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What you need to know about peripheral neuropathy

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BY AUDRA KOLESAR
Winnipeg Health Region
Wave, May / June 2016

What is peripheral neuropathy?

Peripheral neuropathy is a term used to describe problems with the nerves of the peripheral nervous system. It is also called nerve palsy.

What is the peripheral nervous system? 

The peripheral nervous system is the term used for all of the nerves outside the brain and spinal cord. Peripheral nerves transmit 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 internal organs that allow you to do things like breathe and digest food are also part of the peripheral nervous system. 

How does peripheral neuropathy occur?

Peripheral neuropathy has many different causes. Anything that interferes with the function of a nerve can lead to neuropathy. 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, or an abnormal growth, such as a tumor. 
  • Diseases such as diabetes, arthritis, lupus, or alcoholism.
  • Infections (usually viral, for example, infections by the herpes virus).
  • Exposure to poisons.
  • Some medicines, such as some cancer medicines.
  • Lack of vitamins, such as vitamin B-12, or minerals.

What are the symptoms?

The symptoms of peripheral neuropathy depend on which nerves are damaged.

Nerves that help you move your muscles are called motor nerves. If motor nerves are damaged, you may have muscle weakness or you may not be able to move the muscles controlled by the damaged nerves. 

Nerves that conduct sensations, such as touch, are called sensory nerves. When these nerves are affected, you may have numbness, tingling, pain, or extreme sensitivity to touch. 

The nerves controlling internal organs are called autonomic nerves. Symptoms caused by damage to these nerves depend on what organs are affected.

For example, you may have vision problems if the nerves to your eyes are involved. Problems with other nerves may cause dizziness, leaking of urine from the bladder, or digestion problems, such as constipation or diarrhea.

How is it diagnosed?

Your health-care provider will ask about your symptoms and medical history, and will examine you. You may have a nerve conduction test to check the function of specific nerves. You may have other tests.

How is it treated?

The goals of treatment are to manage the condition causing the neuropathy and to relieve symptoms. The treatment depends on the cause. For example, if the problem happens after an injury, depending on how severe the injury is, the neuropathy may go away on its own and not need any specific treatment. If it is caused by a disease, such as diabetes or lupus, the treatment is focused on better control of the disease. If the cause is a vitamin deficiency, your provider may prescribe vitamin supplements.

The symptoms of neuropathy can be treated with medicines, such as:

  • Non-prescription pain relievers such as acetaminophen, aspirin, or ibuprofen.
  • Prescription NSAIDS (nonsteroidal anti-inflammatory drugs).
  • Medicines that can be put on the skin and numb the skin (lidocaine) or cause irritation (capsaicin).
  • Medicines for seizures that also can treat pain, such as gabapentin (Neurontin).
  • Antidepressant medicines that can help relieve pain.

Some of the other possible treatments for nerve pain are:

  • Biofeedback (a way to control your body's responses with your mind) or relaxation methods.
  • Electronic nerve stimulation devices.
  • Shots of local anesthetics, steroids, or other medicines to block pain signals or decrease inflammation.
  • In severe cases, surgery to cut the nerve causing the pain.

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. Neuropathy due to diabetes and other chronic diseases tends to not go away completely, but it may improve with treatment of the disease. Neuropathy caused by a viral infection is less predictable. It may or may not go away with time.

How can I help prevent neuropathy?

It can be hard to prevent neuropathy caused by injury. But you can reduce your risk of neuropathy by taking steps to manage your condition. For example, if you have a condition that requires medication, follow your health-care provider's advice and take your medicines as prescribed. It also helps to lead a healthy lifestyle - exercising and eating a balanced diet that includes fruit, vegetables, whole grains, and lean meat to give you enough vitamin B-12.

Can you tell me more about neuropathy caused by diabetes?

Health-care professionals have been studying diabetic neuropathy for many years, but they do not yet understand how diabetes damages the nervous system. However, they do know that some people can prevent the development of neuropathy by keeping their blood sugar under control.

If a person does develop diabetic neuropathy, how is it treated?

Diabetic neuropathy is treated in several ways:

  • Muscle weakness is treated with support, such as splints. Physical therapy can also help with exercises for the weak muscles. Exercises can be also used to strengthen other muscles that have not weakened.
  • As with other cases of neuropathy, pain-killing drugs or cream can be applied to the skin to help pain during the night. Medicines can be used to treat nausea, vomiting, and diarrhea.

It is important to remember that injuries can be a serious problem for people with diabetic neuropathy. That's because the condition makes it harder to feel if something is hot or sharp. Diabetes also makes it harder for injuries to heal. People with diabetic neuropathy should be extra careful to avoid burns, cuts, and other injuries. Foot care is especially important, as a small injury or ingrown toenail can lead to long-term complications if you do not catch it quickly.

Can I help prevent diabetic neuropathy?

The best way to help prevent diabetic neuropathy is to:

  • Control your diabetes. Try to keep your blood sugar at a normal level. 
  • Do not smoke. 
  • Maintain normal blood pressure. 
  • Exercise regularly, according to your health-care provider's recommendation.
  • Limit the amount of alcohol you drink because it can cause neuropathy, too.
  • Eat a healthy diet with fruits and vegetables (some vitamin deficiencies can cause neuropathy).
  • Keep your checkup appointments with your health-care provider.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.

The information for this column is provided by Health Links - Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé.

Call 204-788-8200 or toll-free 1-888-315-9257.

Wave: November / December 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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