOTHERAPY AGENTS]

The good news is that, in some cases, neuropathy can be corrected. This is why it’s important for the cause to be correctly identified.

“Peripheral neuropathy may be reversible (when caused by vitamin deficiencies or certain medication toxicities) or treatable (such as in certain autoimmune conditions),” says Dr. Patterson. “In some cases, if the cause of neuropathy is reversed, nerves can heal over time, and the symptoms of neuropathy can slowly improve—or even resolve.”

A detailed medical history, electrodiagnostic testing (such as EMG and nerve conduction studies) and blood tests can help a physician uncover the source of a patient’s peripheral neuropathy. Unfortunately, there are many cases in which a cause can’t be found. These instances are termed “idiopathic neuropathy.”

“Idiopathic neuropathy is more common than you think,” says Dr. Patterson. “There is some variability be-tween studies, but on average it is reported that around25percent of patients have idiopathic neuropathy.”

WHAT EXACTLY IS PERIPHERAL NEUROPATHY?

Neuropathy can occur when your peripheral nerves have been damaged. The body’s peripheral nerves communicate between the central nervous system and the extremities. Impairment of these nerves can lead to numbness, weakness and pain in certain areas of the body—usually the hands or feet. Where you experience neuropathy depends on which nerve is affected. In some patients, only one nerve is impacted; in others, there may be multiple peripheral nerves that have been damaged.

“The most common presenting symptoms of peripheral neuropathy involve numbness or burning of the toes or feet,” says Dr. Patterson. “However, in some cases, symptoms can begin in the arms, or include weakness instead of sensory symptoms.”

Other symptoms of peripheral neuropathy can include:

Skin sensitivity

Tingling sensations

Heat intolerance

Difficulty walking and coordination problems

Difficulty lifting one or both feet [KNOWN AS “FOOTDROP”]

Blood pressure changes

Many cases of peripheral neuropathy begin gradually; however, the disorder varies from person to person, and some patients may experience a rapid onset of symptoms. The progression of peripheral neuropathy can also be unpredictable, with some patients seeing improvement in symptoms overtime, and others experiencing a worsening of symptoms.

nnThe pain associated with peripheral neuropathy is typically a sharp, stabbing, burning pain. There are a number of options for people dealing with this type of pain. Sometimes simple lifestyle adjustments can make a big impact. “Some patients experience significant relief simply by wearing more comfortable shoes (supportive, but not constricting, and with a rubber or cushioned sole),” says Dr. Patterson. “And because many patients note a worsening of their foot neuropathic pain if their feet are cold, taking measures to keep their feet warm may be helpful.”

In addition, medications can bring relief. For intermittent, localized and modest symptoms, Dr. Patterson suggests over-the-counter topical anesthetic creams or sprays. Some patients, however, may require or a prescription medications.

“These medications work by altering the activity of nerve cells in different ways,” explains Dr. Patterson. Some were initially developed for other conditions that involve abnormal neuronal activity, such as seizures or depression, and were later discovered to benefit neuropathic pain as well.”

A common medication in the treatment of peripheral neuropathy is Lyrica (pregabalin). It isn’t effective for weakness or numbness, but it can be very helpful in curbing the painful burning sensations common to neuropathy. Lyrica can increase sleepiness and dizziness, but many people do not necessarily experience these side effects. Also, for some people who do experience sleepiness, taking the medication at night, instead of during the day, helps eliminate the problem.

“Many times, people notice that their symptoms are worse at night, and may do well with a neuropathic pain medication that can be used in the evening (the side effects of some neuropathic pain medications may also help them sleep),” says Dr. Patterson. “In more severe cases, multiple medications—or a combination of medication and non-medication approaches—are required.”

Certain antidepressants are also prescribed for the treatment of peripheral neuropathy. These not only help decrease pain, but they can also reduce some of the stress and psychological challenges of dealing with chronic pain.

Most patients find some degree of relief with neuropathic pain treatments. If a person’s underlying neuropathy or related symptoms worsen or lessen, treatment options may need to be adjusted.

It’s important to note that there are currently no across-the-board medications that cure neuropathy itself. (There are some treatments for certain specific types of neuropathy related to the immune system). However, research is evolving, and the hope is that researchers will find a compound that will support nerve regeneration.

neuro2ALTERNATIVE APPROACHES TO TREATING NEUROPATHIC PAIN

There isn’t a lot of clinical data to support overall use of alternative therapies in the treatment of peripheral neuropathy. However, there have been many individual cases in which select treatments have been beneficial. It’s best to experiment with the combination of therapies that works best for you, and use them in conjunction with your existing medical treatments. Talk to your doctor before beginning any alternative therapy.

MIND-BODY APPROACHES

Psychological factors—particularly stress—contribute to pain. Mind-body approaches,such as meditation,hypnosis and biofeedback can help reduce this extra burden. Mindfulness-based stress reduction,which combines meditation and yoga, can limit depressive episodes, blood pressure and stress, while contributing to relaxation.

MASSAGE

Massage is an acknowledged way to reduce stress. It may also help alleviate pain, improve range of motion, increase joint flexibility and improve circulation. Note that not all people with peripheral neuropathy are ideal candidates for massage; some may experience increased discomfort.

TAI CHI

If your peripheral neuropathy has caused issues with balance and stability, tai chi may help. A 2010 study published in the American Journal of Chinese Medicine showed that long-term tai chi exercise improved physical performance among people with peripheral neuropathy.

ACUPUNCTURE

A form of Chinese medicine, acupuncture involves having needles, heat or electrical stimulation applied to precise points on the body. Some believe acupuncture can even help control pain and reduce neurological, muscular and digestive problems.

In the interim, for all patients with peripheral neuropathy, providers should consider available treatments to address pain and other symptoms, says Dr. Patterson. “The role of these medications is to make the individual more comfortable and to be able to live as normal a life as possible—which is very important.” {PP}