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When it comes to your health, you are probably pretty aware when something comes about that is not normal. You may have some pain in some joints, tinging and numbness in others, but when your body starts to go completely numb in the extremities then you are most likely to take notice in a hurry. One thing that comes about in neuropathy, or the loss of sensation in the extremities, is pain and the general unawareness of the limbs. This can be something that causes some grief and many people tend to disregard this as typical aging. However, there are somethings that can be done with neuropathy that can help to treat the condition. Lets take a look at some of the symptoms and treatments for the condition.

1. Tingling Sensation

One of the most commonly reported symptoms of neuropathy is tingling and numbing in the hands, feet, or both. Tingling sensations are a serious matter for anyone and if this comes about (other than when your hand or foot is asleep), you should not take this lightly. Tingling sensations in the hands and feet could mean that you are well into a neurological illness and while many individuals tend to back away when this occurs, the truth is it can be something that you can prevent from worsening or even reverse. Consider consulting with your doctor if you have noticed that you are having some tingling sensations in the hands and feet.

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11 Symptoms and Treatments for Neuropathy | Daily Natural ...

Neuropathy causes tingling or numbness, especially in the hands and feet. It affects about one to two percent of Americans and is caused by damage to a single or multiple nerves. There are different types, but peripheral neuropathy is the most common in those with cancer.

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Peripheral neuropathy may develop at any phase of the cancer journey, even some time after treatment is finished. Knowing what some of the causes are and being able to describe your symptoms to your health care team can help you manage neuropathy. Symptoms are often ignored by both patients and health care professionals. If you have symptoms of neuropathy, it is important to discuss this with your health care team as soon as possible.

Peripheral neuropathy can affect the nerves that tell you the position of your hands or feet that let you sense hot or cold or that senses pain. You can experience a tingling or numbness in certain areas of the body, commonly the hands and feet. These sensations can range from mild to painful and are almost always greatest at night.

Its not easy to deal with neuropathy. If you notice symptoms, talk to your health care team immediately.

Neuropathy may occur from cancer or the treatment received. Cancer types with higher risk of neuropathy include: lung, breast, ovarian, myeloma, lymphoma and Hodgkin's disease and testicular.

Discuss all of these risks with your health care team.

The peripheral nerves have a great ability to heal. Even though it may take months, recovery can occur. However, in some situations, symptoms of neuropathy may lessen but not completely go away. For example, nerve injury caused by radiation often does not recover well. Neuropathy caused by chemotherapy is also difficult to cure, and recovery may take 18 months to five years or longer. During recovery of platinum-induced neuropathy, patients may suffer increased symptoms.

Treatments for peripheral neuropathy depend on the cause. For instance:

Pain from neuropathy can greatly affect your daily activities and quality of life. Symptoms of neuropathy can range from mild to severe. Each survivor's experience will be different. However, with appropriate treatment, the effects of neuropathy can be limited.

Survivors with temperature sensitivity should avoid extreme temperatures, and use protective clothing as needed. If there is numbness or an inability to feel pain, it is important to pay careful attention to the skin on the hands and feet because there could be an undetected wound or a break in the skin.

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If there is pain, day-to-day activities such as putting on shoes or using covers over the feet at night can be difficult. Keep in mind that there are treatments that can lessen the pain. Talk with your health care team about potential treatments as soon as possible.

If neuropathy affects your ability to feel the foot pedals of a car, you should not drive unless your car is adapted for hand controls. Slowed reaction time in moving your foot from the accelerator to the brake pedal may cause an accident. If you lose the ability to drive, you may feel you are losing your independence. However, consider the increased risk to your safety and to the safety of others.

Ask your health care team to provide suggestions and special equipment to make daily tasks safe and easier to manage. The suggestions may include night lights, grab bars and other home safety measures to help reduce the risk of falling. Physical and occupational therapists can assist survivors with physical exercises that can help them maintain physical abilities.

For some, neuropathy can lead to physical and mental stress. Watch for signs of depression, and seek immediate help from your health care team. Together, you can deal with peripheral neuropathy.

Link:

Neuropathy | LIVESTRONG

Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy[1]; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy.

Diabetic neuropathy affects all peripheral nerves including sensory neurons, motor neurons, but rarely affects the autonomic nervous system. Therefore, diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Signs and symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.

Symptoms may include the following:

The following factors are thought to be involved in the development of diabetic neuropathy:

Vascular and neural diseases are closely related and intertwined. Blood vessels depend on normal nerve function, and nerves depend on adequate blood flow. The first pathological change in the small blood vessels is narrowing of the blood vessels. As the disease progresses, neuronal dysfunction correlates closely with the development of blood vessel abnormalities, such as capillary basement membrane thickening and endothelial hyperplasia, which contribute to diminished oxygen tension and hypoxia. Neuronal ischemia is a well-established characteristic of diabetic neuropathy. Blood vessel opening agents (e.g., ACE inhibitors, 1-antagonists) can lead to substantial improvements in neuronal blood flow, with corresponding improvements in nerve conduction velocities. Thus, small blood vessel dysfunction occurs early in diabetes, parallels the progression of neural dysfunction, and may be sufficient to support the severity of structural, functional, and clinical changes observed in diabetic neuropathy.

Elevated levels of glucose within cells cause a non-enzymatic covalent bonding with proteins, which alters their structure and inhibits their function. Some of these glycosylated proteins have been implicated in the pathology of diabetic neuropathy and other long-term complications of diabetes.

Also called the sorbitol/aldose reductase pathway, the polyol pathway appears to be implicated in diabetic complications, especially in microvascular damage to the retina,[2] kidney,[3] and nerves.[4]

Longer nerve fibers are affected to a greater degree than shorter ones because nerve conduction velocity is slowed in proportion to a nerve's length. In this syndrome, decreased sensation and loss of reflexes occurs first in the toes on each foot, then extends upward. It is usually described as a glove-stocking distribution of numbness, sensory loss, dysesthesia and night time pain. The pain can feel like burning, pricking sensation, achy or dull. A pins and needles sensation is common. Loss of proprioception, the sense of where a limb is in space, is affected early. These patients cannot feel when they are stepping on a foreign body, like a splinter, or when they are developing a callous from an ill-fitting shoe. Consequently, they are at risk of developing ulcers and infections on the feet and legs, which can lead to amputation. Similarly, these patients can get multiple fractures of the knee, ankle or foot, and develop a Charcot joint. Loss of motor function results in dorsiflexion, contractures of the toes, loss of the interosseous muscle function that leads to contraction of the digits, so-called hammer toes. These contractures occur not only in the foot but also in the hand where the loss of the musculature makes the hand appear gaunt and skeletal. The loss of muscular function is progressive.

The autonomic nervous system is composed of nerves serving the heart, lungs, blood vessels, bone, adipose tissue, sweat glands, gastrointestinal system and genitourinary system. Autonomic neuropathy can affect any of these organ systems. The most commonly recognized autonomic dysfunction in diabetics is orthostatic hypotension, or becoming dizzy and possibly fainting when standing up due to a sudden drop in blood pressure. In the case of diabetic autonomic neuropathy, it is due to the failure of the heart and arteries to appropriately adjust heart rate and vascular tone to keep blood continually and fully flowing to the brain. This symptom is usually accompanied by a loss of respiratory sinus arrhythmia the usual change in heart rate seen with normal breathing. These two findings suggest autonomic neuropathy.

GI tract manifestations include gastroparesis, nausea, bloating, and diarrhea. Because many diabetics take oral medication for their diabetes, absorption of these medicines is greatly affected by the delayed gastric emptying. This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get absorbed until hours, or sometimes days later when there is normal or low blood sugar already. Sluggish movement of the small intestine can cause bacterial overgrowth, made worse by the presence of hyperglycemia. This leads to bloating, gas and diarrhea.

Urinary symptoms include urinary frequency, urgency, incontinence and retention. Again, because of the retention of urine, urinary tract infections are frequent. Urinary retention can lead to bladder diverticula, stones, reflux nephropathy.

When cranial nerves are affected, neuropathies of the oculomotor nerve (cranial nerve #3) are most common. The oculomotor nerve controls all the muscles that move the eye except for the lateral rectus and superior oblique muscles. It also serves to constrict the pupil and open the eyelid. The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia. All the oculomotor muscles innervated by the third nerve may be affected, but those that control pupil size are usually well-preserved early on. This is because the parasympathetic nerve fibers within CNIII that influence pupillary size are found on the periphery of the nerve (in terms of a cross-sectional view), which makes them less susceptible to ischemic damage (as they are closer to the vascular supply). The sixth nerve, the abducens nerve, which innervates the lateral rectus muscle of the eye (moves the eye laterally), is also commonly affected but fourth nerve, the trochlear nerve, (innervates the superior oblique muscle, which moves the eye downward) involvement is unusual. Mononeuropathies of the thoracic or lumbar spinal nerves can occur and lead to painful syndromes that mimic myocardial infarction, cholecystitis or appendicitis. Diabetics have a higher incidence of entrapment neuropathies, such as carpal tunnel syndrome.

