Peripheral neuropathy is the collective term for a number of medical conditions and concepts related to the spinal column and the nervous system outside of the brain.
The nervous system is that part of the body that coordinates your actions with your senses. It’s made up of two parts: the central nervous system (CNS) and the peripheral nervous system (PNS).
Peripheral neuropathy, then, refers to diseases in the peripheral nervous system.
All of these fall into three categories: acquired, involving lifestyle habits, non-hereditary diseases, and injuries; hereditary, from a genetic predisposition; and idiopathic (meaning the cause is unknown). These diseases can impair motion, sensation, and even some organs or glands, depending on which nerves are affected and how. They can be painful, uncomfortable, or debilitating in daily life.
So what are these diseases?
This article examines the different classifications, symptoms, and signs of peripheral neuropathy, and through a few examples, what can be done to treat them.
What is the Peripheral Nervous System?
The peripheral nervous system covers two key functions of the body–the autonomic nervous system, and the somatic nervous system. This system governs some things you do every day and probably never even noticed it, and is arranged throughout the body in clusters of nerve endings called ganglia.
The autonomic nervous system (ANS), so-called because it controls the body’s autonomous, or self-governing, actions, carries out a lot of functions we can’t even see through the smooth muscles (which can’t be tensed) and the glands.
These include a regular heart rate, eye movement, breathing, sexual arousal, and digestion.
Peripheral neuropathies are so dangerous, in part, because it jeopardises some of the most basic tasks the body needs in order to live normally and comfortably.
The somatic, or voluntary, nervous system (SNS), on the other hand, does just one thing only, but it’s a critical function: it controls the skeletal muscles which allow for conscious movement and reflexive action.
Without the somatic nervous system, you wouldn’t be able to walk, chew, use tools, or react when startled.
So these two features of the body are obviously crucial.
Now that we know what’s at stake, in what ways can they be affected by neuropathies?
– Types of Peripheral Neuropathy –
Mononeuropathies are those that affect just one nerve ending (mono means one), rather than a group or a system of them. Because they’re both the least serious and the most common, it’s important to be able to distinguish these from more systemic neuropathies. They’re usually the result of local traumas or injuries ranging from sexually-transmitted diseases to crouching in an uncomfortable position for too long.
There are two broad subtypes of mononeuropathy:
These are commonly referred to as trapped or pinched nerves, and they can be caused by something as simple as weight or pressure being placed on a nerve unknowingly, such as being trapped in a skeletal joint. They can also be caused by some acquired conditions, including various cancers or alcoholism.
Common examples include:
- Peroneal nerve compression
- Carpal tunnel syndrome
- Radial nerve compression
Symptoms include loss of sensation, decreased reflexes and coordination, muscle spasms or cramps, weakness, paralysis, pain, or tingling and burning.
Compression neuropathies can often be healed through treatment of the cause.
For example: improving posture, treating alcoholism, or healing muscle or bone injuries.
With more persistent conditions, there are a variety of medications which can be used to manage pain and symptoms, including:
- Medical cannabis
- Topical anesthetic and analgesic creams and gels
This mononeuropathy affects the ulnar nerve, which runs along the ulna bone in the arm. It has various causes, including fractures of the humerus and ulna, subdermal contraceptive implants, or hemophilia.
While studies of rates of occurrence have been spotty so far, what work has been done indicates that ulnar neuropathy, especially ulnar neuropathy at the elbow (UNE), might be among the most common form of nerve illness, affecting 20.9% of the population in Italy alone.
Symptoms include pain or discomfort in the elbow (particularly with UNE), difficulty controlling the ring and little finger, tingling or numbness in the hands, wrist, or fingers, a weakened grip, and sensitivity to cold.
While surgery might be required in more persistent cases, most instances of ulnar neuropathy can be alleviated or healed by anti-inflammatory medication or the use of elbow pads, splints, or braces.
Polyneuropathies comprise a wide range of nerve diseases affecting multiple peripheral nerves throughout the body. While mononeuropathies are the most commonly encountered, polyneuropathies are by far the most numerous, with dozens of varieties that fall into a few broad categories.
It’s always best to speak with a doctor about any concerns, but here are the broad strokes on the two most significant types of polyneuropathies.
A chronic polyneuropathy is any that affects large numbers of nerves for an extended period of time. These can take months to develop and can’t be treated quickly. Most polyneuropathies are chronic because they’re the result of some systemic problem in the autonomic peripheral nervous system.
