Peripheral neuropathy
Alternative names:
neuritis - peripheral; neuropathy - peripheral; peripheral neuritis
Treatment:
Treatment goals may be cure of the disorder (if possible), maximal self-care ability and independence, and control of symptoms.
The cause should be identified and treated whenever possible. This may include control of blood-sugar levels for diabetics, abstinence from alcohol, nutritional supplements, surgical decompression or other surgical treatments, or medical treatment of conditions.
Physical therapy, vocational therapy, occupational therapy, and orthopedic interventions may be recommended to promote self care ability and independence. For example, exercises and retraining may be used to increase muscle strength and control. Appliances such as wheelchairs, braces, and splints may improve mobility or ability to use an affected extremity.
Safety is an important consideration for people with neuropathy. Lack of muscle control or decreased sensation increase the risk of falls or other injury. The person may be unable to perceive a potential source of injury because of decreased sensation.
Safety measures for people experiencing difficulty with movement may include railings, various appliances, removal of obstacles (such as loose rugs that may slip on the floor), and other measures as appropriate. Safety measures for people having difficulty with sensation include awareness of the lack of sensation and compensation through other measures. Specific measures may include use of adequate lighting (including lights left on at night), testing of water temperature before bathing or immersing parts of the body in water, use of protective shoes (no open toes, no high heels, and so on), and similar measures. Shoes should be checked often for grit or rough spots that may cause injury to the feet.
People with decreased sensation should check their feet (or other affected area) frequently for bruises, open skin areas, or other injury, which may go unnoticed and become severely infected. People with neuropathy (especially those with polyneuropathy or mononeuropathy multiplex) are prone to new nerve injury at pressure points (knees and elbows, for example). They should avoid prolonged pressure on these areas from leaning on the elbows, crossing the knees, or similar positions.
Over-the-counter analgesics or prescription pain medications may be needed to control pain (neuralgia). Anticonvulsants (phenytoin, carbamazepine), tricyclic antidepressants, or various other medications may be used to reduce the stabbing pains that some people experience. Whenever possible, their use should be avoided or minimized to reduce the risk of side effects of medications. Adjusting position, using frames to keep bedclothes off of a tender body part, or other measures may be helpful to control pain.
Autonomic changes may be treated symptomatically. They may be difficult to treat or respond poorly to treatment. Use of elastic stockings and sleeping with the head elevated may reduce postural hypotension. Fludrocortisone or similar medications may be beneficial in reducing postural hypotension for some people. Medications that increase gastric motility (such as metoclopramide), eating small frequent meals, sleeping with the head elevated, or other measures may be used to treat reduced gastric motility. Manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications such as bethanechol may be necessary to treat bladder dysfunction. Impotence, diarrhea, constipation, or other symptoms are treated as appropriate.
Expectations (prognosis):
If the cause of the peripheral neuropathy can be identified and successfully treated and if damage is limited to the axon or myelin sheath (leaving the cell body intact), there is a possibility of full recovery from peripheral neuropathy.
In some cases, there may be partial or complete loss of movement, function, or sensation resulting in disability. Nerve pain may be quite uncomfortable and may persist for a prolonged period of time. In some instances, the neuropathy may cause severe, life-threatening symptoms.
Complications:
Calling your health care provider:
Call your health care provider if symptoms of peripheral neuropathy are present. In all cases, early diagnosis and treatment increases the possibility that symptoms can be controlled.
Emergency symptoms include irregular or rapid heartbeats, difficulty breathing, difficulty swallowing, and fainting.
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