Diabetic peripheral neuropathy is the most likely diagnosis for someone with diabetes who has pain in a leg or foot, although it may also be caused by vitamin B12 deficiency or osteoarthritis. A 2010 review in the Journal of the American Medical Association's "Rational Clinical Examination Series" evaluated the usefulness of the clinical examination in diagnosing diabetic peripheral neuropathy.[5] While the physician typically assesses the appearance of the feet, presence of ulceration, and ankle reflexes, the most useful physical examination findings for large fiber neuropathy are an abnormally decreased vibration perception to a 128-Hz tuning fork (likelihood ratio (LR) range, 1635) or pressure sensation with a 5.07 Semmes-Weinstein monofilament (LR range, 1116). Normal results on vibration testing (LR range, 0.330.51) or monofilament (LR range, 0.090.54) make large fiber peripheral neuropathy from diabetes less likely. Combinations of signs do not perform better than these 2 individual findings.[5] Nerve conduction tests may show reduced functioning of the peripheral nerves, but seldom correlate with the severity of diabetic peripheral neuropathy and are not appropriate as routine tests for the condition.[6]

Diabetic neuropathy encompasses a series of different neuropathic syndromes which can be schematized in the following way:[7]

Prevention is by good blood sugar control and exercise.[8]

Except for tight glucose control, treatments are for reducing pain and other symptoms.

Medication options for pain control include antiepileptic drugs (AEDs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and capsaicin cream.[9] About 10% of people who use capsaicin cream have a large benefit.[10]

A systematic review concluded that "tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants."[11] A further analysis of previous studies showed that the agents carbamazepine, venlafaxine, duloxetine, and amitriptyline were more effective than placebo, but that comparative effectiveness between each agent is unclear.[12]

The only three medications approved by the United States' Food and Drug Administration for diabetic peripheral neuropathy (DPN) are the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER.[13][14] Before trying a systemic medication, some doctors recommend treating localized diabetic peripheral neuropathy with lidocaine patches.[6]

Multiple guidelines from medical organizations such as the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, and the National Institute of Clinical Excellence recommend AEDs, such as pregabalin, as first-line treatment for painful diabetic neuropathy.[15] Pregabalin is supported by low-quality evidence as more effective than placebo for reducing diabetic neuropathic pain but its effect is small.[16] Studies have reached differing conclusions about whether gabapentin relieves pain more effectively than placebo.[16][17] Available evidence is insufficient to determine if zonisamide or carbamazepine are effective for diabetic neuropathy.[16] The first metabolite of carbamazepine, known as oxcarbazepine, appears to have a small beneficial effect on pain. A 2014 systematic review and network meta-analysis concluded topiramate, valproic acid, lacosamide, and lamotrigine are ineffective for pain from diabetic peripheral neuropathy.[9][16] The most common side effects associated with AED use include sleepiness, dizziness, and nausea.[16]

As above, the serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine and venlafaxine are recommended in multiple medical guidelines as first or second-line therapy for DPN.[15] A 2017 systematic review and meta-analysis of randomized controlled trials concluded there is moderate quality evidence that duloxetine and venlafaxine each provide a large benefit in reducing diabetic neuropathic pain.[16] Common side effects include dizziness, nausea, and sleepiness.[16]

SSRIs include fluoxetine, paroxetine, sertraline, and citalopram have been found to be no more efficacious than placebo in several controlled trials and therefore are not recommended to treat painful diabetic neuropathy. Side effects are rarely serious and do not cause any permanent disabilities. They cause sedation and weight gain, which can worsen a diabetic person's glycemic control. They can be used at dosages that also relieve the symptoms of depression, a common comorbidity of diabetic neuropathy.

TCAs include imipramine, amitriptyline, desipramine, and nortriptyline. They are generally regarded as first or second-line treatment for DPN.[15] Of the TCAs, imipramine has been the best studied.[16] These medications are effective at decreasing painful symptoms but suffer from multiple side effects that are dose-dependent.[16] One notable side effect is cardiac toxicity, which can lead to fatal abnormal heart rhythms. Additional common side effects include dry mouth, difficulty sleeping, and sedation.[16] At low dosages used for neuropathy, toxicity is rare,[citation needed] but if symptoms warrant higher doses, complications are more common. Among the TCAs, amitriptyline is most widely used for this condition, but desipramine and nortriptyline have fewer side effects.

Typical opioid medications, such as oxycodone, appear to be no more effective than placebo. In contrast, low-quality evidence supports a moderate benefit from the use of atypical opioids (e.g., tramadol and tapentadol), which also have SNRI properties.[16] Opioid medications are recommended as second or third-line treatment for DPN.[15]

Capsaicin applied to the skin in a 0.075% concentration has not been found to be more effective than placebo for treating pain associated with diabetic neuropathy. There is insufficient evidence to draw conclusions for more concentrated forms of capsaicin, clonidine, or lidocaine applied to the skin.[16]

Low-quality evidence supports a moderate-large beneficial effect of botulinum toxin injections.[16] Dextromethorphan does not appear to be effective in treating diabetic neuropathic pain. There is insufficient evidence to draw firm conclusions for the utility of the cannabinoids nabilone and nabiximols.[16] There are some in vitro studies indicating the beneficial effect of erythropoietin on the diabetic neuropathy; however, one nerve conduction study in mild-moderate diabetic individuals showed that erythropoietin alone or in combination with gabapentin does not have any beneficial effect on progression of diabetic neuropathy.[18]

Monochromatic infrared photo energy treatment (MIRE) has been shown to be an effective therapy in reducing and often eliminating pain associated with diabetic neuropathy. The studied wavelength of 890nm is able to penetrate into the subcutaneous tissue where it acts upon a specialized part of the cell called the cytochrome C. The infrared light energy prompts the cytochrome C to release nitric oxide into the cells. The nitric oxide in turn promotes vasodilation which results in increased blood flow that helps nourish damaged nerve cells. Once the nutrient rich blood is able to reach the affected areas (typically the feet, lower legs and hands) it promotes the regeneration of nerve tissues and helps reduce inflammation thereby reducing and/or eliminating pain in the area.

Physical therapy may help reduce dependency on pain relieving drug therapies. Certain physiotherapy techniques can help alleviate symptoms brought on from diabetic neuropathy such as deep pain in the feet and legs, tingling or burning sensation in extremities, muscle cramps, muscle weakness, sexual dysfunction, and diabetic foot.[19]

Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) use a painless electric current and the physiological effects from low frequency electrical stimulation to relieve stiffness, improve mobility, relieve neuropathic pain, reduce oedema, and heal resistant foot ulcers.[20]

Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers.[20] Off-loading techniques can include the use of mobility aids (e.g. crutches) or foot splints.[20] Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.[20]

Exercise programs, along with manual therapy, will help to prevent muscle contractures, spasms and atrophy. These programs may include general muscle stretching to maintain muscle length and a persons range of motion.[21] General muscle strengthening exercises will help to maintain muscle strength and reduce muscle wasting.[22] Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet (e.g. walking long distances, running) may be contraindicated.[23]

Heat, therapeutic ultrasound,[20] hot wax[20] are also useful for treating diabetic neuropathy.[20] Pelvic floor muscle exercises can improve sexual dysfunction caused by neuropathy.

Treatment of early manifestations of sensorimotor polyneuropathy involves improving glycemic control.[24] Tight control of blood glucose can reverse the changes of diabetic neuropathy, but only if the neuropathy and diabetes are recent in onset. Conversely, painful symptoms of neuropathy in uncontrolled diabetics tend to subside as the disease and numbness progress.

The mechanisms of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.

As a complication, there is an increased risk of injury to the feet because of loss of sensation (see diabetic foot). Small infections can progress to ulceration and this may require amputation.[25]

Globally diabetic neuropathy affects approximately 132million people as of 2010 (1.9% of the population).[26]

Diabetes is the leading known cause of neuropathy in developed countries, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes. It is estimated that neuropathy affects 25% of people with diabetes.[27] Diabetic neuropathy is implicated in 5075% of nontraumatic amputations.

The main risk factor for diabetic neuropathy is hyperglycemia. In the DCCT (Diabetes Control and Complications Trial, 1995) study, the annual incidence of neuropathy was 2% per year but dropped to 0.56% with intensive treatment of Type 1 diabetics. The progression of neuropathy is dependent on the degree of glycemic control in both Type 1 and Type 2 diabetes. Duration of diabetes, age, cigarette smoking, hypertension, height, and hyperlipidemia are also risk factors for diabetic neuropathy.

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Diabetic neuropathy - Wikipedia

If youre looking for a better nerve support supplement, look no further!

Posted on by Paul Grudnitsky | website

20 million Americans suffer from some form of neuropathy - which is a nerve disorder that produces side effects like pain, tingling, and numbness in the hands, arms, feet, and legs. The symptoms tend to progress over time and keep neuropathy sufferers from enjoying their lives the way they used to.*

Surprisingly, there is no known cure for neuropathy, but that doesnt mean all is lost. You shouldn't have to let nerve related discomfort control your life!

According to the MayoClinic, neuropathy forms because high blood sugar interferes with the nerves ability to transmit signals. Additionally, it weakens the walls of the small blood vessels that carry oxygen and nutrients to the nerves, and without those nutrients and oxygen the nerve cannot properly maintain healthy function.

