PERIPHERAL NEUROPATHY

General Information

DEFINITION--A group of symptoms caused by abnormalities in sensory or motor nerves.

BODY PARTS INVOLVED--Many nerves that end in muscles, blood vessels and skin. This usually affects fingers, toes, hands, feet, lower arms and legs, and may affect bladder or bowel control.

SEX OR AGE MOST AFFECTED--Adults of both sexes.

SIGNS & SYMPTOMS--

Symptoms usually appear gradually over many months:

• Tingling and numbness that begins in the hands and feet and spreads gradually.
• Gradual muscle weakness throughout the body--often in same place on both sides.
• Shooting pains that are often worse at night. Pains are aggravated by touch or temperature changes.
• Painless ulcers on the toes or fingers.
• Pale, dry skin that becomes sensitive to touch.
• Weight loss.
• Severe back pain or loss of bladder or bowel control, if caused by intervertebral disk disease.

CAUSES

> Reactions to drugs or chemicals, including: emetine; hexobarbital; sulfonamides; phenytoin; nitrofurantoin; heavy metals; carbon monoxide; solvents; or industrial poisons. Interactions of drugs required by people with cardiovascular disease

sometimes cause symptoms.

> Complication of an underlying disorder, such as: diabetes mellitus; alcoholism; vitamin deficiency; vitamin B-12 deficiency anemia; or thyroid disorder.

• Poor nutrition.
• Malabsorption disorders.
• Autoimmune reaction.
• Trauma or pressure on a nerve.
• Excessive vomiting, including early pregnancy vomiting.
• Decreased thyroid function.
• Acute porphyria.
• Complication of dialysis treatment.
• Cancer.
• Ruptured intervertebral disc.
• Some hereditary disorders.

RISK INCREASES WITH

• Adults over 60.
• Use of drugs listed in Causes, especially multiple medications.
• Exposure to chemicals listed in Causes.
• Poor nutrition, such as in alcoholism.
• Poor control of diabetes.
• Family history of neuropathies.

HOW TO PREVENT--Avoid as many causes and risks as possible.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory studies of blood, urine, vitamin B-12 levels, thyroid function and spinal fluid.
• Electromyography (See Glossary) and nerve conduction studies.

APPROPRIATE HEALTH CARE

• Doctor's care.
• Hospitalization (sometimes).
• Surgery to relieve pressure, if nerves are compressed.

POSSIBLE COMPLICATIONS--Chronic pain and disability.

PROBABLE OUTCOME--Mild cases can be cured if the underlying cause is diagnosed and treated. Serious cases may be incurable but treatment can help symptoms improve.

How To Treat

GENERAL MEASURES--

• Most important aspect of treatment is to identify the underlying cause and correct it if possible. For example, identify and remove toxic agents, correct nutritional deficiencies or avoid alcohol.
• Biofeedback training to learn relaxation techniques that relieve pain may be helpful.
• Inspect hands and feet daily for wounds.
• Keep feet clean and toenails trimmed properly; wear shoes that fit well.

MEDICATION--

• For minor pain, you may use non-prescription drugs such as aspirin or acetaminophen.
• Your doctor may prescribe medications to treat underlying disorders.

ACTIVITY--

• If peripheral neuropathy is interfering with normal activities, physical therapy may help.
• If you have difficulty maintaining balance, walk with a cane or other support.
• Install rails next to the bathtub.

DIET--No special diet. Vitamin and mineral supplements probably will be necessary. Pyridoxine (vitamin B-6) may help.

Call Your Doctor If

• You have symptoms of peripheral neuropathy.
• Symptoms (especially muscle weakness) persist or worsen, despite treatment.
• You develop a severe bruise or open sore.