Peripheral Neuropathy: Types, Causes, & Treatments
While “peripheral” means on the edge of something, your peripheral nervous system is so much more than just the edges. It encompasses your entire nervous system outside of the brain and spinal cord. Your smile is your peripheral nervous system at work, as is a friendly wave to a friend or goosebumps from a sudden chill. Peripheral neuropathy is damage or disease to this critical nerve network, and although it can noticeably impact your quality of life, it can be manageable and improve with treatment.
What Is Peripheral Neuropathy?
"Neuropathy" means nerve damage, and peripheral neuropathy is damage to any of the nerves in the complex networks outside of your brain and spinal cord. Due to the complexity of the peripheral nervous system, there are many different and unrelated ways that peripheral neuropathy can present itself, including carpal tunnel syndrome, dizziness, and digestive problems. However, it typically affects the hands and lower legs and feet.
Peripheral neuropathy affects about 2.4% of the population. This prevalence increases in those who are 55 years and older to about 8%. The prognosis for this condition depends on the type of neuropathy. Axonal degeneration (nerve cell damage) is less damaging than demyelination (nerve coating damage), which can be reversed.
Stages and Types of Peripheral Neuropathy
There are more than 100 different types of peripheral neuropathy. Each type has identifiable symptoms and a type-specific prognosis.
There are three main types of peripheral neuropathy:
- Autonomic neuropathy: This type occurs when there's damage to your autonomic nerves, which control bodily functions, such as heart rate and digestion.
- Motor neuropathy: This type occurs when there's damage to your motor nerves, which control your muscles.
- Sensory neuropathy: This type occurs when there's damage to your sensory nerves, which receive sensory information, such as touch, temperature or vibration, from your skin.
Diagnosticians classify the types of peripheral neuropathy according to the amount of damage they do. Doctors refer to neuropathies that damage only one nerve as mononeuropathies and those that damage more than one nerve as polyneuropathies.
The type of peripheral neuropathy determines how the nerve cells are damaged. Some forms of damage involve the long part of the cell, called the axon, while others occur in the nerve coating, or myelin sheath. Cells can also have both demyelination and axonal damage.
Symptoms and Causes
You can either inherit peripheral neuropathy or develop it. Some causes include:
- Repetitive stress
- Autoimmune disease
- Small vessel disease
- Metabolic disorder
- Exposure to toxins
Symptoms depend on the type of nerves involved. Muscle weakness, cramping, twitching and reduced reflexes suggest motor nerve neuropathy.
Sensory nerves have a broader range of functions, so their damage results in a greater variety of symptoms such as:
- Decreased sensation or numbness, especially of the limbs, hands, and feet
- Reduced reflexes
- Poor coordination
- Loss of balance
- Reduced sensitivity to pain or temperature
- Lessened awareness of injury symptoms
- Heightened sensitivity to pain
Damage to autonomic nerves, or those that control your organs, can cause diverse symptoms such as:
- Heat intolerance
- Poor bladder control
- Dizziness or fainting
- Irregular heartbeat
Prevention and Risk
Your risk of developing peripheral neuropathy increases if certain factors are present, such as a family history of it. Other factors include certain diseases and health issues:
- Autoimmune disease
- Kidney problems
- Liver problems
- Thyroid problems
- Infections like Lyme disease or Hepatitis C
Some lifestyle factors can also lead you to develop peripheral neuropathy, such as:
- Exposure to toxins
- Repetitive motions (may be job- or sports-related)
- Vitamin deficiency
While you can't prevent some types of peripheral neuropathy, like those that are genetic in origin, you can avoid other types. You can:
- Prevent diabetic neuropathy with strict blood glucose control.
- Avoid alcoholic neuropathy with abstinence from alcohol, which is toxic to nerve tissue.
- Stop vitamin deficiency neuropathy with proper diet or supplementation.