Other factors that can contribute to neuropathy are:

Inflammation of Nerves: Inflammation of Nerves: In simple terms, neuropathy is inflammation of the nerves. Inflammation is the characterized by swelling, redness, heat, and pain.1

Vitamin Deficiencies: Vitamin B12 deficiency causes a wide range of hematological, gastrointestinal, psychiatric and neurological disorders.2

Alcohol abuse: Drinking too much on a single occasion or over time can take a serious toll on your health. Drinking too much can weaken your immune system, making your body a much easier target for disease.3

Now that we know whats happening to the nerves, its easy to speculate as to why neuropathy causes tingling, numbness, and pain:

The tingling sensation is the undernourished nerves misfiring, the numbness is a starved group of nerves without enough blood flow to function at all, and the pain is the body alarm system signaling that something is going wrong.*

Given what we know about the cause of neuropathy, what are the mainstream solutions?

The current medical treatments focus almost entirely on reducing the symptom of neuropathy: chronic pain. But they tend to focus on making the symptoms more bearable without treating nerve health at all, and unfortunately, theyre expensive and come at the cost of some nasty side effects:

Antidepressants: Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors.4

Anticonvulsants: Antiepileptic drugs are widely used in pain clinics to treat neuropathic pain. They have a long track record in this regard, phenytoin having first been used in the early 1940s for the treatment of trigeminal neuralgia.This has led to their use in other neuropathic pain conditions such as post-stroke pain, phantom limb pain and pain following spinal injury although the published evidence for their use in these conditions is less robust.5

Painkillers: prescription painkillers are used to treat and manage neuropathic pain. These painkillers are generally regarded as terrible for long-term pain management because users quickly develop a tolerance - meaning higher doses are required to achieve the same effect. This makes prescription painkillers extremely addictive and even life threatening.6

What do all of these options have in common?

So, the real question is:

We have a passion for natural health and many of us have suffered from nerve-related discomfort ourselves. Thats why we went out and compared some natural nerve support supplements to see which ones delivered and which ones we can throw in the garbage.

With years of experience, our research team dove into stacks of medical journals and consumer reports and studied exactly how certain vitamins and herbs can help sooth nerve discomfort and rebuild healthy nerves. We narrowed the list to 3 ESSENTIAL ingredients that no effective nerve support supplement would be without:*

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Alpha Lipoic Acid (ALA) is an organosulfur compound derived from octanoic acid. Alpha Lipoic Acid contains two sulfur atoms connected by a disulfide bond. ALA is unique because it is both water and fat soluble. Alpha Lipoic Acid has been apart of several double blind placebo studies and has been used in European countries for years.7

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Vitamin B12 is a water soluble vitamin that functions as a cofactor for methionine synthase and is required for proper red blood cell formation, neurological function, and DNA synthesis.8

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Omega-3 Fatty Acids are polyunsaturated fatty acids which have two ends. One is known as carboxylic acid which is considered the beginning of the chain and the other is methyl which is considered the end of the chain.9

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Turmeric is a deep orange rhizomatous herbaceous perennial plant of the ginger family, and is native to the Indian subcontinent and southeast Asia.10

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We gave heavy favoritism to liquid extracts, and it was for good reason. Pills and capsules have to be digested, liquids do not. Liquids are formulated for optimal bioavailability, and their ingredients can get to work fast. Liquids are also portable, require no water, theyre easy to digest, and theyre easy on the stomach.

Strength of Money-Back Guarantee: A money-back guarantee shows the manufacturer is so confident in the product that theyre willing to put their money where their mouth is. Theres simply no reason to trust a product that doesnt offer a money-back-guarantee.

24 Hour Customer Support: A 24-hour customer-support service shows a manufacturers commitment to their customers, because 24-hour support isnt cheap. With any remedy, youre likely to have questions, and those questions can arise at any time of the day or night; 24-hour customer service offers a peace-of-mind knowing the answers are only a phone call away.

What we found is that there are a number of good choices for natural nerve support, but some were certainly better than others. For us, there was a clear winner

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Nerve Remedy Reviews

Neuropathy is the general term for pain or discomfort caused by damage to the nerves of the peripheral nervous system. Your peripheral nervous system is made up of the many nerves that bring signals from the brain and spinal cord to other or peripheral parts of the body, such as the hands and feet. Damage to those nerves can affect the way the body sends signals to muscles, joints, skin, and internal organs. This can cause pain, numbness, loss of sensation, and other symptoms.

For people with breast cancer, the most common cause of uncomfortable or even painful neuropathy that limits activity is chemotherapy often referred to as chemotherapy-associated peripheral neuropathy. Chemotherapy medications travel throughout the body, where they can cause damage to the nerves.

Chemotherapy medications that can cause neuropathy include:

Chemotherapy-associated neuropathy can start any time after treatment begins, and it may worsen as treatment continues. Usually it begins in the toes, but it can expand to include the legs, arms, and hands. The most common symptoms include:

Other possible symptoms are:

If you suspect you have neuropathy, talk to your doctor as soon as possible. Your doctor might be able to switch your medication to ease your nerve problems. Your doctor also may prescribe medicines, pain patches, or topical creams that can help. If neuropathy isn't treated, it can become a long-term problem.

Depending on what symptoms youre experiencing, you may find the following tips helpful in managing the effects of neuropathy:

Although chemotherapy is the most common cause of peripheral neuropathy, other treatments sometimes can lead to neuropathy as well. Surgery and radiation therapy also may cause damage to nerves in the chest and underarm areas, which can lead to neuropathic symptoms such as pain, numbness, tingling, and/or increased sensitivity in those areas. Perjeta (chemical name: pertuzumab), Ibrance (chemical name: palbociclib), and Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine), targeted therapies, can also cause neuropathy.

Advanced breast cancer can cause peripheral neuropathy if it grows into, on, or along the nerves such as the nerves around lymph nodes, or nerves connected to the brain or spinal cord where it can interfere with signals going out to the peripheral nervous system. Symptoms would depend on which nerves are affected.

Listen to Dr. Michael Stubblefield explain how neuropathy happens and the breast cancer treatments that cause it, treatments for neuropathy, and the three things that anyone diagnosed with it should know.

See original here:

Neuropathy - breastcancer.org

What is neuropathic pain?

When the sensory system is impacted by injury or disease, the nerves within that system cannot work to transmit sensation to the brain. This often leads to a sense of numbness, or lack of sensation. However, in some cases when this system is injured, individuals experience pain in the affected region. Neuropathic pain does not start abruptly or resolve quickly; it is a chronic condition which leads to persistent pain symptoms. For many patients, the intensity of their symptoms can wax and wane throughout the day. Although neuropathic pain is thought to be associated with peripheral nerve problems, such as neuropathy caused by diabetes or spinal stenosis, injuries to the brain or spinal cord can also lead to chronic neuropathic pain.

Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain which occurs when someone experiences an acute injury, such as smashing a finger with a hammer or stubbing a toe when walking barefoot. This type of pain is typically short-lived and usually quite responsive to common pain medications in contrast to neuropathic pain.

What are the risk factors for neuropathic pain?

Anything that leads to loss of function within the sensory nervous system can cause neuropathic pain. As such, nerve problems from carpal tunnel syndrome or similar conditions can trigger neuropathic pain. Trauma, causing nerve injury, can lead to neuropathic pain. Other conditions which can predispose patients to developing neuropathic pain include diabetes, vitamin deficiencies, cancer, HIV, stroke, multiple sclerosis, shingles, and cancer treatments.

There are newer medications on the market that may be of benefit called duloxetine (Cymbalta) and Lyrica. You should speak with your doctor about the possibility of trying these agents either alone or in combination with other medication.

What causes neuropathic pain?

There are many reasons that patients may develop neuropathic pain. However, on a cellular level, one explanation is that an increased release of certain neurotransmitters which signal pain, combined with an impaired ability of the nerves to regulate these signals leads to the sensation of pain originating from the affected region. Additionally, in the spinal cord, the area which interprets painful signals is rearranged, with corresponding changes in neurotransmitters and loss of normally-functioning cell bodies; these alterations result in the perception of pain even in the absence of external stimulation. In the brain, the ability to block pain can be lost following an injury such as stroke or trauma. Over time, further cellular damage occurs and the sense of pain persists.

Neuropathic pain is associated with diabetes, chronic alcohol intake, certain cancers, vitamin B deficiency, infections, other nerve-related diseases, toxins, and certain drugs.

What are the signs and symptoms of neuropathic pain?

Unlike other neurological conditions, identification of neuropathic pain is hard. Few, if any, objective signs are present. Examiners have to decipher and interpret a collection of words that patients use to describe their pain. Patients may describe their symptoms as sharp, dull, hot, cold, sensitive, itchy, deep, stinging, burning, or some other descriptor. Additionally, some patients may feel pain with a light touch or pressure.

In an effort to help identify how much pain patients may be experiencing, different scales are often used. Patients are asked to rate their pain based on a visual scale or numeric graph. Many examples of pain scales exist. Often, pictures of faces depicting various degrees of pain can be helpful when patients have a difficult time describing the amount of pain they are experiencing.

How is neuropathic pain diagnosed?

The diagnosis of pain is based upon further assessment of a patient's history. If underlying nerve damage is suspected, then evaluation of the nerves with testing may be warranted. The most common way to evaluate whether a nerve is injured is with electrodiagnostic medicine. This medical subspecialty uses techniques of a nerve conduction studies with electromyelography (NCS/EMG). Clinical evaluation may reveal some evidence of loss of function, and can include assessment of light touch, the ability to distinguish sharp from dull, the ability to discern temperature, and assessment of vibration. Once a thorough clinical examination is performed, the electrodiagnostic study can be planned. These studies are performed by specially trained neurologist and physiatrists.

