Peripheral Neuropathy is typically the result of nerve damage to one or more nerves of the Peripheral Nervous System (PNS), often causing sensations of numbness and pain in the extremities. Although the severity of this condition ranges widely from acute difficulties, to chronic pain, symptoms often begin subtly and simply worsen slowly over time.
Chronic Peripheral Neuropathy takes several months to develop, most likely in individuals with the associated risk factors. Because this condition often occurs in association with other underlying disorders, treatment is commonly intended to treat any other illnesses and to manage the chronic pain and symptoms associated with the ailment. For those who are persistent, however, chronic Peripheral Neuropathy is manageable, and doesn’t have to mean forfeiting a normal, functional life.
An Anatomy Lesson: What is the Peripheral Nervous System?
The Peripheral Nervous System (PNS) and the Central Nervous System (CNS) are the two systems responsible for the network of nerves found throughout the body. While the CNS consists of the brain and spinal cord, the PNS is made up of the network of nerves that receives information from the CNS to communicate to the rest of the body. Peripheral nerves act as messengers to the brain, indicating things such as temperature and pain.
There are three types of nerves within the PNS, all of which can be affected by chronic Peripheral Neuropathy. The first type of nerves found in the PNS are sensory nerves, which transmit information about physical sensations like heat, cold and pain. Another type of nerves in the PNS are motor nerves, which communicate with the muscles throughout the body.
These nerves cause the muscles to move through electrical impulses that are carried by the nerves of the PNS. The last type of nerves that comprise the PNS are autonomic nerves, which carry information to the organs and glands. Autonomic nerves also help an individual control bodily functions that are not consciously executed such as the beating of one’s heart, breathing, sweating and blood pressure, among others.
The PNS is vital to survival and normal functioning. Conditions that affect the PNS can seriously compromise the quality of life for an individual, as the issues manifest in symptoms that are quite debilitative if left untreated.
Possible Causes of Chronic Peripheral Neuropathy
There is any number of conditions that can lead to the development of chronic Peripheral Neuropathy, making it more difficult to diagnose and treat.
Many major causes of the condition are related to lifestyle choices or genetics. Alcoholism is one major factor in the development of the ailment. This is because many alcoholics make poor dietary choices due to their lifestyle, leading to deficiencies in vitamins crucial to nerve health. Others who neglect B vitamins, vitamin E and niacin in their diets are also at risk for the onset of chronic Peripheral Neuropathy.
More often than not, Peripheral Neuropathy is the result of some other condition that an individual may develop. Diabetes is often the cause of damage to several nerves. Kidney disease, liver disease and hypothyroidism can also cause this ailment, leading to further complications during treatment. Autoimmune diseases are also common culprits of PNS chronic pain, especially for those individuals with lupus and rheumatoid arthritis.
Exposure to poisons, infections, trauma to the nerves and tumors are all possible causes as well. Toxic substances that are introduced into the body, especially those used to treat cancer, can often have adverse effects on the nerves found throughout the PNS. Additionally, particular viral or bacterial infections are known to promote the onset of chronic Peripheral Neuropathy including Lyme disease, shingles, hepatitis C and HIV/AIDS.
Because there is no one cause of the condition, doctors must undertake a personalized approach to each case that they are confronted with. Treatment is often more influenced by what is underlying the ailment rather than the ailment itself, which also eases the symptoms experienced due to Peripheral Neuropathy.
What are the Symptoms of PNS Pain?
Pain and discomfort for individuals with Peripheral Neuropathy is often felt first in the longest nerves, meaning those that reach down towards the feet. Over time, these symptoms will affect shorter nerves, such as those that extend into the arms and hands. Symptoms may also grow more severe over time, making it increasingly difficult to carry out normal tasks.
One of the indications of Peripheral Neuropathy most unique to the condition is the gradual onset of the symptoms. Many chronic pain disorders involve telltale signs that are both fast and furious in nature. However, tingling and numbness in this condition almost always begins at the feet and spreads upward into the legs, arms and hands.
