Peripheral Neuropathy Diagnosis and Treatment

Peripheral neuropathy is damage to the peripheral nervous system, or the message network that sends information from the brain and spinal cord (the central nervous system) to and from other parts of the body. Peripheral neuropathy may affect one nerve (mononeuropathy), two or more nerves in different locations (multiple neuropathy) or many nerves (polyneuropathy). It is not a disease, but a symptom with many possible causes.

Peripheral neuropathy can be caused by exposure to toxins, traumatic injuries, infections, poor nutrition and medications. The most familiar cause is diabetes.

Peripheral neuropathy includes signs and symptoms such as weakness, numbness and pain in the hands and feet, but can occur in other areas of the body. Symptoms of peripheral neuropathy are typically first found in the nerves of the toes. Symptoms differ depending on the affected nerves and may include:

• Tingling in the feet and hands that may spread to the legs and arms
• Burning pain
• Sharp pains
• Sensitivity to touch
• Changes in the skin, hair and nails
• Disruption in coordination
• Paralysis
• Bowel, bladder and digestive problems
• Noticeable changes in blood pressure that cause dizziness

Peripheral neuropathy is not easy to diagnose. To determine where the nerve damage is located and what the cause is, your doctor will take a full medical history, neurological exam and physical exam. The doctor will also order tests that may include:

• Blood tests
• CT
• EMG
• Lumbar puncture
• MRI
• Nerve conduction studies
• Skin biopsy

If the cause of the peripheral neuropathy is determined, the objective is to treat the cause, after which, peripheral neuropathy symptoms may improve.

In cases where a cause cannot be determined, treatment focuses on symptom management, which may include:

• Pain relievers
• Anti-seizure medications
• Immunosuppressive medications
• Capsaicin
• Lidocaine patch
• Antidepressants
• Physical therapy
• Spinal cord stimulation

Lifestyle changes can also help with peripheral neuropathy. Some examples include: exercise, not smoking, a healthy diet, no alcohol, and not crossing knees or leaning on elbows for a long period, as it may cause nerve damage. If diabetes is the cause, options may include monitoring sugar/glucose levels, massaging hands and feet and taking care of the feet.