Classifications of Peripheral Neuropathy
| Mononeuropathies are neuropathies that involve only one nerve and can be very painful. If you have more than one mononeuropathy, it may be called mononeuropathy multiplex or multifocal mononeuropathy. |
| Peripheral Polyneuropathies involve a number of nerves and are typically distributed in a "stocking and glove" distribution bilaterally - meaning they affect both feet, both legs and/or both hands. These can be classified in a number of ways. |
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Sensory neuropathy is neuropathy of the nerves that control your ability to feel pain, temperature, position and touch. These nerves can become "hypersensitive" and can cause significant pain. Damage to sensory nerves may also make your feet feel numb or like you are walking on cushions or blocks of wood and can affect your ability to feel an injury and your ability to keep your balance. |
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Motor neuropathy is neuropathy of the nerves that control your ability to move your muscles, your coordination and your ability to walk. |
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Sensory-motor neuropathy means that both sensory and motor nerves are impaired. |
| Autonomic Polyneuropathies involve the nerves that regulate biological activities that you do not control consciously, such as digesting food, sweating and heart and gland functions. If you have peripheral neuropathy, your feet and hands may not sweat and can become cracked and dry, putting you at risk of other complications. |
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| Symptoms of neuropathy depend on the types of nerves affected and can affect people in many different ways. |
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Sensory neuropathy symptoms include: |
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Pain – Neuropathic pain is often described as burning, shooting, stabbing, like electrical shocks, pins and needles and throbbing. Painful symptoms are often more common in the earlier phases of sensory neuropathy. Many times the pain is worse at night and can interrupt sleep and make it difficult to walk, wear shoes, exercise or even tolerate sheets touching your feet! This pain may last for years in some cases. In other cases, the pain progresses to numbness, but may still return from time to time. |
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Numbness or loss of sensation – This is the inability to feel touch, temperature or vibration. This numbness may be described as feeling like you are wearing stockings and gloves, or that you are walking on sponges, cushions or blocks of wood. Some people describe that it feels like their feet are not touching the ground. Numbness in the hands makes it difficult to use your fingers to write, button clothing, pick up small objects, etc. |
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Loss of balance – This is due to the inability to feel uneven surfaces, such as when you walk outside. Neuropathy may cause you not to feel the position of your feet and ankles (known as proprioception) and whether your feet are up or down. If you cannot feel the position of your feet, it becomes very difficult to maintain your balance, especially with your eyes closed. |
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| Motor neuropathy symptoms include: |
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Muscle weakness – When your muscles feel weak, you can lose your ability to walk and do activities that require coordination. Sometimes people have to wear braces to better control their muscles. In severe cases, people may have to use a wheelchair. |
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Twitching/Restless Leg Syndrome – Some people develop twitching, tics or a condition called restless leg syndrome (RLS) when motor nerves are affected by peripheral neuropathy. RLS is characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. People affected with RLS describe the sensations as burning, creeping, tugging, or like insects crawling inside the legs. The sensations range in severity from uncomfortable to irritating to painful. |
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Foot Drop – With severe motor neuropathy, some people lose the ability to raise the foot at the ankle. When this occurs, walking can be difficult and can result in a slapping motion. Some people may have to wear a brace to control this slapping motion. Foot drop may also be caused by injuries or surgery when certain nerves are damaged. |
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Painful muscle cramps or spasms – Cramping can occur in the muscles, especially when the motor nerves and muscles are not getting enough blood flow. |
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Changes in skin, hair, nails – People with neuropathy may develop very dry, itchy skin due to the the lack of sweating and lack of blood flow. Skin may crack and peel. Some people lose the hair on the legs and feet and may develop more frequent fungal infections in their feet and toenails – or may lose their toenails entirely. |
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Wounds that don’t heal – Sores may not heal properly in people with neuropathy, and sometimes they are not discovered right away due to loss of sensory nerve function. In fact, peripheral neuropathy is the leading cause of lower extremity amputations. |
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Degeneration of bone, cartilage and ligaments – People with peripheral neuropathy may also see their foot bones and the ligaments that hold them in place degenerate to the point where they develop what is known as Charcot Foot. At the latest stages of Charcot foot, the foot develops a rocker bottom as the foot bones fracture and may require special shoes to prevent callous formation and wounds. |
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Diabetic Peripheral Neuropathy (DPN)
Diabetes mellitus, characterized by high blood sugar levels, is a leading cause of peripheral neuropathy in the United States
and Canada. About 60 to 70 percent of people with diabetes have mild to severe forms of neuropathy. People with diabetes either have Type 1 diabetes (an autoimmune condition that destroys the pancreatic cells that make insulin) or Type 2 diabetes (a condition typically of obesity characterized by insulin resistance and often accompanied by high blood pressure and high cholesterol).
