Peripheral neuropathy

Diagnosis 

Diagnosis of peripheral neuropathy typically involves a comprehensive assessment, encompassing the following elements: 

• Medical history: Your healthcare provider will delve into your medical history, exploring aspects such as your symptoms, lifestyle, exposure to toxins, alcohol consumption, and any family history of neurological diseases. 
• Neurological examination: A thorough neurological examination will be conducted to evaluate various aspects of your nervous system function, including: 

• • Tendon reflexes 
  • Muscle strength and tone 
  • Sensation perception 
  • Balance and coordination 

• Diagnostic tests: To aid in diagnosis, your healthcare provider may order the following tests: 

• • Blood tests: These tests can help detect low vitamin levels, diabetes, signs of inflammation, or metabolic issues that could be contributing to peripheral neuropathy. 
  • Imaging tests: Imaging studies, such as nerve ultrasound, Computed Tomography (CT) scans, or Magnetic Resonance Imaging (MRI) scans, may be employed to identify structural abnormalities like herniated disks, pinched nerves, growths, or vascular and bone-related issues. 
  • Nerve function tests: Electromyography (EMG) is a procedure that records electrical activity in your muscles to assess nerve damage. During EMG, a fine needle electrode is inserted into muscles to measure electrical activity while the muscle contracts. Additionally, nerve conduction studies are often conducted in conjunction with EMG. This involves placing flat electrodes on the skin and stimulating nerves with a low electric current to evaluate their response. 
  • Other nerve function tests: Further specialized tests may be utilized, including autonomic reflex screens to assess autonomic nerve function, sweat tests to measure sweat production, and sensory tests to assess touch, vibration, cooling, and heat perception. 
  • Nerve biopsy: In some cases, a nerve biopsy may be performed, involving the removal of a small portion of a sensory nerve to investigate the underlying cause of neuropathy. 
  • Skin biopsy: A skin biopsy may be conducted to examine the number of nerve endings in a small section of skin. 

These diagnostic measures are employed in combination to gain a comprehensive understanding of the condition, its potential causes, and the extent of nerve damage. The information gathered from these assessments assists in formulating an accurate diagnosis and developing an appropriate treatment plan for peripheral neuropathy. 

Treatment  

Treatment goals for neuropathy management include addressing the underlying condition responsible for the neuropathy and alleviating its associated symptoms. If diagnostic tests reveal no specific cause for the neuropathy, a healthcare professional may recommend a watchful waiting approach to monitor whether the condition remains stable or improves over time. 

• Medications: 
• Pain relievers: Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful in managing mild neuropathic symptoms. 
• Antidepressants: Certain tricyclic antidepressants like amitriptyline and nortriptyline can help manage neuropathic pain by affecting chemical processes in the brain and spinal cord responsible for pain perception. Serotonin and norepinephrine reuptake inhibitors like duloxetine, venlafaxine, and desvenlafaxine may also be effective, particularly for neuropathy related to diabetes. Antidepressants can have side effects like dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain, and constipation. 
• Anti-seizure medications: Drugs such as gabapentin and pregabalin, originally designed to treat epilepsy, are often prescribed to alleviate nerve pain. Possible side effects may include drowsiness and dizziness. 
• Topical treatments: Lidocaine cream, available without a prescription, can be applied to the skin for localized pain relief. Lidocaine patches are another option but can lead to side effects like drowsiness, dizziness, and numbness at the application site. 
• Therapies and Procedures 
• Scrambler therapy: This treatment employs electrical impulses to send non-pain signals to the brain, replacing pain messages from the nerves. The aim is to retrain the brain to perceive reduced or no pain. 
• Plasma exchange, steroids, and intravenous immune globulin: These treatments are often employed when inflammation or autoimmune conditions contribute to neuropathy symptoms, including weakness, numbness, or balance issues. They are primarily used to address underlying causes rather than pain management. 
• Spinal cord stimulation: Utilizing neurostimulator devices implanted in the body, this therapy delivers low-level electrical impulses that can block pain signals from reaching the brain. 
• Physical therapy: For individuals experiencing muscle weakness or balance problems, physical therapy can improve mobility. Assistive devices like hand or foot braces, canes, walkers, or wheelchairs may also be necessary. 
• Surgery: In cases where nerve compression, often due to tumors, is the root cause of neuropathy, surgical intervention may be required. 

Effective neuropathy management involves a tailored approach, considering both the underlying condition and the specific symptoms experienced by the individual. Healthcare professionals will work closely with patients to determine the most appropriate treatment plan.