If neuropathy is suspected, a search for reversible causes should be done. This can include blood work for vitamin deficiencies or thyroid abnormalities, and imaging studies to exclude a structural lesion impacting the spinal cord. Depending on the results of this testing, there may be a way to decrease the severity of the neuropathy and potentially decrease the pain that a patient is experiencing. Unfortunately, in many conditions, even good control of the underlying cause of the neuropathy cannot reverse the neuropathy. This is commonly seen in patients with diabetic neuropathy.

In rare instances, there may be evidence of changes in the skin and hair growth pattern in an affected area. These alterations may be associated with changes in sweating or perspiration as well. When present, these changes can help identify the probable presence of neuropathic pain associated with a condition called complex regional pain syndrome.

What is the treatment for neuropathic pain?

Various medications have been used in an attempt to treat neuropathic pain. The majority of these medications are used off-label, meaning that the medication was approved by the FDA to treat other conditions and was then identified as being beneficial to treat neuropathic pain. Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine) have been prescribed for control of neuropathic pain for many years. Some patients find that these can be quite effective in giving them relief. Other types of antidepressants have also been shown to provide some relief. Selective serotonin reuptake inhibitors (SSRIs like paroxetine and citalopram) and other antidepressants (venlafaxine, bupropion) have been used in some patients.

Another common treatment of neuropathic pain includes antiseizure medications (carbamazepine, phenytoin, gabapentin, lamotrigine, and others). In severe cases of painful neuropathy which don't respond to first-line agents, medications typically used to treat heart arrhythmias may be of some benefit; however, these can lead to significant side effects and must be monitored closely. Medications applied directly to the skin can provide modest to pronounced benefit for some patients. The forms commonly used include lidocaine (in patch or gel form) or capsaicin. Multiple arguments have been made both promoting and vilifying the use of narcotic agents to treat chronic neuropathic pain. No specific recommendations regarding the use of narcotics will be made at this time.

Curing neuropathic pain is dependent on the underlying cause. If the cause is reversible, then the peripheral nerves may regenerate and the pain will abate; however, this reduction in pain may take many months to years.

What is the prognosis for neuropathic pain?

Many patients with neuropathic pain are able to find some measure of relief, even if their pain persists. Although neuropathic pain is not dangerous to a patient, the presence of chronic pain can negatively impact quality of life. Patients with chronic nerve pain may suffer from sleep deprivation or mood disorders, including depression and anxiety. Because of the underlying neuropathy and lack of sensory feedback, patients are at risk of developing injury or infection or unknowingly causing an escalation of an existing injury.

Can neuropathic pain be prevented?

The best way to prevent neuropathic pain is to avoid development of neuropathy. Monitoring and modifying lifestyle choices, including limiting the use of tobacco and alcohol; maintaining a healthy weight to decrease the risk of diabetes, degenerative joint disease, or stroke; and using good ergonomic form at work or when practicing hobbies to decrease the risk of repetitive stress injury are ways to decrease the risk of developing neuropathy and possible neuropathic pain.

References

REFERENCES:

Magrinelli, F., et al. "Neuropathic pain: diagnosis and treatment." Practical Neurology 13.5 (2013): 292-307.

Marchettini, P., et al. "Painful peripheral neuropathies." Current Neuropharmacology 4.3 (2006): 175-181.

Mendell, J., et al. "Clinical practice. Painful sensory neuropathy." New England Journal of Medicine 348.13 (2003): 1243-1255.

O'Connor, A. and R. Dworkin. "Treatment of neuropathic pain: an overview of recent guidelines." The American Journal of Medicine 122.10 Suppl (2009): S22-S32.

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What Is Neuropathic Pain? Treatment, Medication, Definition

Neuropathy is a common side effect of certain medications, especially those used to treat HIV/AIDS and those used in chemotherapy, to fight cancer.

In some people, these medications may cause nerve damage that results in a loss of sensation or movement in part of the body. Although uncomfortable and perhaps painful, this condition is not life threatening. Peripheral neuropathy will often go away if these drugs are changed or discontinued, or if the dose is reduced. It can take several months for peripheral neuropathy to completely heal after discontinuing these drugs, but the patient may start to feel better within a few weeks. In extreme cases, however, the nerve damage may be permanent.

Some of the drugs that may cause peripheral neuropathy include:

For a more extensive list click here.

(Not all symptoms and signs may be present.)

(Not all evaluation and tests may be necessary.)

(Not all treatments and therapies may be indicated.)

Therapies focus on treating the symptoms, including:

View post:

Drugs Causing Peripheral Neuropathy - Medications List

Dr. Michael Rose is an expert in nerve decompression surgery for people suffering from all forms of neuropathy, with an emphasis on undertreated lower extremity neuropathy. Experienced in various forms of microsurgery, he is one of a select number of plastic surgeons trained in the nerve decompression technique.

Dr. Rose is Chief of the Division of Plastic Surgery at Jersey Shore University Medical Center. He is also a member of the Center For Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore Medical Center, which provides some of the most advanced surgical treatment of paralysis and nerve injuries in the world today.

Solutions for Neuropathy

Ive been performing this surgery since 2004 with various types of neuropathy. The three most common causes of neuropathy I treat are probably diabetic; followed by chemotherapy-induced; and finally idiopathic (unknown cause). Ive also treated a variety of other types, such as alcohol-related neuropathy and neuropathy caused from obscure medications. All types of neuropathy seem to respond similarly to this surgery.

The most well-known and accepted neuropathy surgery is for carpal tunnel syndrome, cubital tunnel syndrome or other conditions of the upper extremity. Surgeries performed on the lower extremities are not widely known since generally this area has been ignored by the medical community. People tend to assume that when their feet hurt, its because theyre getting older and their feet are supposed to hurt. They dont realize there is something they can do about it. For this reason, I developed a subspecialty in this surgical area which applies the knowledge we have of decompression surgery for the upper extremity to the lower extremity.

Approximately half of patients who are deemed eligible candidates for this surgery will experience measurable improvement in their quality of life, with a reduction in symptoms of pain and tingling. However, it is very difficult to predict who will be eligible and potentially benefit from the procedure until a person comes in and has a thorough evaluation.

I routinely see people who have had neuropathy of a lower extremity for 10 to 15 years. It is ideal if they come in between one and three years after the onset of their issues. I think this could likely raise the overall success rate of this surgery to 75 percent. The shorter the time the nerve is compressed, the less damage the nerve suffers. With a longer wait for treatment, it can be difficult, if not impossible, for the nerve to recover. I equate it to a house fire. If you can put out a small fire, you can easily rebuild the house. If the fire keeps burning, it destroys the house, including the foundation. At some point the house is gone and you cant recover from it. Obviously, we prefer to see people before this is the case.

I open the various areas on the leg (or arm) where the nerve is most susceptible to being entrapped or pinched. We know where these places are, as they are the same in almost everyone. I release the nerve from the surrounding structure so that it is able to recover. This procedure is a relatively minor outpatient (one day) surgery. It takes about 45 minutes to do one leg, and patient recovery takes about a week. Results are not generally immediate, but I have had some patients who did get immediate relief. It may take some months to a year or even more for the nerve fibers to grow back, and a person begins to get normal feeling and the pain is reduced.

Neuropathy affects the quality of life, but it also has other consequences. People with neuropathy have many more fractures, such as broken hips. Many times people cant feel their feet, so balance is impacted and thus they are much more likely to fall and break a bone. Also, they dont notice cuts, which can become infected. They can lose toes. Correcting the neuropathy results in reduced orthopedic fractures, infections and amputations.

The rules for being a good candidate for any surgery apply. People should be in reasonably good general health with adequate blood flow down to the feet. They should also be of reasonable weight, since obesity interferes with wound healing. Candidates should generally be under age 65, since after that age the nerves usually do not regenerate (grow back). They should also have had neuropathy for fewer than 10 years. In my evaluation, I do a complete medical history and order tests, such as a nerve conduction study. If a person fits all the criteria, I offer to do the surgery.

Link:

NJ Neuropathy Treatment & Surgery - Discover Your Options!

Peripheral neuropathy is a type of damage to the nervous system. Specifically, it is a problem with your peripheral nervous system. This is the network of nerves that sends information from your brain and spinal cord (central nervous system) to the rest of your body.

There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis.

Peripheral neuropathy has many different causes. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.

The most common type of peripheral neuropathy is diabetic neuropathy, caused by a high sugar level and resulting in nerve fiber damage in your legs and feet.

Symptoms can range from tingling or numbness in a certain body part to more serious effects, such as burning pain or paralysis.

Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents. Others develop it because of an injury or another disorder.

In many cases, a different type of problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.

Johns Hopkins researchers find that common preservative may thwart pain and damage of peripheral neuropathy.

Read more.

There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. To help doctors classify them, they are often broken down into the following categories:

Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.

Sensory neuropathy. Sensory nerves control what you feel, such as pain, temperature or a light touch. Sensory neuropathy affects these groups of nerves.

Autonomic nerve neuropathy. Autonomic nerves control functions that you are not conscious of, such as breathing and heartbeat. Damage to these nerves can be serious.

Combination neuropathies. You may have a mix of 2 or 3 of these other types of neuropathies, such as a sensory-motor neuropathy.

The symptoms of peripheral neuropathy vary based on the type that you have and what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis.

