Peripheral neuropathy - what it is, causes, symptoms, diagnosis and treatment
Peripheral neuropathy is a complex condition of the nervous system that affects millions of people around the world.
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Peripheral neuropathy is a complex condition of the nervous system that affects millions of people around the world, characterised by sensations of numbness, tingling, pain and so on. With varied symptoms and diverse causes, peripheral neuropathy is a medical problem with a significant impact on the quality of life and on the daily functioning of individuals. This condition can be caused by a wide range of factors, from chronic conditions such as diabetes and autoimmune diseases to exposure to toxins or physical trauma.
In this article we will explore in depth the nature of peripheral neuropathy, examining its pathophysiological mechanisms, its varied symptoms and its impact on patients. We will also look into the methods of diagnosing and assessing peripheral neuropathy, highlighting the ways of treating and managing this complex condition.
By integrating current knowledge from the fields of neuroscience, internal medicine, endocrinology and physiotherapy, we aim to offer a comprehensive view of peripheral neuropathy, covering its clinical, therapeutic and research aspects. A deep understanding of this condition is essential for developing more effective treatment strategies and for improving the quality of life of patients affected by peripheral neuropathy.
Causes and risk factors for peripheral neuropathy
Diabetes
It is one of the most frequent causes of peripheral neuropathy. Chronic hyperglycaemia can damage the peripheral nerves, causing lesions and dysfunction.
Exposure to toxins
Toxic substances, such as heavy metals, organic solvents or certain medicines, can cause peripheral neuropathy by damaging the nerves.
Autoimmune diseases
Conditions such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis can trigger autoimmune reactions that affect the peripheral nervous system.
Infectious diseases
Viral infections, such as herpes zoster, HIV or hepatitis C, can cause peripheral neuropathy through inflammation and nerve damage.
Nutritional deficiencies
The lack of certain essential nutrients, such as vitamin B12, folic acid and thiamine (vitamin B1), can lead to damage of the peripheral nerves.
Excessive alcohol consumption
Chronic alcohol abuse can cause peripheral neuropathy, usually in association with nutritional deficiencies and direct toxicity to the nerves.
Genetic diseases
Certain genetic conditions, such as hereditary neuropathies, can lead to damage of the peripheral nerves from childhood or adolescence.
Physical trauma
Accidents that involve injuries to the peripheral nerves can cause neuropathy, and chronic nerve compression can also lead to nerve damage.
Vascular diseases
Vascular conditions, such as atherosclerosis and high blood pressure, can affect the blood flow to the peripheral nerves, causing nerve damage.
Kidney diseases
Chronic kidney failure can cause the accumulation of toxins in the blood, affecting the peripheral nerves.
Liver diseases
Severe liver conditions, such as cirrhosis, can lead to peripheral neuropathy through the accumulation of toxins in the blood and through nutritional deficiencies.
Ageing
Natural ageing can be associated with a gradual deterioration of the peripheral nerves, increasing the risk of neuropathy.
It is important to remember that peripheral neuropathy can sometimes be idiopathic, which means that a specific cause cannot be identified. In these cases, diagnosis and symptom management are essential for improving patients’ quality of life.
The symptoms of peripheral neuropathy:
The symptoms associated with peripheral neuropathy can vary with the type and the severity of the condition. They can be diverse and can affect several aspects of the individual’s daily functioning. Here is a detailed list of the common symptoms:
Numbness and tingling
One of the most frequent manifestations of peripheral neuropathy is the sensation of numbness and tingling in the areas supplied by the affected nerves. These sensations can be persistent or can appear intermittently.
Pain
Patients with peripheral neuropathy can experience different types of pain, including burning pain, stabbing pain or dull pain. The pain can be localised in a certain area or can be spread throughout the body.
Altered sensitivity
Some people can show increased or decreased sensitivity to touch, temperature or pain in the areas affected by neuropathy.
Muscle weakness
Damage to the peripheral nerves can also affect muscle function, causing weakness and difficulty carrying out certain movements.
Balance and coordination problems
Peripheral neuropathy can also influence a person’s balance and coordination, increasing the risk of falls and injuries.
Sexual dysfunction
Some forms of peripheral neuropathy can also affect sexual function, causing erectile dysfunction or reduced sensitivity in the genital area.