While they’re uncomfortable and painful, most chronic neuropathies can at least be managed with medication and physical therapy. Generally, these only involve the loss of sensation, most typically in the feet and not quite as frequently in the hands, although they can affect the ANS anywhere it’s found in the body.
Since these are the most common of the polyneuropathies, it’s a good idea to recognize the signs and the methods for treating at least a few different types.
Diabetic and acquired polyneuropathy
A frequent cause of polyneuropathy is through lifestyle or health, as a secondary condition resulting from a more enduring one. Diabetes is the most common cause, and is associated with any number of nerve injuries and illnesses. Other frequent indicators are:
- Poor diet
- Nutritional deficiencies such as a lack of thiamine or vitamin B12, both indications of malnutrition, the former particularly associated with alcohol abuse
- Hyperthyroidism, in which the thyroid, which regulates iodine in the body, is underactive
- Various cancers, either by directly damaging nerve cells or through the general strain cancer places on the body
Common symptoms of diabetic and acquired polyneuropathies usually manifest first in the feet and hands, and include pain, burning sensations, pins-and-needles sensations, and loss of vibration sense and sense of position. Due to the loss of position sense, walking and using one’s limbs can become excessively difficult.
Because of this, a particular tertiary danger of chronic polyneuropathy is muscular atrophy, as sufferers will often be unable or unwilling to walk or move under their own power. Additionally, those with these diseases can just as easily lose the sense of pain and temperature, leading to an increased risk of minor injuries such as open sores, untended cuts or burns, and even unnoticed minor fractures.
Because chronic neuropathies are usually the result of some other disorder or illness, the best way to alleviate or even cure these diseases is to remedy the condition causing them. Diabetics, for example, can improve their health and comfort by adhering to appropriate diets, reducing negative factors such as alcohol and tobacco use, and regularly using insulin (for those diabetics who require it).
Those who are suffering from neuropathy as a result of long term substance abuse can seek medical and psychological treatment for addiction, and those with dietary deficiencies such as a lack of thiamine can seek the aid of a dietician.
Perhaps most obviously, if a cancer is the root cause of a polyneuropathy, then successful elimination of the cancer immensely improves chances of recovering from the resultant neuropathy.
These more serious neuropathies are chronic in the sense that they are persistent, but incredibly alarming to patients because they appear suddenly rather than developing over periods of years.
Acute polyneuropathies have many causes, but it’s often a quite traumatic condition that gives rise to them, including:
- Toxins resulting from infections such as diphtheria, hepatitis B and C, Lyme disease, shingles, Epstein-Barr virus, leprosy, and HIV
- Conditions like Guillain-Barré syndrome, an autoimmune condition in which the immune system weakens the peripheral nervous system, causing an overall weakening of the muscles; or multiple sclerosis (MS)
- Hereditary conditions such as Sjögren syndrome, in which the immune system negatively affects moisture- producing glands, or Charcot–Marie–Tooth disease, which is itself a hereditary neuropathy particularly harmful to the feet and legs
Acute polyneuropathies share many of the same symptoms as chronic neuropathies, although, as the name implies, they are much more immediately painful, inconvenient, and threatening. Most symptoms will begin as either the loss of sensation or the development of burning, tingling, or painful sensations in the feet, moving rapidly up the legs and spreading to the rest of the body, particularly affecting the limbs.
What makes acute neuropathies so immediately dangerous is the severe impact they can have on the autonomic nervous system, potentially destroying a sufferer of such a condition to lose the ability to breathe, control defecation or urination, chew, or regulate eye movement at will. These can be inconvenient at the very least, frequently debilitating, and sometimes lethal, especially if unchecked or unnoticed by others.
The onset of acute polyneuropathy warrants an immediate examination and likely hospitalization. Longer-term treatments are possible, such as getting blood pressure and blood sugar to manageable levels in diabetics, altering less beneficial diets, decreasing weight, physical therapy, or the use of pain medications like lidocaine.
Even some antidepressants, such as amitriptyline, have been found to have some positive effect on pain management due to their interaction with the nervous system generally.
– Prevention –
Many neuropathies can be stopped before they start by considering controllable risk factors and taking appropriate steps to reduce that risk. For example, it may seem obvious to some, but a healthy diet including plenty of grains, fruits, vegetables, and lean proteins like eggs, beans, and fish can prevent deficiencies of thiamin and vitamin B12 as well as reducing the overall risk of diabetes or poor blood pressure.
One should always avoid overconsumption of alcohol, any consumption of tobacco, use proper protective equipment around hazardous materials, and get plenty of exercise several times a week.
But when prevention isn’t quite enough, it’s always good to be aware of the risks and the best methods of treatment.
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