Muscle weakness

Cramps

Muscle twitching

Loss of muscle and bone

Changes in skin, hair, or nails

Numbness

Loss of sensation or feeling in body parts

Loss of balance or other functions as a side effect of the loss of feeling in the legs, arms, or other body parts

Emotional disturbances

Sleep disruptions

Loss of pain or sensation that can put you at risk, such as not feeling an impending heart attack or limb pain

Inability to sweat properly, leading to heat intolerance

Loss of bladder control, leading to infection or incontinence

Dizziness, lightheadedness, or fainting because of a loss of control over blood pressure

Diarrhea, constipation, or incontinence related to nerve damage in the intestines or digestive tract

Trouble eating or swallowing

Life-threatening symptoms, such as difficulty breathing or irregular heartbeat

The symptoms of peripheral neuropathy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

The symptoms and body parts affected by peripheral neuropathy are so varied that it may be hard to make a diagnosis. If your healthcare provider suspects nerve damage, he or she will take an extensive medical history and do a number of neurological tests to determine the location and extent of your nerve damage. These may include:

Depending on what basic tests reveal, your healthcare provider may want to do more in-depth scanning and other tests to get a better look at your nerve damage. Tests may include:

Usually a peripheral neuropathy cant be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.

In some cases, over-the-counter pain relievers can help. Other times, prescription medicines are needed. Some of these medicines include mexiletine, a medicine developed to correct irregular heart rhythms; antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.

Lidocaine injections and patches may help with pain in other instances. And in extreme cases, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.

Lifestyle choices can play a role in preventing peripheral neuropathy. You can lessen your risk for many of these conditions by avoiding alcohol, correcting vitamin deficiencies, eating a healthy diet, losing weight, avoiding toxins, and exercising regularly. If you have kidney disease, diabetes, or other chronic health condition, it is important to work with your healthcare provider to control your condition, which may prevent or delay the onset of peripheral neuropathy.

Want to boost your overall health with diabetes? A Johns Hopkins expert offers healthy strategies to help you control your blood sugar, protect your heart and more.

Read more.

Even if you already have some form of peripheral neuropathy, healthy lifestyle steps can help you feel your best and reduce the pain and symptoms related to the disorder. Youll also want to quit smoking, not let injuries go untreated, and be meticulous about caring for your feet and treating wounds to avoid complications, such as the loss of a limb.

In some cases, non-prescription hand and foot braces can help you make up for muscle weakness. Orthotics can help you walk better. Relaxation techniques, such as yoga, may help ease emotional as well as physical symptoms.

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Peripheral Neuropathy | Johns Hopkins Medicine Health Library

Medication can help relieve pain symptoms, as well as improve sleep and quality of life, but it wont reverse or cure neuropathy, Dr. Williams says.

Common over-the-counter medication that people reach for to address mild to moderate neuropathic pain includesTylenol (acetaminophen),nonsteroidal inflammatory drugs (NSAIDs)such as Advil (ibuprofen) and Aleve (naproxen),and topical treatments such as capsaicin and lidocaine creams. Prescription medication such as COX-2 inhibitors likeCelebrex (celecoxib), opioids, and Ultram (tramadol) can be taken as well. (22)

Patients can get a measure of relief from such traditional, nonspecific medication, he says. But they are more likely to gain relief from certain categories of medication that have a specific effect on the pain pathways. They act on pain from abnormal nerve firing or nerve signals.

Williams says antidepressant, antiseizure, and antiepileptic medications are the types of categories were likely to turn to and can be most helpful.

Antidepressants have an effect on some of the neurotransmitters like norepinephrine and serotonin, which can have an effect on pain, he explains. Among the options in this category of treatment are selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Zoloft (sertraline), which restore the chemical balance in the nerve cells of the brain; serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine; norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine; and serotonin receptor modulators, such as Oleptro (trazodone), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves.

Williams says the effectiveness of anticonvulsants is still being investigated, but we believe the mechanism of effect is on calcium channels, and that can reduce transmission of those abnormal nerve signals, often within the peripheral nerve or the spinal cord. Gabapentin is an example of an anticonvulsant thats used to relieve nerve pain in people who have had shingles or have diabetes. (23,24)

There are other treatments that act more directly on nerves, such as neuromodulation or surgery. Neuromodulation can involve placing an electrode along a peripheral nerve. These are helpful by essentially turning off pain signals, explains Williams. You can do that very selectively with individual peripheral nerves or you can take a more regional approach with spinal cord stimulation.

Surgery can be useful to release pressure on a nerve, says Peter Highlander, DPM, a podiatrist based in Sandusky, Ohio.Its a technique more commonly used to treat the pain of carpal tunnel syndrome, but it can also be used to treat diabetic neuropathy. (25,26)

Learn More About Neuropathy Treatment Options

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Neuropathy: Symptoms, Causes, Types, Treatment, Nutrition ...

What Is Neuropathy?

Neuropathy is a term that refers to general diseases or malfunctions of the nerves. Nerves at any location in the body can be damaged from injury or disease. Neuropathy is often classified according to the types or location of nerves that are affected. Neuropathy can also be classified according to the disease causing it. (For example, neuropathy from the effects of diabetes is called diabetic neuropathy.)

Types of Neuropathy

Peripheral neuropathy: Peripheral neuropathy is when the nerve problem affects the nerves outside of the brain and spinal cord. These nerves are part of the peripheral nervous system. Accordingly, peripheral neuropathy is neuropathy that affects the nerves of the extremities- the toes, feet, legs, fingers, hands, and arms. The term proximal neuropathy has been used to refer to nerve damage that specifically causes pain in the shoulders, thighs, hips, or buttocks.

Cranial neuropathy: Cranial neuropathy occurs when any of the twelve cranial nerves (nerves that exit from the brain directly) are damaged. Two specific types of cranial neuropathy are optic neuropathy and auditory neuropathy. Optic neuropathy refers to damage or disease of the optic nerve that transmits visual signals from the retina of the eye to the brain. Auditory neuropathy involves the nerve that carries signals from the inner ear to the brain and is responsible for hearing.

Autonomic neuropathy: Autonomic neuropathy is damage to the nerves of the involuntary nervous system. These nerves that control the heart and circulation (including blood pressure), digestion, bowel and bladder function, the sexual response, and perspiration. Nerves in other organs may also be affected.

Focal neuropathy: Focal neuropathy is neuropathy that is restricted to one nerve or group of nerves, or one area of the body.

What Causes Neuropathy?

Nerve damage may be caused by a number of different diseases, injuries, infections, and even vitamin deficiency states.

What Are the Symptoms of Neuropathy?

Regardless of the cause, neuropathy is associated with characteristic symptoms. Although some people with neuropathy may not have symptoms, certain symptoms are common. The degree to which an individual is affected by a particular neuropathy varies.

Damage to the sensory nerves is common in peripheral neuropathy. Symptoms often begin in the feet with a gradual onset of loss of feeling, numbness, tingling, or pain and progress toward the center of the body with time. The arms or legs may be involved. The inability to determine joint position may also occur, which can result in clumsiness or falls. Extreme sensitivity to touch can be another symptom of peripheral neuropathy. The sensation of numbness and tingling of the skin is medically known as paresthesia.

The loss of sensory input from the foot means that blisters and sores on the feet may develop rapidly and not be noticed. Because there is a reduced sensation of pain, these sores may become infected and the infection may spread to deeper tissues, including bone. In severe cases, amputation may be necessary.

When damage to the motor nerves (those that control movement) occurs, symptoms include weakness, loss of reflexes, loss of muscle mass, cramping, and/or loss of dexterity.

Autonomic neuropathy, or damage to the nerves that control the function of organs and glands, may manifest with a wide variety of symptoms, including:

When to Seek Medical Care for Neuropathy

If you have any unusual or troubling symptoms suggestive of neuropathy, it is appropriate to seek medical care by consulting a healthcare professional.

Certain prescription medications have been shown to bring relief for those with neuropathy. In severe cases, a combination of medications may be necessary. Oral medications that have been successfully used to help the pain of neuropathy include:

Antidepressants such as:

Anticonvulsants such as

Opioids and opioid-like drugs such as:

Topical medications that may bring pain relief include capsaicin cream and lidocaine patches (Lidoderm, Lidopain).

What Are the Exams and Tests to Diagnose Neuropathy?

All exams and tests performed depend on the clinical presentation of the symptoms of the patient with suspected neuropathy. The diagnosis of neuropathy and its cause involve a thorough medical history and physical examination to help your health care professional determine the cause and severity of neuropathy. A neurological examination, testing the reflexes and function of sensory and motor nerves, is an important component of the initial examination.

Although there are no blood tests that are specific for determining whether of not neuropathy is present, when neuropathy is suspected, blood tests are often used to check for the presence of diseases and conditions (for example, diabetes or vitamin deficiencies) that may be responsible for nerve damage.

Imaging studies such as X-rays, CT scans, and MRI scans may be performed to look for sources of pressure on or damage to nerves.

Specific tests of nerve function include:

What is Neuropathy Treatment?

The treatment of neuropathy involves measures to control the symptoms as well as treatment measures that address the underlying cause of neuropathy, if appropriate. Medical treatments for diabetes, autoimmune diseases, infections, kidney disease, and vitamin deficiencies are varied and are directed at the specific underlying condition. In many cases, treatment of the underlying disease can reduce or eliminate the symptoms of neuropathy. Some cases, especially those involving compression or entrapment of nerves by tumors or other conditions, can be relieved by surgery.

