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Peripheral Neuropathy




What is peripheral neuropathy?

Peripheral neuropathy is a type of damage to the nervous system. Specifically, it is a problem with your peripheral nervous system (PNS). This is the network of nerves that sends information from your brain and spinal cord (central nervous system/ CNS) to the rest of your body. Peripheral nerves are the nerves that exit the spinal canal or skull and go to your face, trunk, or arms and legs.



There are more than 100 types of peripheral neuropathy. Each has its own set of symptoms and prognosis. They are classified as:


  • Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.


  • Sensory neuropathy. Sensory nerves control what you feel, such as pain, temperature, or a light touch. Sensory neuropathy affects these groups of nerves.


  • Autonomic nerve neuropathy. Autonomic nerves control functions that you are not conscious of, such as breathing and heartbeat.


  • Combination neuropathies. A mix of 2 or 3 of these other types of neuropathies, such as a sensory-motor neuropathy.




What causes peripheral neuropathy?

Peripheral neuropathy has many different causes. This is by no means a comprehensive list:

  • Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.

  • Diabetes. More than half the people with diabetes develop some type of neuropathy.

  • Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV. And of course now Covid-19.

  • Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.

  • Tumours. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.

  • Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.

  • Other diseases. These include kidney disease, liver disease, connective tissue disorders an underactive thyroid (hypothyroidism) and pernicious anaemia.


Other causes of neuropathies include:

  • Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.

  • Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.

  • Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.

  • Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.

  • Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.

  • Idiopathic. A cause is not found.


Complications

Complications of peripheral neuropathy can include:

  • Burns and skin trauma. You might not feel temperature changes or pain on parts of your body that are numb.

  • Infection. Your feet and other areas lacking sensation can become injured without your knowing.

  • Falls. Weakness and loss of sensation may be associated with lack of balance and falling.


What are the symptoms of peripheral neuropathy?

Every nerve in your peripheral system has a specific function so symptoms depend on the type of nerves affected sensory, motor or autonomic. Signs and symptoms of peripheral neuropathy might include:

  • Gradual onset of numbness, prickling or tingling in your feet, hands, which can spread upward into your legs and arms

  • Sharp, jabbing, throbbing or burning pain

  • Extreme sensitivity to touch

  • Pain during activities that shouldn't cause pain such as pain in your feet when putting weight on them

  • Lack of coordination and falling

  • Muscle weakness, cramps, muscle twitching, muscle wasting

  • Feeling as if you are wearing gloves and socks all the time

  • Numbness, loss of sensation feeling

  • Emotional distrubances

  • Sleep disruption

  • Loss of pain or sensation

  • Inability to sweat properly leading to heat intolerance

  • Loss of bladder control leading to infection or incontinence

  • Dizziness, lightheadedness, fainting

  • Diarrhoea or constipation

  • Trouble chewing and swallowing

  • Shortness of breath, irregular heartbeat, palpitations

  • Internal vibrations


How is peripheral neuropathy diagnosed?

The symptoms and body parts affected by peripheral neuropathy are so varied that it may be hard to make a diagnosis. If your healthcare provider suspects nerve damage, he or she will ask about your medical history and do a number of neurological tests. These can help determine the location and extent of your nerve damage. These include:








I am not sure why coeliac disease is not on these lists?


Depending on what basic tests reveal, your healthcare provider may want to refer you to a neurologist. You may need other tests to get a better look at your nerve damage, such as:

  • CT scan

  • MRI scan

  • Electromyography (EMG) and nerve conduction studies (NCS)

  • Nerve and skin biopsy


How is peripheral neuropathy treated?

Often peripheral neuropathy can’t be cured. Firstly if an underlying cause is found this is treated. Then treatment may be needed for the symptoms. Over the counter pain relief tablets may help and should be tried initially. Other times, prescription pain medicines are needed. Some of these medicines are:

  • Antiseizure medicines, such as gabapentin, phenytoin, and carbamazepine

  • Some classes of antidepressants including tricyclics such as amitriptyline

  • Lidocaine injections and patches may help with pain in other cases.

  • And in extreme cases, surgery can be used to destroy nerves or fix injuries that are causing neuropathic pain and symptoms.

Physical therapy can treat weakness and muscle loss. It can also treat problems with balance. Some people may need splints or braces to help them walk.



Prevention


1. Manage underlying conditions

The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis.


2. Make healthy lifestyle choices

These habits support your nerve health:

  • Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Especially foods rich in Vitamin B12

  • Exercise regularly but within your limits

  • Avoid factors that may cause nerve damage, including repetitive motions, cramped positions that put pressure on nerves, exposure to toxic chemicals, smoking and overindulging in alcohol.

  • Some may benefit from removing gluten in diet


References

https://www.nhs.uk/conditions/peripheral-neuropathy/diagnosis/

https://www.aafp.org/afp/2010/0401/p887.html

https://www.mountsinai.org/health-library/diseases-conditions/peripheral-neuropathy

https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061


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