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Peripheral Neuropathy

Your nervous system is divided into two divisions: 

  1. the central nervous system, consisting of your brain and spinal cord
  2. the peripheral nervous system, consisting of all of the nerves connecting the central nervous system to your organs and limbs

Peripheral neuropathy is pain associated with injury to these nerves. Injury may result from direct trauma, metabolic diseases such as diabetes, exposure to toxins such as alcohol, and exposure to infections such as Lyme disease. If it is injury to one nerve, it is called a mononeuropathy, and if it is to multiple nerves, it is referred to as a polyneuropathy.         

Symptoms

Patients with peripheral neuropathy may experience a variety of symptoms. All nerves have a specific function, whether it is to transmit sensation from your limbs and organs back to your spinal cord and brain or to produce a muscle response. You may not experience pain but rather just experience numbness. The nerves of the hands and feet tend to be the most vulnerable, and the neuropathy may spread up the arms and legs toward the trunk. The pain is typically described as burning and tingling but may also be described as stabbing and gnawing.   

Causes

Peripheral neuropathy can be from a variety of causes: chronic diseases such as diabetes, hypothyroidism and kidney failure; autoimmune diseases, such as lupus, rheumatoid arthritis and Sjogren’s; alcoholism; contact with poisons such as chemicals and heavy metals;  medications such as chemotherapy; infections such as shingles, Lyme disease, HIV; trauma from direct injury; tumors causing direct compression; or vitamin deficiency such as vitamins B, E and niacin.

Treatments

If you have pain associated with peripheral neuropathy, your primary care physician may refer you to a pain management specialist. On your first visit at the JLR Center for Pain Medicine, your doctor will take a comprehensive medical history and perform a physical examination. A treatment plan will then be devised with your particular needs in mind. 

Early treatment focuses on confirmation of the diagnosis and the initiation of a treatment plan to alleviate pain. Your doctor may want to confirm the diagnosis by ordering certain labs, performing imaging studies, or having you obtain a nerve conduction study and an electromyography (EMG). Most of the time, the diagnosis can be made by obtaining an accurate history and physical.

Your pain management physician may discuss with you lifestyle modifications depending on the cause of your pain and may prescribe a combination of medications to include non-steroidal anti-inflammatories, nerve-stabilizing medications (anti-convulsants), anti-depressants which also work to stabilize the nerve and topical patches and creams.

Depending on the cause of the pain, your doctor may suggest peripheral nerve injection therapy. If the pain persists despite the initial treatment options, your provider may suggest a spinal cord stimulator trial. Depending on the cause of the peripheral neuropathy, surgery may be recommended.