Control of blood glucose (sugar) levels is important in the treatment of diabetic neuropathy to help prevent further damage to nerves.

Clinical trials are underway to help find new and more effective treatments for neuropathy. For example, treatments that involve electrical nerve stimulation or magnetic nerve stimulation are being studied.

Are There Home Remedies for Neuropathy?

Special and careful care of the feet is important in people with neuropathy to reduce the chance of developing sores and infections. The nerves to the feet are the nerves most commonly affected by neuropathy. Proper foot care includes:

What Medications Are Used to Treat Neuropathy?

A number of medications have been useful in controlling the pain of peripheral neuropathy.

What Are Neuropathy Medications?

Typical pain medications sold over-the-counter such as acetaminophen (Tylenol and others) and ibuprofen (Motrin and others) are not generally effective for controlling the pain of neuropathy. These drugs may be effective for lessening pain or joint damage and deformities associated with neuropathy, but they should be used with caution because there is some concern that these drugs may worsen nerve injury.

Certain prescription medications have been shown to bring relief for those with neuropathy. In severe cases, a combination of medications may be necessary. Oral medications that have been successfully used to help the pain of neuropathy include:

Topical medications that may bring pain relief include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Alternative or complementary therapies like acupuncture, biofeedback, and physical therapy have been shown to be helpful in some cases.

The antioxidant alpha-lipoic acid (ALA, taken in one oral 600 mg dose daily) has been shown to be effective in treatment of diabetic neuropathy in several short-term trials; evidence for its effectiveness over the long term is not yet available.

For those whose pain is not controlled by medications, a procedure known as trans-cutaneous electrical nerve stimulation (TENS) may be an option. Although data are limited on the effectiveness of this method, a 2010 guideline issued by the American Academy of Neurology stated that TENS is probably effective for reducing pain from diabetic neuropathy.

Follow-up for Neuropathy Treatment

Follow-up is dependent upon the cause of the neuropathy and they type of treatment. Always follow recommendations of your health care professional regarding follow-up examinations and visits.

How Do I Prevent Neuropathy?

Neuropathy is preventable only to the extent that the underlying condition or cause is preventable. For those with diabetes, studies have conclusively shown that long-term control of blood glucose levels is critically important in preventing the development of neuropathy and other complications of diabetes. Neuropathy that arises due to poor nutrition or alcohol abuse may be preventable if these causes can be eliminated. Genetic or inherited causes of neuropathy are not preventable.

What Is the Prognosis for Neuropathy?

The outlook for nerve damage depends upon its cause. If the underlying medical condition or cause can be effectively treated with medicine and/or surgery and severe damage has not occurred, the prognosis can be excellent or very good. Nerves that have been affected by neuropathy can take time to recover, even when the underlying cause is appropriately treated. In other conditions, such as genetic conditions, there may be no effective treatment. Severe nerve damage from any cause is typically not reversible.

Reviewed on 11/21/2017

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology

REFERENCES:

Dubinsky RM; Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. Epub 2009 Dec 30.

eMedicine.com. Diabetic neuropathy.< http://emedicine.medscape.com/article/1170337-overview>

MedlinePlus. Peripheral Neuropathy.<http://www.nlm.nih.gov/medlineplus/ency/article/000593.htm>

National Institutes of Health. Diabetic Neuropathies: The Nerve Damage of Diabetes.<http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/>

Continued here:

Neuropathy Types (Diabetic), Causes, Treatment, & Medication

Neuropathy, medically referred to as peripheral neuropathy or PN, signifies a problem with the functionality of the peripheral nerves. These nerves are responsible for transmission of signals from the central nervous system to the rest of the body. Depending upon which type of peripheral nerve is affected, PN may produce a wide variety of symptoms with varying degrees of severity. In a lot of cases, other health conditions perpetuate PN, and thus, it can be both a symptom and disease unto itself. Here is a list of symptoms that may signal the onset of peripheral neuropathy. If they occur, getting tested for PN would be wise.

If peripheral neuropathy affects the sensory nerves in an individual, it is likely that they may experience numbness andtingling in localized areas of the body. This occurs because the nerves that carry messages of sensationi.e., touch, pain, temperature, etc.are not performing optimally. Numbness generally occurs in the lower half of the body with an increasing loss of perception of stimuli in the region. Tingling signifies a kind of mild, prickly feeling of localized magnitude.

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10 Symptoms of Neuropathy - Bodily Numbness and Tingling

Diagnosis

Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:

Your doctor may order tests, including:

Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.

Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include:

Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.

Medications containing opioids, such as tramadol (Conzip, Ultram) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are prescribed only when other treatments fail.

Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.

Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch.

Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also might ease the pain of peripheral neuropathy caused by diabetes. Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation.

Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.

Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.

Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

To help you manage peripheral neuropathy:

Some people with peripheral neuropathy try complementary treatments for relief. Although researchers haven't studied these techniques as thoroughly as they have most medications, the following therapies have shown some promise:

You're likely to start by seeing your primary care provider. You may then be referred to a doctor trained in nervous system disorders (neurologist).

Here's information to help you prepare for your appointment.

When you make the appointment, ask if there's anything you need to do in advance, such as fasting for a specific test. Make a list of:

Take a family member or friend along, if possible, to help you remember the information you're given.

For peripheral neuropathy, basic questions to ask your doctor include:

Don't hesitate to ask other questions.

Your doctor is likely to ask you questions, such as:

Aug. 09, 2017

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Peripheral neuropathy - Diagnosis and treatment - Mayo Clinic

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests OnlineEditorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

National Institute of Neurological Disorders and Stroke (December 2014). Peripheral Neuropathy Fact Sheet. Available online at http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Accessed May 19, 2016.

The Foundation for Peripheral Neuropathy. Available online at https://www.foundationforpn.org. Accessed May 19, 2016.

Mayo Clinic (20 May 2016 updated). Peripheral Neuropathy. Available online at http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/home/ovc-20204944. Accessed May 20, 2016.

Azhary H, Farooq MU, Bhanushali M, et al. Peripheral Neuropathy: Differential Diagnosis and Management. American Family Physician. 2010;81 (7):887-892.

Quest Diagnostics. Laboratory Diagnosis of Peripheral Neuropathy. Available online at http://www.questdiagnostics.com/testcenter/testguide.action?dc=WP_LabDiagnosis_PeripheralNeurop. Accessed November 2016.

Mikhael, Joseph. A Diagnostic Approach to Patients with an IgM Monoclonal Protein. The Hematologist. September-October 2014, Volume 11, Issue 5. Available online at http://www.hematology.org/Thehematologist/Ask/3186.aspx. Accessed November 2016.

Ramchandren S1, Lewis RA. An update on monoclonal gammopathy and neuropathy. Curr Neurol Neurosci Rep. 2012 Feb;12(1):102-10. Available online at https://www.ncbi.nlm.nih.gov/pubmed/22090258. Accessed November 2016.

Sources Used in Previous Reviews

Dugdale, D. (Updated 2010 August 27). Peripheral neuropathy. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000593.htm. Accessed May 2011.

(2010 April 21). Peripheral Neuropathy. JAMA Patient Page v 303 (15) [On-line information]. PDF available for download at http://jama.ama-assn.org/content/303/15/1556.full.pdf. Accessed May 2011.

(Updated 2011 February 18) Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Accessed May 2011.

Lin, H. (Updated 2011 May 13). Diabetic Neuropathy. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/1170337-overview. Accessed May 2011.

Sewell, A. (Updated 2010 September 27). Nutritional Neuropathy. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/1171558-overview. Accessed May 2011.

Hill, H and Tebo, A. (Updated 2011 April). Neuropathic Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/NeuropathicDz.html?client_ID=LTD. Accessed May 2011.

(2009 February). Diabetic Neuropathies: The Nerve Damage of Diabetes National Diabetes Information Clearinghouse [On-line information]. Available online at http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/. Accessed May 2011.

Mayo Clinic Staff (2009 November 3). Peripheral Neuropathy. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/METHOD=print. Accessed May 2011.

Mayo Clinic Staff (2010 April 15). Autonomic Neuropathy. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/autonomic-neuropathy/DS00544/METHOD=print. Accessed May 2011.

(Updated 2011 March 22). Giant Axonal Neuropathy. National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/gan/GiantAxonalNeuropathy.htm. Accessed May 2011.

(Updated 2011 February 15). Charcot-Marie-Tooth Disease Fact Sheet. National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/charcot_marie_tooth/detail_charcot_marie_tooth.htm. Accessed May 2011.

Dugdale, D. (Updated 2010 August 27). Alcoholic neuropathy. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000714.htm. Accessed May 2011.

Eckman, A. (Updated 2010 April 19). Diabetic neuropathy. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000693.htm. Accessed May 2011.

Rubin, M. (Revised 2008 February). Peripheral Neuropathy. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merckmanuals.com/professional/sec16/ch223/ch223h.html?qt=neuropathy&alt=sh. Accessed May 2011. [On-line information]. Available online at

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005) Harrison's Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 2500-2509, 2510-2514.

What is Neuropathy? Neuropathy Causes and Treatments. Medical News Today. Article date 29 Apr 2009.Available online at http://www.medicalnewstoday.com/articles/147963.php.Accessed August 2011.

ARUP Lab Tests. Motor Neuropathy Panel. Available online at http://www.aruplab.com/guides/ug/tests/0051225.jsp.Accessed August 2011.

