What is a Peripheral Neuropathy?
What Is a Peripheral Neuropathy?
A peripheral neuropathy is a disorder in which nerves outside the brain and spinal cord are injured or breaking down. This keeps them from working properly, which can lead to a wide range of symptoms.
Peripheral neuropathies can show up in many different ways and places. They most often affect the hands, feet or face, but they can also affect the arms, legs, chest and back. They can cause pain, numbness, weakness, pins and needles, or other uncomfortable sensations (1).
What Is the Peripheral Nervous System?
The brain, brainstem, cerebellum and spinal cord make up the central nervous system. The peripheral nervous system is made up of all the nerves outside the brain and spinal cord. These nerves carry electrical signals to and from the central nervous system.
What Are the Different Types of Peripheral Nerves?
There are several types of peripheral nerves. The symptoms you have depend on which types of nerve fibers are affected and where.
Sensory nerves. These carry information from the body to the brain and spinal cord, such as temperature, touch, pain and body position. Different sensory receptors in the skin respond to touch, pressure, vibration, temperature and pain. Other receptors in the muscles and joints create proprioception, your brain’s automatic awareness of where your body is and the stresses on your muscles and joints. Position and touch signals travel along large, fast nerve fibers, while pain and temperature signals travel along small, slower fibers.
Motor nerves. These carry messages from the brain to the muscles to control movement, from keeping your posture steady to moving your hands and feet. They are large, fast nerve fibers. When they are injured, muscles may twitch, weaken and shrink.
Autonomic nerves. These are thin, slower fibers that run from the brainstem and spinal cord to the organs. They control automatic functions like blood pressure, heart rate, digestion, bladder and bowel control, and breathing (2).
What Are the Different Types of Peripheral Neuropathy?
Neuropathies are grouped by their cause, where they occur, and how many nerves are involved.
A mononeuropathy affects a single nerve, usually because of an injury or repetitive stress. Some people have injuries to several individual nerves, which is called multiple mononeuropathy.
A polyneuropathy affects many nerves in more than one area of the body.
There are more than 100 known types of peripheral neuropathy, and each has its own pattern of symptoms and outlook (3).
What Are the Symptoms of Peripheral Neuropathy?
Peripheral neuropathy can cause many different symptoms, ranging from numbness and weakness to paralysis of a body part after a severe nerve injury. It can also make normally painless sensations painful, such as clothing touching your skin or bedsheets resting on your feet.
Depending on the cause, symptoms may include numbness, tingling or prickling that starts gradually in the hands and feet and moves up the arms and legs; burning, throbbing or stabbing pain; and a feeling of always wearing gloves or socks. Some people develop muscle weakness that makes everyday activities tiring, painful sensitivity to touch or pressure, or muscle twitching and shrinking.
Neuropathy can also cause balance problems and trouble walking, which often lead to falls. When autonomic nerves are affected, symptoms can include dizziness or lightheadedness when standing up, digestive problems, trouble with bladder or bowel control, intolerance to heat or cold, and either heavy sweating or an inability to sweat (1).
If weakness or numbness comes on suddenly, spreads quickly over days, or is accompanied by trouble breathing or swallowing, seek emergency care right away.
What Causes Peripheral Neuropathy?
Peripheral neuropathy can result from injuries that compress, cut or cut off blood flow to nerves. It can also come from metabolic problems like diabetes, viral infections, autoimmune conditions, toxins or inherited conditions.
Nerves can be damaged by direct injury, by being trapped, or by ongoing pressure from repetitive stress, as in carpal tunnel syndrome. With compression and injury, larger nerve fibers are usually affected first, causing numbness, tingling and weakness. In more severe cases, the small fibers that carry pain and temperature signals can also be affected.
When toxins or metabolic problems damage nerves, they usually affect the same type of fiber in many nerves at once. Most polyneuropathies affect both sides of the body evenly and start in the hands and feet. They may continue to spread up the limbs toward the body until the underlying cause is addressed. Most people with neuropathy have some form of polyneuropathy.
There are many inherited neuropathies, and they can show up in many different ways. Their course can be hard to predict, and some become progressive and disabling.
Peripheral neuropathy may be caused by:
Direct nerve injury. Car accidents, falls and sports injuries can cut or damage peripheral nerves. Nerves can also be compressed by a cast, by using crutches, or by repeating a motion like typing many times (4).
Autoimmune diseases. These include chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjögren’s syndrome and vasculitis (5).
Diabetes. Many people with diabetes develop peripheral neuropathy, especially when blood sugar is poorly controlled (6).
Infections. Infections that can cause neuropathy include shingles, Lyme disease, Epstein-Barr virus and hepatitis (7).
Inherited disorders. Hereditary neuropathies include Charcot-Marie-Tooth disease and several types of autonomic neuropathy (8).
Tumors. Both noncancerous and cancerous growths can press on nerves. Some cancers also trigger the immune system to attack peripheral nerves (9).
Toxins. These include industrial chemicals and heavy metals like lead and mercury (10).
