Questions About Neuropathy

What is Peripheral Neuropathy?

Peripheral Neuropathy is a common but often disabling disorder of peripheral nerves. Peripheral Neuropathy is the medical term which describes damage to the peripheral nervous system, the communications network that transmits information from the brain and spinal cord (i.e. the central nervous system) to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Peripheral nerves are structures that connect muscles and sensory organs to the brain and spinal cord. Without them there is no movement and there is no sensation. Peripheral Neuropathy is not well understood by the general public and has received relatively little attention compared to other better known disorders.

There are over 500,000 people in Canada who suffer from some form of neuropathy.

Common symptoms of Peripheral Neuropathy are:

    • numbness or insensitivity to pain or temperature
    • tingling, burning, or prickling
    • sharp pains or cramps
    • extreme sensitivity to touch, even light touch
    • loss of balance or co-ordination

Foot Exam

Peripheral Neuropathy can occur from a wide variety of causes, the most common being diabetes mellitus. Other causes include inflammation (chronic inflammatory demyelinating polyneuropathy (CIDP)) and inflammation of blood vessels (vasculitis). In many parts of the world, leprosy is a common and difficult disorder of peripheral nerves. Partial peripheral nerve injury is associated with a pain syndrome that can be severe and is known as “neuropathic pain”. Its treatment requires different approaches toward pain treatment. Many patients with Peripheral Neuropathy can suffer from pain but very often feel that their family and friends do not understand them since there is no visible and obvious disease.

The most common form of neuropathy is the distal (e.g., lower extremities) symmetric (both sides) axonal (large fiber) polyneuropathies (involving many nerves), whose etiologies or causes are most frequently diabetes mellitus (1/3 to 1/2 frequency) and alcoholism/nutritional/vitamin deficiencies (1/4 to 1/3 frequencies). Other causes in order of frequency are: idiopathic, hereditary (usually sensory) and medical diseases, such as; monoclonal protein disorder, metabolic and endocrinal conditions (e.g., diabetes and hypothyroidism), connective tissues (as with lupus and rheumatoid arthritis), infections (as with HIV or Lyme disease), cancers and toxicities (more often prescription drugs than environmental causes).

Early signs for these neuropathies are pain and numbness in the feet, imbalance, sensory loss, hypoactive or absent ankle reflexes, occasional weakness or wasting of foot, and later leg muscles. Later signs would include sensory impairment slowly spreading up the lower legs and on to the hands, in a stocking and glove distribution.

(Re-printed courtesy of Yolo County Peripheral Neuropathy Support Group (Sacramento, California) from a video presentation by Richard Olney, M.D., former UCSFMC Neurologist.

What is Neuropathic Pain?

Neuropathic pain (NeP) is a type of chronic pain caused by injury or disease of the nervous system that frequently results in a burning, tingling, numbness and/or shock-like sensations. Nerve pain is often puzzling and frustrating for people with NeP and can be a challenge to manage, as it seems to respond poorly to standard pain therapies. It can also last indefinitely, may escalate over time and can result in disability. Nerve pain can be so extreme that some sufferers find that even the touch of clothing on their skin will trigger an unbearable burning pain. Nerve pain is often under-diagnosed and under-treated.

Neuropathic Pain Meter

            Neuropathic Pain Meter

How does Neuropathy occur?

Neuropathic pain most likely occurs after an injury to some part of the nervous system. Changes in the nervous system very likely occur as nerves attempt to heal or become persistently active after an injury. Some injuries are associated with changes in the body”s system for detecting normal sensations. For example, some persons with neuropathic pain have pain from a simple light touch on the skin. This is the result of abnormal activity in the body’s sensing mechanisms. These changes can become persistent. (Source: National Pain Foundation).