Mayo Clinic. 57234 Clinical: Motor Neuropathy Antibody Panel (Serum). Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/57234.Accessed August 2011.

ARUP Lab Tests. Sensory Neuropathy Antibody Panel with Reflex to PCCA Titer, ANNA Titer & Neuronal Immunoblot. Available online at http://www.aruplab.com/guides/ug/tests/0051222.jsp.Accessed August 2011.

Quest Diagnostics. Motor and Sensory Neuropathy Panel. Available online at http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?s=M&test_code=95775&fn=17540X.html&labCode=SJC.Accessed August 2011.

Nervous System Information. Body Guide, Powered by ADAM. Available online at http://www.pennmedicine.org/health_info/body_guide/reftext/html/nerv_sys_fin.html. Accessed August 2011.

Neuropathic Pain. Weill Cornell Pain Medical College. Available online at http://www.cornellpainmedicine.com/health_library/neuropathic_pain.html. Accessed August 2011.

Dr. Wayne Moore,Neuropathologist.Vancouver General Hospital Associate Professor,Dept. of Pathology & Laboratory Medicine,The University of British Columbia Vancouver, Canada.

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Neuropathy - Lab Tests Online

Other names: Neuropathy

About Peripheral Neuropathy: Peripheral neuropathy is failure of the nerves that carry information to and from the brain and spinal cord. This produces symptoms like pain, loss of sensation, and inability to control muscles.

See also: sub-topics

The following list of medications are in some way related to, or used in the treatment of this condition.

6.0

Generic name:gabapentin systemic

Drug class: gamma-aminobutyric acid analogs

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

Off Label: Yes

6.0

Generic name:levocarnitine systemic

Brand names: L-Carnitine, Carnitor, Carnitor SF

Drug class: nutraceutical products

For consumers: dosage, interactions,

For professionals: AHFS DI Monograph, Prescribing Information

Off Label: Yes

6.0

Generic name:duloxetine systemic

Drug class: serotonin-norepinephrine reuptake inhibitors

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

Off Label: Yes

6.0

Generic name:carbamazepine systemic

Drug class: dibenzazepine anticonvulsants

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

Off Label: Yes

7.0

Generic name:levocarnitine systemic

Drug class: nutraceutical products

For consumers: dosage, interactions, side effects

Off Label: Yes

7.0

Generic name:capsaicin topical

Brand name: Qutenza

Drug class: miscellaneous topical agents

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts

Off Label: Yes

7.0

Generic name:pregabalin systemic

Drug class: gamma-aminobutyric acid analogs

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph

Off Label: Yes

5.0

Generic name:capsaicin topical

Drug class: miscellaneous topical agents

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

Off Label: Yes

Generic name:levocarnitine systemic

Drug class: nutraceutical products

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

Off Label: Yes

1.0

Generic name:phenytoin systemic

Drug class: hydantoin anticonvulsants, group I antiarrhythmics

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

Off Label: Yes

4.0

Generic name:levocarnitine systemic

Drug class: nutraceutical products

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

Off Label: Yes

The following products are considered to be alternative treatments or natural remedies for Peripheral Neuropathy. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. However there may be historical, cultural or anecdotal evidence linking their use to the treatment of Peripheral Neuropathy.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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List of Peripheral Neuropathy Medications (11 Compared ...

Lymph nodes are small, bean-shaped masses of tissue that are located in clusters throughout the body, including in the armpit. Lymph nodes play a crucial role in helping to fight infection; they filter and trap bacteria, viruses, and other unwanted substances in the body, so that special white blood cells (called lymphocytes) can then destroy them.

When treating cancer, doctors sometimes choose to remove and biopsy nearby lymph nodes to learn whether any of the nodes contain cancer cells. This information helps determine whether the cancer has spread to other parts of the body, a process known as staging. This information also helps the health care team decide on an appropriate and tailored treatment plan.

As with any surgical procedure, there might be side effects. You may sustain some degree of nerve damage during the procedure, resulting in tingling, numbness, or weakness in your arm. These neuropathy symptoms can be mild or more severe, depending on the extent of nerve involvement. You may experience swelling in the arm due to a build-up of lymph fluid that is no longer draining effectively through the remaining lymph nodes; this condition is called lymphedema. You may experience a temporary inflammation of blood vessels in your armpit as well as a higher potential for blood clotting and infection at the biopsy site.

If your health care team has recommended this procedure for you, it is likely because they feel that the benefits outweigh any of these potential risks. Nevertheless, it is always a good idea to have a frank discussion with your surgeon about possible side effects and any preventive measures you can take to lower your risk of experiencing them.

We offer resources about lymphedema and neuropathy.

For more information about lymphedema, please visit The National Lymphedema Network.

To learn more about lymph node removal surgery, please visit The National Cancer Institute.

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Neuropathy, Cancer, Information, Resources | CancerCare

What is neuropathy?

Neuropathy also called peripheral neuropathy refers to any condition that affects the normal activity of the nerves of the peripheral nervous system. The peripheral nervous system is the network of nerves that connects the central nervous system the brain and spinal cord to the rest of the body.

The peripheral nervous system is made up of 3 types of nerves, each with an important role to play in keeping your body healthy and functioning properly.

Neuropathy results when nerve cells, or neurons, are damaged or destroyed. This distorts the way the neurons communicate with each other and with the brain. Neuropathy can affect 1 nerve or nerve type, or a combination of nerves.

Neuropathy is very common. It is estimated that about 25% to 30% of Americans will be affected by neuropathy. Neuropathy occurs in 60% to 70% of people with diabetes.

Neuropathy affects people of all ages; however, older people are at increased risk. It is more common in men and in Caucasians. People in certain professions, such as those that require repetitive motions, have a greater chance of developing compression-related neuropathy.

There are many causes of neuropathy. The cause can be hereditary (runs in families) or acquired (develops after birth).

The most common hereditary neuropathy is Charcot-Marie-Tooth (CMT) disease, which affects both motor and sensory nerves. CMT affects about one in 2,500 people in the United States. CMT causes weakness in the foot and lower leg muscles. Deformities of the feet are also common, making it difficult to walk and often resulting in falls. In its later stages, CMT can also affect the muscles in the hands. There is no cure for hereditary neuropathy.

Acquired neuropathy is much more common. There are many causes of acquired neuropathy, including:

When the cause of the neuropathy cannot be determined, it is called idiopathic neuropathy. About 30 to 40% of neuropathy cases are idiopathic. Another 30% are the result of diabetes.

Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can appear suddenly, which is called acute neuropathy, or develop slowly over time, called chronic neuropathy.

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Neuropathy | Cleveland Clinic

Peripheral neuropathy is not a single disease. Its a general term for a series of disorders that result from damage to the bodys peripheral nervous system.

The bodys nervous system is made up of two parts. The central nervous system (CNS) includes the brain and the spinal cord. The peripheral nervous system (PNS) connects the nerves running from the brain and spinal cord to the rest of the bodythe arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin.

Peripheral neuropathy occurs when nerves are damaged or destroyed and cant send messages from the brain and spinal cord to the muscles, skin and other parts of the body.

Peripheral nerves go from the brain and spinal cord to the arms, hands, legs, and feet. When damage occurs, numbness and pain in these areas may occur.

Peripheral neuropathy can affect multiple nerves (polyneuropathy) or only one nerve or nerve group (mononeuropathy) at a time.

Mononeuropathy is usually the result of damage to a single nerve or nerve group by trauma, injury, local compression, prolonged pressure, or inflammation.

Examples include:

The majority of people, however, suffer from polyneuropathy, an umbrella term for damage involving many nerves at the same time.

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What Is Peripheral Neuropathy? | Living With Peripheral ...

by Waden E. Emery III MD FAAN, Neuromuscular NeurologistBoard Certified in Neurology, Asst Clinical Professor in NeurologyMiller School of Medicine University of Miami

Your nervous system consists of two primary systems, the Peripheral Nervous System and the Central Nervous System.

The Central Nervous System is made up of the brain and spinal cord.

The Peripheral Nervous System is the largest nervous system of the human body running throughoutyour entire body except foryour brain andyour spinal cord, and is separated into two distinct systems, the Somatic Nervous System and the Autonomic Nervous System.

Autonomic Neuropathy is a Peripheral Neuropathy. That is to say every person that has Autonomic Neuropathy has Peripheral Neuropathy, but everyone that has Peripheral Neuropathymay or maynot have Autonomic Neuropathy.

Peripheral Neuropathyusually affects the hands and feet, causing weakness, numbness, tingling and pain. It can also result in trouble with balance and walking, as well as in problems with grasping items, such as a coffee cup or salt shaker. Peripheral Neuropathys course is variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating. However, if diagnosed early, Peripheral Neuropathy can often be controlled.

Human Nerve Cell

Neuropathy is a result of damage to the nerves most often found in the Peripheral Nervous Systemthat controlsthe motor, sensory, or autonomic nerves required to transmit voluntary and involuntary messages to the brain. Neuropathy can affect or damage the axon (actual nerve), and/or the myelin (covering of the nerves which assists in the transmission signals). Neuropathy can alsoaffect or damage the small and/or large fiber nerves. Small Fiber Neuropathy can now be diagnosed with a simple skin biopsy.