Cancer treatment. Some chemotherapy drugs and radiation can cause peripheral neuropathy (11).
Vitamin problems. Deficiencies of vitamins B1, B6 and B12 can damage nerves. These can result from heavy alcohol use, certain medications or poor absorption. Taking too much vitamin B6 can also damage nerves (12).
Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (13).
In some cases, no cause can be found (1).
How Is Peripheral Neuropathy Diagnosed?
Peripheral neuropathy can be challenging to diagnose. A neurological exam can reveal a lot, including tests of reflexes, muscle strength, sensation, walking, balance and coordination.
Lab tests may be needed, including tests for vitamin and nutrient deficiencies. Electrodiagnostic testing may also be needed. A nerve conduction study measures how fast signals travel along nerves to look for areas of compression, and electromyography (EMG) measures the electrical activity of muscles (14). In some cases, a physician may order a nerve biopsy to look for other causes of nerve damage (15).
How Is Peripheral Neuropathy Usually Treated?
Most treatment for peripheral neuropathy focuses on the condition causing the nerve damage. For compression from repetitive stress, changes to posture and workstation setup may help. When diabetes is the cause, medication and diet changes to control blood sugar can help keep the neuropathy from getting worse. For autoimmune causes, medication to control the immune system may be needed (16).
Controlling the underlying condition can help, but it doesn’t always make the neuropathy go away. Symptoms often last long after the original cause has been treated, and they can sometimes become permanent.
How the NeuroRescue Program Can Help
We start by looking for the factors that may be contributing to your neuropathy. Depending on what we find, that may include lab testing, nutrition and supplement recommendations, and lifestyle changes. When a cause needs medical treatment, we’ll coordinate with your physician or refer you to the right specialist. Our care works alongside your medical treatment, including any medications you take. Please don’t change any medication without talking with your prescriber.
From there, we build your NeuroRescue Program with the goal of reducing your symptoms and improving your function as much as possible.
One of the most important jobs your brain has is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving. It uses signals from your muscles and joints to sense where your body is and what it’s doing. And it uses your eyes to sense where you are in relation to everything around you.
Your brain combines all of this into a kind of map of where you are. It keeps separate maps from your inner ear, your eyes, and your muscles and joints, and it needs them to agree. The map from your muscles and joints depends on your peripheral nerves.
An often overlooked part of peripheral neuropathy is that these maps can stop matching. Your eyes and inner ear may be telling your brain one thing about where your body is, while damaged nerves send a different message from your muscles and joints. When the maps don’t match, it becomes hard for your brain to keep track of where you are automatically. This often leads to problems with balance, coordination and falls.
And when you can’t trust where you are in the world, the world can become a scary place.
Your NeuroRescue Program is designed to help you get as much function as possible from your peripheral nerves, and to help your brain’s maps work together again, so you can move with more confidence and live a fuller life.
Laser therapy. Research suggests that low-level laser therapy may help improve sensory nerve function in several types of peripheral neuropathy (17). It has also been studied for improving strength and reducing pain in compression neuropathies such as carpal tunnel syndrome (18).
Electrical stimulation. We use several forms of electrical stimulation, applied through the skin, including transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC). Research has studied these for reducing pain and improving function in various types of peripheral neuropathy (19).
Balance and fall prevention. When nerve damage throws off your body’s maps, we take extra steps to help keep you steady and safe. Falls are common in people with peripheral neuropathy and can have serious consequences (20). Reducing fall risk is a priority in our neuropathy programs.
Vestibular rehabilitation. Research suggests that the inner ear’s balance system may be involved in some types of neuropathy (21), and that the vestibular nerve can undergo similar damage, leading to dizziness and balance problems (22). When testing shows a need, your program will include vestibular rehabilitation, which can help improve balance and coordination and reduce dizziness and vertigo (23). Our balance training ranges from traditional leg strength and balance exercises (24) to balance exercises in a virtual reality environment (25).
Transcranial magnetic stimulation. TMS uses a magnetic coil placed against the head to deliver gentle magnetic pulses to targeted areas of the brain. It has been studied for reducing pain and abnormal sensations in several types of peripheral neuropathy (26). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you.
Structural rehabilitation. When nerve compression is part of the problem, structural care can be helpful. Depending on your needs, this may include soft tissue techniques, therapeutic exercise and, when appropriate, joint manipulation.
Not every therapy is right for every person with peripheral neuropathy. Because there are so many types of neuropathy, we use your history and test results to build a program that fits your specific situation.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
Because symptoms that look like peripheral neuropathy can sometimes involve the brain and spinal cord as well, we also evaluate your central nervous system. We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions.
Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving energy, endurance and function in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
We can’t bring back nerve cells that have been lost. What we can do is work with the pathways that remain, helping them work more efficiently and work better together. Our goal is to help you manage your symptoms, improve your balance and function, and enjoy more of your life.
Your Next Step
Living with peripheral neuropathy can be challenging, but there is hope for easing symptoms and improving function. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
References
