Peripheral Neuropathy is a condition in which the nerves in the peripheral nervous system become damaged, and often causes weakness, numbness and pain, usually in the hands and feet. Eventhough hands and feet are commonly associated with this affliction, it can also affect other parts of the body.

It is estimated that 2% to 7% of the general population suffers from Peripheral Neuropathy, and that older people tend have a higher risk of developing this condition. The prevalence of Peripheral Neuropathy was estimated at 8% in those aged 55 years and is more common in men compared to women.

Certain diseases can also significantly increase the risk of Peripheral Neuropathy. Studies have estimated the prevalence of Peripheral Neuropathy in patients with type 2 diabetes mellitus at between 20% and 70%. There is also a link between occupational activities and the risk of developing Peripheral Neuropathy – for example, it is higher among people working in professions that require constant repetitive motions.

Most neuropathies will affect all the three types of nerves to varying degrees :

• Motor Nerves – control the movement of all muscles under voluntary conscious control-mainly skeletal muscles that control the ability to walk, grasp objects or even talk.
• Sensory Nerves – transmit information from the senses through the spinal cord to the brain.
• Autonomic Nerves – control involuntary body functions, such as breathing, digesting food, and heart and gland functions.

Peripheral Neuropathy can be categorized by the following factors:

• size of the nerve fibers involved, that is, whether it is large or small
• onset of symptoms i.e acute, subacute or chronic
• nerve fibres involved i.e. motor, sensory or mixed

Causes of Peripheral Neuropathy

There are over 100 causes of Peripheral Neuropathy including neurological syndromes, systemic diseases, nutritional deficiencies, toxins/drugs, and genetic disorders. Unfortunately, in up to 40% of cases, no cause can be determined despite a full medim examination and screening. Peripheral Neuropathy can also be inherited in about 20% of cases, and as such, family history should often be investigated for conditions like Charcot-Marie-Tooth disease, which can affect the motor and sensory nerves.

Some of the common causes of Peripheral Neuropathy include :

• Diabetes and impaired glucose tolerance
• Heavy metal poisoning (eg, lead, mercury, arsenic, and thallium)
• Neurotoxic drugs (example, amiodarone, phenytoins, statins, colchicine, dapsone and nitrofurantoin)
• Some forms of chemotherapy
• Acute intermittent porphyria
• Infections such as HIV, hepatitis C, diphtheria and leprosy
• Vitamin B1 deficiency (often occurring in patients who have undergone laparoscopic gastric banding as well as cases of alcoholism)
• Vitamin B6 deficiency (often associated with concurrent use of medicines such as isoniazid and hydralazine, alcoholism and peritoneal dialysis)
• Vitamin B12 deficiency (often associated with lack of dietary vitamin B12, or the inability to absorb vitamin B12)
• Nerve entrapment
• Monoclonal gammopathies. For example multiple myeloma, heavy chain diseases, plasmacytoma, and Waldenstrom macroglobulinaemia)
• Immune-mediated neuropathies. For example, Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, Sjögren’ syndrome and systemic lupus erythematosus

Symptoms Of Peripheral Neuropathy

Peripheral Neuropathy encompasses a wide array of symptoms such as

• feeling numbness, tingling, burning, aching, swelling, tightness, and electric-like shocks in the distal lower extremities
• problems in sensing temperature changes and vibrations
• ‘pinprick-like’ sensation
• uncontrolled twitching of the muscles under the skin
• muscle cramps, muscle weakness, paralysis, atrophy of the foot muscles, and ankle weakness
• constantly experiencing falls and the loss of dexterity
• developing bilateral foot drop
• impaired proprioception – perception or awareness of the position and movement of the body) over that the motor
• sensation of ‘wearing gloves or gloves’ on the upper calf and finger tips
• impairment of one’s balance and gait
• trouble maintaining the streaming of urine (urine hesitancy)
• early satiety (cannot consume a full meal without feeling bloated)
• diarrhoea or constipation
• weight loss
• sexual dysfunction
• sweating disturbances
• abnormal blood pressure or heart rate
• orthostatic hypotension (lightheadedness)

Remedy Or Treatment for Peripheral Neuropathy

Basically, there are two objectives when treating Peripheral Neuropathy, which are : treating the underlying cause and managing the symptoms experienced.

For the treating of medical problem associated with Peripheral Neuropathy, these could include :

• Immune-mediated neuropathies can improve with treatment of the autoimmune disease using immunosuppressive drugs like corticosteroids, azathioprine, cyclosporine, or immunoglobulins.
• Physical therapy, injections and surgery are different forms of treatment for nerve entrapment
• Deficiencies in vitamins B1, B6 and B12 as well as other nutritional deficiencies should be corrected
• Good control of blood glucose levels may reduce neuropathic symptoms and prevent further damage to the nerves
• Prompt treatment of shingles to minimize the risk of progression to postherpetic neuralgia

For symptomatic management of Peripheral Neuropathy, these could include :

• over-the-counter (OTC) medications such as paracetamol, and non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin for neuropathic pain
• antidepressants such as tricyclic antidepressants (for example, amitriptyline and nortriptyline), and serotonin and norepinephrine reuptake inhibitors (for example, duloxetine and venlafaxine)
• antiepileptic medications such as sodium valproate, carbamazepine, topiramate, gabapentin and pregabalin have also been used to help relieve the pain of Peripheral Neuropathy
• opioids such tramadol, oxycodone and morphine coul also help to reduce pain attributed to Peripheral Neuropathy but patients has to be first be evaluated for their risk of addiction, dependence, and substance abuse.
• topical patches and sprays containing lidocaine or capsaicin may also relieve pain in some patients. It should be noted, the side effects of capsaicin aree burning sensation upon exposure to heat, hot weather or warm water.

In addition to the symptomatic management of Peripheral Neuropathy, additional supportive measures can be taken, such as :

Foot Care

Peripheral Neuropathy sufferers are advised to take care of their feet, especially for those who suffer from diabetes. Proper foot care includes checking daily for blisters, cuts or calluses. Patients should be recommended to wear soft, loose cotton socks and padded shoes.

Exercise

Exercise regularly, for example, three times or more a week. Exercise activities may include brisk walking, yoga and taichi. Regular exercise can help patients reduce the intensity of neuropathic pain, besides improving muscle strength and function, coordination and dexterity at the same time.

Physiotherapy and Occupational Therapy

Physiotherapy can be effective in helping Peripheral Neuropathy sufferers increase their strength, improve their balance and range of motion, while occupational therapy can help patients cope with the pain as well as compensate for any loss of function that arises from the neuropathy.

Use Walking Aids (and other tools)

Wear tools like splints, hand and foot braces, and orthotics. Ensure that these tools are utilise properly to mobility and function.

Stop Smoking

Smoking can effectively constrict and damage blood vessels, affecting circulation and increasing the risk of foot problems other neuropathy complications.

Eat Healthy Meals

Good nutrition is especially important, more so to those who suffers from Peripheral Neuropathy arising from nutritional deficiencies.

Avoid Alcohol

Alcohol can worsen Peripheral Neuropathy by aggravating neuropathic pain and increasing nerve damage.

Achieve Good Glycaemic Control

For Peripheral Neuropathy sufferers with diabetes, achieving a strict control of their blood glucose levels is probably the most impactful thing that can be done to slow down the progression of their neuropathy. Studies have indicated that episodes of hyperglycaemia can induce further nerve damage and aggravate neuropathic pain. additionally, good glycaemic control has been shown to also reduce abnormalities in nerve conduction.