| DPN is a microvascular complication, which means it is a disease of the small blood vessels that supply the nerves with nutrients. Other microvascular complications of diabetes include diabetic nephropathy (kidney damage) and diabetic retinopathy (eye damage). Often these three complications go hand in hand and the Diabetes Control and Complications Trial (DCCT) showed that tight blood glucose control was critical to prevention of these complications. |
| Recent research suggests that diabetic peripheral neuropathy is caused by endothelial dysfunction (poor function of the cells that line the blood vessels) and a lack of appropriate release of nitric oxide. Nitric oxide is an important molecule which allows the blood vessels to properly dilate, controls blood pressure and is important for the many growth factors that rebuild tissue and bone as part of healing. Many people with diabetes have high blood pressure, and research suggests that high blood glucose scavenges nitric oxide and endothelial dysfunction prevents the production of normal amounts of nitric oxide. |
| In some cases, just because you have diabetes, it may not be the only cause of your neuropathic symptoms! In cases where DPN is complicated by other factors such as nutritional deficiencies, thyroid disease, kidney or liver disease, vascular disease, anemia, spinal problems, etc. those issues should also be addressed. Below are some of the many non-diabetic conditions that can also cause peripheral neuropathy. |
Pre-Diabetic Neuropathy
Pre-diabetes is characterized by glucose intolerance and is believed to also begin causing nerve damage and other complications of diabetes. If you have ever been told you are have “borderline diabetes,” you either already have diabetes, or are at significant risk of developing diabetes and peripheral neuropathy if you do not take appropriate measures to lose weight and address the other vascular risks associated with diabetic neuropathy. If you have ever been diagnosed with Gestational Diabetes during pregnancy, you are also at higher risk of developing pre-diabetes or diabetes.
Non-Diabetic Peripheral Neuropathies
Non diabetic or Idiopathic Neuropathy can be very frustrating to people who have it. There can be many causes and sometimes more than one can contribute to the nerve damage. It can be as simple as undiagnosed diabetes, since high blood sugars may go on for years undetected. It could be complicated by drugs, toxins, infections, vitamin deficiencies, heredity and autoimmune conditions. Below is a description of some of the known causes of peripheral neuropathy. More and more things are being found to cause peripheral neuropathy, so don’t lose hope of finding the cause of your neuropathy.