Sleep disturbances
The pain and the discomfort associated with peripheral neuropathy can interfere with sleep quality, causing insomnia or frequent waking during the night.
Changes in autonomic function
Peripheral neuropathy can also affect the nerves that control the autonomic functions of the body, such as blood pressure, heart rate, digestion and sweating. This can lead to symptoms such as orthostatic hypotension (a sudden drop in blood pressure when standing up), erectile dysfunction, digestive disturbances and the inability to regulate body temperature.
Changes in the sensitivity to pain
Some people with peripheral neuropathy can develop a partial or total loss of sensitivity to pain, which can lead to an increased risk of undetected wounds and injuries.
The symptoms of peripheral neuropathy can be progressive over time and can vary with the underlying cause, with the severity of the nerve damage and with appropriate treatment. Consulting a doctor or a specialist is essential for the correct diagnosis and for the management of the symptoms of peripheral neuropathy.
Diagnosing peripheral neuropathy
Diagnosing peripheral neuropathy often involves a combination of a detailed medical history, a physical examination, tests assessing nerve function and additional investigations. Here are some of the common methods used in diagnosing peripheral neuropathy:
Medical history and physical examination
The doctor will take a detailed history in order to identify the risk factors, the symptoms and the possible causes of peripheral neuropathy. The physical examination can reveal signs such as muscle weakness, loss of sensation or changes in reflexes, which can suggest damage to the peripheral nerves.
Tests assessing nerve function
- Sensitivity tests: They can include tests such as the monofilament test (for detecting the loss of tactile sensation), temperature discrimination tests and vibration tests in order to assess sensory function.
- Examining the reflexes: The doctor can test the tendon reflexes in order to assess the function of the motor nerves.
- Assessing muscle function: Tests of muscle strength and coordination can be carried out in order to detect signs of muscle weakness or atrophy associated with neuropathy.
Electromyography (EMG) and nerve conduction studies
These tests measure the electrical activity and the conduction speed of nerve impulses through the peripheral nerves. EMG can help identify nerve damage and determine the severity of the neuropathy or of the polyneuropathies. Nerve conduction studies can offer information about the integrity of the nerves and can identify abnormalities such as slowed nerve conduction or nerve blocks.
Blood tests
Blood tests can be used in order to assess blood glucose levels (for detecting diabetes), the levels of vitamins and minerals, as well as inflammatory or autoimmune markers that could indicate the underlying causes of the neuropathy.
Imaging tests
In some cases, medical imaging such as computed tomography (CT), magnetic resonance imaging (MRI) or BrainMap (qEEG) can be used in order to assess the anatomical structures of the nerves and to identify compressions or other physical lesions that can affect the peripheral nerves.
Nerve biopsy
In cases where the diagnosis remains uncertain or a specific cause is suspected, such as an autoimmune disease, a nerve biopsy can be carried out in order to examine the nerve tissue under a microscope and to identify any abnormalities.
Diagnosing peripheral neuropathy can be complex and requires a multidisciplinary approach, often involving doctors specialised in neurology, internal medicine or other relevant specialities. It is important for the diagnosis to be established as accurately as possible in order to guide the proper management and treatment of the patient’s unique case.
Treatment options for peripheral neuropathy
There are several treatment options available for peripheral neuropathy, and the choice of the right treatment often depends on the underlying cause of the condition and on the severity of the symptoms. Here is a list of the treatment methods:
Blood sugar control
In the case of diabetic peripheral neuropathy, keeping blood glucose levels optimal is crucial for preventing and relieving the symptoms.
Nutritional therapy
Supplements of vitamin B12, B6 and folic acid can be prescribed in order to correct the nutritional deficiencies that can contribute to neuropathy.
Creams and ointments
Some creams and ointments can offer temporary relief for the numbness, tingling or pain associated with peripheral neuropathy.
Medicines
- Painkillers: Painkillers or non-steroidal anti-inflammatory drugs can help manage the pain associated with peripheral neuropathy.
- Tricyclic antidepressants: They can be prescribed in order to treat neuropathic pain by changing the way the brain perceives pain.
