8 Questions About Peripheral Neuropathy

All of us have had that sensation of numbness or “pins and needles” in our arms and legs at some point—perhaps after sitting the wrong way or sleeping in a funny position, causing the limbs to “fall asleep” temporarily. Now imagine if that sensation never went away. That’s what millions of people in the U.S. experience every day, due to a condition known as peripheral neuropathy. We’ve gotten many inquiries from readers over the years about peripheral neuropathy and its causes and reputed cures. Here are some basics about the condition and how, while not curable, it can be made easier to live with.

1. What is peripheral neuropathy?

Peripheral neuropathy refers to a condition in which the nerves going from the brain and spinal cord to the legs, feet, arms, and hands are damaged. As a result, the nerves no longer conduct impulses properly, either transmitting the signals poorly or spontaneously activating. Depending on what nerves are damaged, the person may experience pain or numbness, a burning or tingling sensation, increased sensitivity to touch, muscle weakness, or a number of other symptoms in the extremities connected to the affected nerves.

2. Who’s most at risk?

The most common risk factor is diabetes, especially in those who are over 40 years old, have had diabetes for more than 25 years, and have poorly controlled blood sugar. An estimated 60 to 70 percent of people with diabetes have peripheral neuropathy. Exactly why isn’t completely understood; some research has linked peripheral neuropathy to smoking and high blood pressure, which are also risk factors for diabetes. Genetics may play a role as well. Prediabetes, in which blood sugar is only modestly elevated, also appears to increase the risk of peripheral neuropathy—one more reason to reduce blood sugar levels before full-blown diabetes develops.

People undergoing cancer chemotherapy also have a high incidence of peripheral neuropathy; the risk is higher for people who are older and for those using certain chemotherapy drugs. Other people at risk include people who abuse alcohol or who have vitamin B1 (thiamine) or B12 deficiency, autoimmune diseases such as lupus or rheumatoid arthritis, or liver or kidney disease, as well as people taking certain drugs for HIV (in which case switching to a different medication may help). In about 30 percent of cases, no cause for peripheral neuropathy can be identified.

3. How does peripheral neuropathy develop?

It depends somewhat on the type (there are about 100 different types of peripheral neuropathy, which vary in terms of which nerves they affect, the specific symptoms they cause, and how they develop). But in general, experts believe that compounds that cause inflammation, as well as specific growth factors and proteins that affect nerve signaling, may all play a role. Among people with diabetes or prediabetes, increased free radicals and abnormal blood sugar levels are believed to contribute to nerve damage.

4. How is it diagnosed?

If you are at risk for peripheral neuropathy or are experiencing symptoms, your healthcare provider can screen for the condition in the office with some quick neurological tests that check your ability to detect pain, light touch, and vibration on the skin, as well as evaluate your reflexes and muscle strength. If the results suggest you have peripheral neuropathy, additional tests will probably be done to determine the type; those may include blood tests, electromyography (which involves inserting a fine needle into a muscle to determine its electrical activity), or nerve conduction velocity tests, which use a probe to stimulate a nerve and analyze how its fibers are functioning. Less commonly, a nerve biopsy will be performed.

5. How is peripheral neuropathy treated?

Most treatments for peripheral neuropathy target the symptoms, such as pain and tingling. Among the first-line drug, treatments are amitriptyline, duloxetine (Cymbalta), pregabalin (Lyrica), and gabapentin (Neurontin). Only pregabalin is approved specifically for peripheral neuropathy; the others are prescribed off-label. Your healthcare provider may also recommend a topical treatment to apply to the affected area, such as a patch containing 0.075% capsaicin, an ingredient in hot peppers that has pain-relieving properties, or 5% lidocaine, an anesthetic. These may be effective if the pain is limited to one area.

Transcutaneous electrical nerve stimulation, or TENS, may also be a viable option. It can be administered at your doctor’s office or, if your doctor recommends it, on your own at home. TENS involves applying electrodes to the skin on or near the painful spot while an attached device emits a gentle electrical stimulus. A review paper published in Pain Management found evidence that 4 to 6 weeks of TENS treatments may significantly improve various types of pain. The treatment may also help reduce numbness and boost the quality of life in people with diabetic peripheral neuropathy, the review found. Often, a combination of treatment approaches will provide the best relief.

6. Are there other non-drug strategies that can help?

Yes, and they’re worth trying before or in addition to conventional therapies. Seeing a skilled physical therapist can improve your physical functioning, and a type of psychological therapy called cognitive behavioral therapy can help counter negative thinking or changes in behavior that can exacerbate anxiety and pain. Some evidence suggests that diet and exercise may both prevent and reverse nerve damage from peripheral neuropathy in people with diabetes or prediabetes, as well as reduce symptoms. A review paper in the journal Frontiers in Cellular Neuroscience, for instance, concluded that exercise can be highly beneficial for preventing peripheral neuropathy and alleviating its symptoms by preserving and promoting nerve function, reducing pain, and improving sensation.

In addition, if you have peripheral neuropathy, it’s important to examine your legs and feet regularly for things like cuts, bruises, or blisters. If sensation in these areas is reduced, you may not notice such injuries, which need to be treated promptly to reduce the risk of more serious problems like infection.

7. What about alternative or complementary therapies?

Relaxation techniques such as deep, controlled breathing and muscle relaxation are worth a try for reducing pain and discomfort. Acupuncture is another option—though, as, with relaxation techniques, there’s limited evidence to support its effectiveness, and many of the studies have methodological problems.

A type of biofeedback called neurofeedback may help treat people with chemotherapy-induced peripheral neuropathy. The treatment typically involves placing electrodes on the affected person’s scalp that pick up the brain’s activity (including pain), which is displayed on a video screen. Participants are taught how to reduce pain-associated brain waves by playing a video game that responds to their brain activity. In a small study of patients with cancer who were experiencing peripheral neuropathy, conducted at the University of Texas MD Anderson Cancer Center, those who were trained to alter their pain-related brain waves through electroencephalopathy (EEG) feedback experienced a significant improvement in pain, numbness, and quality of life compared with those who were not trained.

8. Can peripheral neuropathy be prevented?

For people with diabetes, preventive strategies include keeping blood sugar well controlled, exercising regularly, quitting smoking, not drinking excessively, and maintaining healthy body weight and blood pressure. To prevent chemotherapy-induced peripheral neuropathy, your healthcare provider may use smaller doses of chemotherapy administered more frequently or give the same dose over a longer time period.

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