Pharmaceutical Drugs
Some of the drug classes that can cause peripheral neuropathy are below. If you have a pre-existing condition that causes peripheral neuropathy such as diabetes, vascular disease or alcoholism, these drugs may be more likely to cause peripheral neuropathy. |
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Chemotherapy/Cancer Drugs – Cisplatin, Vincristine, Paclitaxel, Etoposide, Tenoposide, Thalidomide, Interferon, Docetaxel, Oxaliplatin, Bortezimib |
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Antibiotics and antivirals – Metrinidazole - Flagyl®, Nitrofurantoin, Thalidomide, INH (Isoniazid), Stavudine (Zerit®) |
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Cholesterol lowering drugs (Statins) |
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Anticonvulsants (Phenytoin - Dilantin®) |
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Anti-alcohol drugs (Disulfiram) |
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Heart or blood pressure medications (Amiodarone, Hydralazine, Perhexiline) |
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Skin treatment drugs (Dapsone) |
| Certain vitamins and minerals are essential for healthy nerve function and healthy blood flow to the nerves. Lack of these vitamins and minerals can cause lack of blood flow and nerve function deficits. If you have difficulty digesting food, have an eating disorder or are just not eating properly, you may have a vitamin deficiency. Some of the most important vitamins and minerals for blood vessel and nerve health include the following: |
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| Vitamins E, B1 (thiamine), B6, B12 |
| Niacin |
| Folic acid |
| Magnesium |
| Alpha Lipoic Acid |
| The kidneys and liver are very important organs for eliminating drugs, toxins and waste substances from the body and maintaining chemical balance in the body. When these organs do not function properly as a result of infection, inflammation or other types of damage, their dysfunction can result in neuropathy. |
| Kidney disease – Kidney disease is a microvascular complication and one of the most common complications of diabetes. People who are on kidney dialysis can have abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. A majority of patients who require dialysis because of kidney failure develop polyneuropathy. |
| Alcohol Abuse and Liver Disease – Alcohol abuse may cause neuropathy directly, or can cause vitamin and nutritional deficiencies that can lead to neuropathy. In addition, liver disease can lead to neuropathies as a result of chemical imbalances and abnormally high levels of toxic substances. |
Toxins
Environmental and industrial toxins can cause neuropathy. Below is a partial listing only. |
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Heavy metals – Lead, mercury, arsenic, thallium |
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Organic solvents |
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Insecticides |
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Herbacides (Agent Orange) |
Infections
| Bacteria and viruses can attack the nerves causing pain and numbness. Some of those known to cause peripheral neuropathy include: |
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Viral infections that can cause peripheral neuropathy |
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HIV/AIDS |
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Herpes varicella-zoster (Shingles) |
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Herpes simplex |
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Cytomegalovirus |
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Epstein-Barr virus (Mononucleosis, Chronic Fatigue Syndrome |
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Hepatitis B and C |
Nearly 30,000 patients have found relief through the use of Anodyne® Therapy Home Systems, and tens of thousands more have received treatment for their neuropathic symtoms with Anodyne® Therapy Professional Systems.
Treatments with Anodyne® Therapy Systems help relieve skin sensation disturbances (such as pain and numbness) of diabetic and peripheral neuropathy because a majority of the underlying causes of neuropathy are directly related to poor circulation.
Diabetes, vascular disease (PVD and PAD), hypertension and atherosclerosis contribute to blood vessel narrowing and reduced blood flow to the extremities – leading to pain. The use of Anodyne® Therapy helps to counterbalance microvascular blood vessel constriction or disfunction brought on by these diseases - however, as these conditions are generally chronic in nature - treatments with Anodyne Therapy must be continued for lifetime symptomatic relief.
Unfortunately, many neuropathies (like diabetic peripheral neuropathy) are progressive in nature - meaning they actually get worse as the years pass even when blood sugar levels are kept under control with medication and proper diet.
Nerves and the blood vessels work together. Nerves control dilation and constriction of the blood vessels. In order to function properly, the nerves need adequate blood flow. If blood flow is reduced, the nerves may cause constriction of the blood vessels, which further reduces the blood flow - causing what is known as 'ischemic pain'.
Eventually, the nerves can simply die, due to lack of oxygen and nourishment from the blood.
When nerves die, it causes patients to experience another common symptom of neuropathy - numbness, or lack of protective sensation - as it is referred to in clinical terms. Numbness - is very dangerous - as patients are more likely to fall and develop foot ulcers. Statistics show that this numbness is experienced by 2/3 of diabetic patients over the course of their disease!
Don't spend another day trying to just cope with neuropathic pain - or even worse - ignoring it!
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The information on this page has been gathered from several reputable health websites on your behalf, to help you learn about peripheral neuropathy, its causes, symptoms and treatment options. This Website, together with and including all content thereon, is not a substitute for guidance from a health care professional.
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