- Anticonvulsants: Anticonvulsant medicines are often used in order to treat neuropathic pain by stabilising nerve activity.
- Stopping or adjusting medication: If the neuropathy is caused by medicines or toxic substances, stopping them or adjusting the doses may be necessary.
Physical and occupational therapy
- Stretching and strengthening exercises: A personalised physical therapy programme can help maintain flexibility and muscle strength, reducing the risk of complications associated with peripheral neuropathy, such as falls or injuries.
Light and laser therapy (Photobiomodulation)
Light and laser therapies can help reduce pain and improve nerve function in peripheral neuropathy.
Brain training therapy
Neurofeedback therapy is a non-invasive technique that involves monitoring the electrical activity of the brain and providing feedback in real time in order to help regulate it. In the case of peripheral neuropathy, neurofeedback therapy can help reduce pain and other symptoms by improving the way the brain processes and responds to pain signals. By training the brain to regulate nerve activity, neurofeedback therapy can contribute to managing the symptoms and improving the quality of life of patients with peripheral neuropathy. Brain training therapy is a method unique in Europe that includes both neurofeedback and photobiomodulation for a more effective management of the symptoms of peripheral neuropathy.
Nerve decompression
In cases where the neuropathy is caused by nerve compression, such as in carpal tunnel syndrome or other nerve compressions, surgery to release the pressure on the nerve can be considered.
Healing neuropathy by restoring the peripheral nerves
Neuropathy is a condition that involves damage to the peripheral nerves, the ones that connect the brain and the spinal cord with the rest of the body. Healing neuropathy can be possible in certain cases, but it depends on the underlying cause of the neuropathy and on the degree of nerve damage. In general, the aim of treatment is to manage the symptoms, to prevent the progression of the illness and, in some cases, to attempt the restoration of the damaged nerves.
The treatments for restoring the peripheral nerves can include:
- Physical therapy: Physical exercise and physical therapy can help maintain flexibility, strength and muscle function, as well as improve blood circulation, which can contribute to the restoration of the nerves.
- Alternative treatments: Some people can try complementary or alternative treatments, such as acupuncture, therapeutic massage or nutritional supplements, although their effectiveness can vary and they should be used with caution.
- Neurofeedback: Neurofeedback is a non-invasive technique based on the principle of training the brain to regulate neural activity. Neurofeedback can help restore the peripheral nerves by stimulating neuronal activity and by promoting brain plasticity. For example, if the neuropathy has caused a decrease in sensitivity in a certain area of the body, neurofeedback can be used in order to stimulate neuronal activity in the regions of the somatosensory cortex associated with that specific area. This could facilitate the process of restoring the neuronal connections and of the brain relearning how to regain sensitivity and function in that area.
It is important to talk to your doctor in order to determine which treatment options could be suitable in your case, given the specifics of the symptoms and the underlying causes of the peripheral neuropathy.
Peripheral neuropathy remains a complex and often debilitating condition, which affects millions of people around the world. With a wide range of causes and varied symptoms, diagnosing and managing this condition is a challenge for doctors and patients alike. Even so, advances in research and the development of new therapies offer hope for improving the quality of life of patients affected by peripheral neuropathy.
The treatment of peripheral neuropathy requires a multidisciplinary and personalised approach, which can include the control of the risk factors, the management of the symptoms and the improvement of nerve function. In this context, complementary therapies, such as neurofeedback therapy, can offer an innovative and promising way of addressing the symptoms of peripheral neuropathy and of improving patients’ quality of life.
If you are dealing with symptoms of peripheral neuropathy and you are looking for new and effective ways of managing them, neurofeedback therapy could be a promising option for you. Contact us today in order to find out more about how neurofeedback therapy can help reduce the pain, relieve the unpleasant sensations and improve your quality of life. Fill in the attached form for a free phone conversation with a specialist.
References:
- Prinsloo, S., Novy, D., Driver, L., Lyle, R., Ramondetta, L., Eng, C., McQuade, J., Lopez, G. and Cohen, L. (2017). Randomized controlled trial of neurofeedback on chemotherapy-induced peripheral neuropathy: A pilot study. Cancer, [online] 123(11), pp. 1989-1997. https://doi.org/10.1002/cncr.30649.
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