The sensation felt in this condition can be burning, sharp or even electric-like pain. Consequently, individuals will be extremely sensitive to touch and will experience muscle weakness or possible paralysis should the motor nerves be among those affected. If autonomic nerves are involved, however, bowel or bladder problems might result.
It is important to keep in mind that Peripheral Neuropathy can affect one nerve, as in mononeuropathy, two or more nerves, such as in multiple mononeuropathy or many nerves, as is the case in polyneuropathy. Therefore, not only can the condition affect different areas of the PNS, but it can also affect different numbers of nerves. This makes individualized treatment all the more important in addressing the signs and symptoms of PNS pain.
Diagnosis Dilemma: Addressing Many Possible Causes
Diagnosing chronic Peripheral Neuropathy can sometimes be difficult because it is a symptom that is associated with numerous potential causes. The most important thing to determine is not only where the nerve damage is, but also more importantly, what is causing it.
Diagnosis can involve any number of tests, depending upon the potential causes of the condition, but almost always involves a full medical history, a neurological exam and a physical exam. Knowing about a patient’s medical history is important because symptoms, lifestyle choices and family history are all related not only to Peripheral Neuropathy, but the conditions that underlie it.
A neurological exam can help a doctor check reflexes, muscle strength and a person’s reaction to different stimuli, which can indicate where the damage is throughout the body. A physical exam is another routine part of the diagnosis process, allowing a doctor to get any additional information that they may need to make a proper diagnosis.
Additional tests might be required should a doctor have any suspicions as to what is causing the chronic pain. Blood tests, imaging tests, nerve function tests and nerve biopsies are all common ways to check for tumors or just to get a better perspective bodily functions. Typically, the more extreme measures, such as nerve biopsies, are recommended should there be almost no signs pointing to a certain disease or abnormality.
Medication and Therapy: The Dynamic Duo
Almost all treatments for chronic Peripheral Neuropathy entail some combination of medication and therapy.
Common medications used to treat the condition include pain relievers, anti-seizure medications, capsaicin, lidocaine patches and antidepressents. Depending upon the severity of the symptoms, doctors may give patients prescription painkillers should the over-the-counter version not be strong enough to counter possible symptoms of PNS pain.
Capsaicin and lidocaine are two popular options for direct relief, as they both are applied directly to the area in which there is pain. Aside from some discomfort from the heat generated by the creams of patches, there are no side effects, making people more comfortable using it. Additionally, antidepressants help to address the cognitive symptoms of Peripheral Neuropathy.
More specifically, they help with the chemical processes in the brain and spinal cord that cause the sensation of pain, making the discomfort of Peripheral Neuropathy more manageable.
Therapies, such as Transcutaneous Electrical Nerve Stimulation (TENS) may also help to relieve the pain of Peripheral Neuropathy. A gentle electric current is applied through electrodes during this treatment. When applied regularly, many patients note a marked improvement in their symptoms.
Aside from medicinal treatments, there are several lifestyle changes that individuals can make to lessen the pain of chronic Peripheral Neuropathy. Exercise, a healthy diet and no smoking are key features of the lifestyle decisions needed to help with the pain of this ailment. Avoiding prolonged pressure is another key thing to avoid becauseexcessive amounts of it can cause new nerve damage and exacerbate damage that an individual already has.
Prognosis and Prevention of Peripheral Neuropathy
The key to recovery and prevention in terms of this chronic pain disorder is to avoid activities that can cause nerve damage and to treat underlying conditions already in existence. Repetitive motions, toxic chemicals and excessive use of tobacco and alcohol are all factors that can cause further damage to the PNS.
By following a treatment plan and making the necessary changes, a person doesn’t have to live in fear from their chronic pain. Peripheral Neuropathy is manageable and in many cases, treatable. For this reason, there is great hope for individuals suffering from the condition, as they can be optimistic about their prognosis and future.