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Peripheral Neuropathy

What is peripheral neuropathy?

Peripheral neuropathy is a problem with the peripheral nerves. The peripheral nerves are all of the nerves outside the brain and spinal cord. They move information from the brain and spinal cord to every other part of the body. They connect your brain and spinal cord to your muscles and allow you to move your muscles. They also conduct sensations such as pain, temperature, and touch to your brain. The nerves connecting to your lungs, digestive system, and other organs are also part of the peripheral nervous system.

When peripheral neuropathy decreases your ability to move one or more muscles, it is also called nerve palsy.

What is the cause?

Peripheral neuropathy can have many causes. Anything that makes it hard for a nerve to work properly can lead to this problem. Some common causes are:

  • Direct injury to the nerve, such as a sports injury
  • Pressure on a nerve caused by:
    • Repetitive use (such as carpal tunnel syndrome)
    • Improper use of crutches
    • An abnormal growth, such as a tumor
  • Diseases such as diabetes, arthritis, lupus, or alcoholism
  • Infections (usually viral, such as herpes or shingles, which is caused by the chickenpox virus)
  • Poisons and some medicines, such as some cancer medicines
  • A lack of vitamins, such as vitamin B-12, or a lack of minerals

What are the symptoms?

The symptoms depend on which nerves are damaged. Possible symptoms include:

  • Muscle weakness
  • Numbness
  • Tingling
  • Pain
  • Being very sensitive to touch
  • Lightheadedness
  • Leaking of urine
  • Bowel problems, such as constipation, diarrhea, or frequent abdominal pain

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. He or she will examine you. You may have a nerve conduction test to check how well your nerves are working. You may have blood tests to look for possible causes, such as diabetes, lupus, or a lack of vitamins.

How is it treated?

The treatment depends on the cause. For example:

  • If the nerve is just bruised after an injury, the symptoms may go away without treatment.
  • If the neuropathy is caused by a disease, such as diabetes or lupus, you may need treatment that controls the disease better.
  • If the cause is a lack of vitamins, your healthcare provider may prescribe vitamin supplements.

The symptoms can be treated with medicines, such as:

  • Nonprescription pain relievers, such as acetaminophen, aspirin, or ibuprofen
  • Prescription nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Medicine that can be put on the skin and numb the skin (lidocaine) or block pain (capsaicin)
  • Medicine that also treats seizures
  • Antidepressant medicines that can help relieve pain

Some other possible treatments for nerve pain are:

  • Biofeedback, which is a way to learn to control your body's responses with your mind
  • Relaxation methods
  • Heat or ice
  • Physical therapy to help you with an exercise program
  • Counseling to help you learn ways to cope with the pain
  • TENS (transcutaneous electrical nerve stimulation), which is a device that uses electrodes on the skin to send small electrical impulses to your nerves to block pain
  • Shots of local anesthetics, steroids, or other medicines to block pain signals or decrease irritation of the nerves
  • Acupressure or acupuncture
  • Massage
  • In severe cases, surgery to cut the nerve causing the pain

If the standard treatments do not provide relief, your healthcare provider may refer you to a pain management specialist. A counselor may also be able to help you learn ways to cope with the pain.

Try hard to avoid taking narcotic pain medicine for neuropathic pain. As your body gets used to the medicine, you may need higher and higher doses to get the same effect. This can become a serious long-term problem if you are taking the medicine for a chronic pain condition. Narcotic medicine may also cause sleepiness and other unpleasant side effects, such as constipation. In high doses the medicine may cause trouble breathing and even death, especially combined with alcohol. If you do start taking narcotic pain medicine, your healthcare provider may ask you to sign an agreement about how you will and won’t use this addictive medicine.

How long will the effects last?

Peripheral neuropathy caused by an injury usually lasts from a few days to several weeks, depending on the injury, but in some cases it can be permanent. When the problem is caused by diabetes and another chronic disease, it tends to not go away completely. However, it may get better with treatment of the disease and with medicine that helps lessen nerve pain. Neuropathy caused by a viral infection, such as shingles, may or may not go away with time. Prompt treatment of the shingles can help prevent long-term pain.

How can I take care of myself?

If you have a disease, such as diabetes, the best way to take care of yourself is to follow your healthcare provider's advice. Be sure to take your medicines as prescribed. If the cause of your neuropathy is an injury, the best thing you can do is to try to protect against further injury.

Be cautious if you are taking a nonprescription pain reliever. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin and ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take NSAIDs for more than 10 days for any reason. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome.

How can I help prevent neuropathy?

Sometimes it’s hard to avoid injuries that cause neuropathy. Seatbelts, helmets, and proper workplace safety equipment are a good start. Home accident prevention is also important. Pay attention to how you use your computer so you can prevent carpal tunnel syndrome. If the problem is caused by a disease, carefully follow your healthcare provider’s treatment plan. For example, neuropathy caused by diabetes can be prevented or delayed with good control of blood sugar. Follow your provider's advice and take your medicines as prescribed. Eat a healthy diet that includes fruits, vegetables, whole grains, and lean meat to give you enough vitamin B-12, and stay physically active.

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