Diagnosis and Tests
Since the symptoms of peripheral neuropathy are so varied, you may require extensive testing to rule out other medical conditions or identify underlying causes that are contributing to your nerve damage. After taking a thorough medical history, your doctor may conduct tests such as:
- Neurological exam, including reflexes, muscle strength, coordination, posture, and sensory responses.
- Blood test to check for nutrient levels, toxins, and immune system function.
- Genetic test in which a blood sample is taken for gene analysis to see if your neuropathy is hereditary.
- Cerebrospinal fluid test, via a lumbar puncture, to assess for an autoimmune disorder.
- Biopsies, or surgical removal of small tissue samples, to check for demyelination and axon degeneration.
- Nerve conduction test to check nerve function done using electrodes placed on the skin.
The testing your doctor does will assist with arriving at a correct diagnosis by determining the types of nerves that are damaged and the extent of that damage.
Treatment, Procedures, and Medication
If you have any symptoms of or risk factors for peripheral neuropathy, start with a visit to your family doctor. They can begin the diagnostic process with a physical exam, blood work, and urine analysis. Your doctor can then refer you to a neurologist who specializes in this condition and who can order more specific tests. If your neuropathy is related to nutrition, enlist the aid of a nutritionist who can make recommendations to ensure all your dietary needs are met.
The primary goals of treating peripheral neuropathy are to manage symptoms and resolve any underlying condition. If the affected nerve cells are still alive when treatment is administered, axons can regrow and lead to a reduction in symptoms.
Medications commonly used to ease neuropathy symptoms include the following:
- Pain relievers
- Topical treatments such as capsaicin cream
- Anti-seizure medication
Therapies for the treatment of peripheral neuropathy include:
- Transcutaneous electrical nerve stimulation (TENS), which uses an electrical current to provide pain relief by blocking pain signals and by producing endorphins
- Physical therapy
- Plasma exchange
- Intravenous immune globulin
You can also gain symptom relief from alternative medicine treatments, including acupuncture, amino acids, herbs and alpha-lipoic acid.
Healthy Lifestyle Tips
Lifestyle can make a significant impact on the progression or reversal of peripheral neuropathy. Maintain a healthy weight, eat well and stay active. Exercising helps nerve health by improving muscle strength and size. Manage your digestive functioning with dietary strategies. Avoid alcohol, cigarettes, and exposure to other toxins.
If you have reduced pain sensation, be vigilant about checking for wounds or injuries that need treatment.
If your peripheral neuropathy stems from diabetes, pay close attention to your blood glucose levels. Stable blood sugar can ease your symptoms and reduce the chance of further nerve damage.
Nutrition is vital for the growth and maintenance of your nervous system, which is why malnutrition can cause peripheral neuropathy. An imbalanced diet, excessive alcohol use, and inadequate Vitamin B12 intake can all compromise the health of your nerves and lead to deterioration. Vitamin B12 is crucial for nerve health. You can find it in eggs, red meat, poultry, fish, and dairy. If your diet is regularly low in these items, ask your doctor about a B12 supplement.
Certain foods can also make peripheral neuropathy worse. Refined carbohydrates increase the blood sugar, while saturated fats and gluten can cause inflammation. Avoid refined carbohydrates and choose whole grain versions instead. Also, eat more fruit and vegetables, lean meats, and healthy fats.
Early diagnosis and treatment of peripheral neuropathy can significantly improve your outcome by stopping the progression of the disease before it gets too serious. Visit your doctor at the first sign of symptoms and ask questions. Additionally, take the initiative by doing your own research. Know as much as you can about your condition, and adopt a mindset of continual learning. You are your own best defense on your road to wellness.
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- National Institute of Neurological Disorders and Stroke: Peripheral Neuropathy Fact Sheet
- Precision Brain, Spine and Pain Centre: Peripheral Neuropathy
- The Foundation for Peripheral Neuropathy
- Cleveland Clinic Center for Continuing Education: Peripheral Neuropathy
- American Family Physician: Peripheral Neuropathy: Differential Diagnosis and Management
- American Family Physician: An Algorithm for the Evaluation of Peripheral Neuropathy