Living with Autonomic Neuropathy In looking at the various components of the autonomic nervous system which can be affected by autonomic neuropathy, these authorities note that it can and does affect the urinary, the cardiac (heart beat), digestive, pulmonary (breathing) systems, it also affects the bodys ability to regulate temperature, tearing, sexual functions, blood pressure, saliva production, swallowing among other body systems that function automaticallyREAD MORE

Small Fiber Neuropathy So many neuropathy patients have heard these words from very qualified neurologists and health professionals. Your EMG and Nerve Conduct Studies are normal. You do not have neuropathy not so quick. Dr. Norman Latov of Cornell University states that the EMG and Nerve Conduct Studies only measure damage toREAD MORE

Diabetic Neuropathy According to the experts, diabetic neuropathy is the most common cause of about 50% of all neuropathies. Dr. Todd Levine recently participated in a Facebook chat on the subject of Understanding Pre-Diabetes, Diabetes, and Diabetic Neuropathy. Some doctors deny the existence of neuropathy from pre-diabetes but see the following two references: 1. Norman Latov, MDREAD MORE

Celiac Disease and Neuropathy Dr. Howard Sanders published an article on The Link Between Celiac Disease and Neuropathy and was featured on The Neuropathy Associations website before they closed on Dec 31, 2014 and brings attention to the need for some patients presenting with neuropathy and the symptoms of Celiac Disease to be tested. Howard. W. Sander, M.D. is aREAD MORE

Medication Induced Neuropathy Peter D. Donofrio, M.D. is professor of Neurology and director of the Neuromuscular Division of the Department of Neurology at Vanderbilt University Medical Center. He is director of Neuropathy Center at Vanderbilt. To read his excellent article on Medication Induced Neuropathy and insights on the LIMITS of the blood-brain barrier a concept which was often misused byREAD MORE

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What is Neuropathy? | Neuropathy Support Network

Peripheral neuropathy (PN) is damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected. Common causes include toxic exposure such as Agent Orange, systemic diseases (such as diabetes or leprosy), hyperglycemia-induced glycation,[1][2][3] vitamin deficiency, medication (e.g., chemotherapy, or commonly prescribed antibiotics including metronidazole and the fluoroquinolone class of antibiotics (Ciprofloxacin, Levaquin, Avelox etc.)), traumatic injury, including ischemia, radiation therapy, excessive alcohol consumption, immune system disease, coeliac disease, or viral infection. It can also be genetic (present from birth) or idiopathic (no known cause).[4][5][6] In conventional medical usage, the word neuropathy (neuro-, "nervous system" and -pathy, "disease of")[7] without modifier usually means peripheral neuropathy.

Neuropathy affecting just one nerve is called "mononeuropathy" and neuropathy involving nerves in roughly the same areas on both sides of the body is called "symmetrical polyneuropathy" or simply "polyneuropathy". When two or more (typically just a few, but sometimes many) separate nerves in disparate areas of the body are affected it is called "mononeuritis multiplex", "multifocal mononeuropathy", or "multiple mononeuropathy".[4][5][6]

Peripheral neuropathy may be chronic (a long-term condition where symptoms begin subtly and progress slowly) or acute (sudden onset, rapid progress, and slow resolution). Acute neuropathies demand urgent diagnosis. Motor nerves (that control muscles), sensory nerves, or autonomic nerves (that control automatic functions such as heart rate, body temperature, and breathing) may be affected. More than one type of nerve may be affected at the same time. Peripheral neuropathies may be classified according to the type of nerve predominantly involved, or by the underlying cause.[4][5][6]

Neuropathy may cause painful cramps, fasciculations (fine muscle twitching), muscle loss, bone degeneration, and changes in the skin, hair, and nails. Additionally, motor neuropathy may cause impaired balance and coordination or, most commonly, muscle weakness; sensory neuropathy may cause numbness to touch and vibration, reduced position sense causing poorer coordination and balance, reduced sensitivity to temperature change and pain, spontaneous tingling or burning pain, or skin allodynia (severe pain from normally nonpainful stimuli, such as light touch); and autonomic neuropathy may produce diverse symptoms, depending on the affected glands and organs, but common symptoms are poor bladder control, abnormal blood pressure or heart rate, and reduced ability to sweat normally.[4][5][6]

Peripheral neuropathy may be classified according to the number and distribution of nerves affected (mononeuropathy, mononeuritis multiplex, or polyneuropathy), the type of nerve fiber predominantly affected (motor, sensory, autonomic), or the process affecting the nerves; e.g., inflammation (neuritis), compression (compression neuropathy), chemotherapy (chemotherapy-induced peripheral neuropathy).

Mononeuropathy is a type of neuropathy that only affects a single nerve.[8] Diagnostically, it is important to distinguish it from polyneuropathy because when a single nerve is affected, it is more likely to be due to localized trauma or infection.

The most common cause of mononeuropathy is physical compression of the nerve, known as compression neuropathy. Carpal tunnel syndrome and axillary nerve palsy are examples. Direct injury to a nerve, interruption of its blood supply resulting in (ischemia), or inflammation also may cause mononeuropathy.

"Polyneuropathy" is a pattern of nerve damage that is quite different from mononeuropathy, often more serious and affecting more areas of the body. The term "peripheral neuropathy" sometimes is used loosely to refer to polyneuropathy. In cases of polyneuropathy, many nerve cells in various parts of the body are affected, without regard to the nerve through which they pass; not all nerve cells are affected in any particular case. In distal axonopathy, one common pattern is that the cell bodies of neurons remain intact, but the axons are affected in proportion to their length; the longest axons are the most affected. Diabetic neuropathy is the most common cause of this pattern. In demyelinating polyneuropathies, the myelin sheath around axons is damaged, which affects the ability of the axons to conduct electrical impulses. The third and least common pattern affects the cell bodies of neurons directly. This usually picks out either the motor neurons (known as motor neuron disease) or the sensory neurons (known as sensory neuronopathy or dorsal root ganglionopathy).

The effect of this is to cause symptoms in more than one part of the body, often symmetrically on left and right sides. As for any neuropathy, the chief symptoms include motor symptoms such as weakness or clumsiness of movement; and sensory symptoms such as unusual or unpleasant sensations such as tingling or burning; reduced ability to feel sensations such as texture or temperature, and impaired balance when standing or walking. In many polyneuropathies, these symptoms occur first and most severely in the feet. Autonomic symptoms also may occur, such as dizziness on standing up, erectile dysfunction, and difficulty controlling urination.

Polyneuropathies usually are caused by processes that affect the body as a whole. Diabetes and impaired glucose tolerance are the most common causes. Hyperglycemia-induced formation of advanced glycation end products (AGEs) is related to diabetic neuropathy.[9] Other causes relate to the particular type of polyneuropathy, and there are many different causes of each type, including inflammatory diseases such as Lyme disease, vitamin deficiencies, blood disorders, and toxins (including alcohol and certain prescribed drugs).

Most types of polyneuropathy progress fairly slowly, over months or years, but rapidly progressive polyneuropathy also occurs. It is important to recognize that at one time it was thought that many of the cases of small fiber peripheral neuropathy with typical symptoms of tingling, pain, and loss of sensation in the feet and hands were due to glucose intolerance before a diagnosis of diabetes or pre-diabetes. However, in August 2015, the Mayo Clinic published a scientific study in the Journal of the Neurological Sciences showing "no significant increase in...symptoms...in the prediabetes group", and stated that "A search for alternate neuropathy causes is needed in patients with prediabetes." [10]

The treatment of polyneuropathies is aimed firstly at eliminating or controlling the cause, secondly at maintaining muscle strength and physical function, and thirdly at controlling symptoms such as neuropathic pain.

Mononeuritis multiplex, occasionally termed polyneuritis multiplex, is simultaneous or sequential involvement of individual noncontiguous nerve trunks,[11] either partially or completely, evolving over days to years and typically presenting with acute or subacute loss of sensory and motor function of individual nerves. The pattern of involvement is asymmetric, however, as the disease progresses, deficit(s) becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy.[12] Therefore, attention to the pattern of early symptoms is important.

Mononeuritis multiplex also may cause pain, which is characterized as deep, aching pain that is worse at night and frequently in the lower back, hip, or leg. In people with diabetes mellitus, mononeuritis multiplex typically is encountered as acute, unilateral, and severe thigh pain followed by anterior muscle weakness and loss of knee reflex.[medical citation needed]

Electrodiagnostic medicine studies will show multifocal sensory motor axonal neuropathy.

It is caused by, or associated with, several medical conditions:

Autonomic neuropathy is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system), affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax, abdomen, and pelvis outside the spinal cord. They have connections with the spinal cord and ultimately the brain, however. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2. In mostbut not allcases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy.

Autonomic neuropathy is one cause of malfunction of the autonomic nervous system, but not the only one; some conditions affecting the brain or spinal cord also may cause autonomic dysfunction, such as multiple system atrophy, and therefore, may cause similar symptoms to autonomic neuropathy.

The signs and symptoms of autonomic neuropathy include the following:

Neuritis is a general term for inflammation of a nerve[21] or the general inflammation of the peripheral nervous system. Symptoms depend on the nerves involved, but may include pain, paresthesia (pins-and-needles), paresis (weakness), hypoesthesia (numbness), anesthesia, paralysis, wasting, and disappearance of the reflexes.

Causes of neuritis include:

Types of neuritis include:

Those with diseases or dysfunctions of their nerves may present with problems in any of the normal nerve functions. Symptoms vary depending on the types of nerve fiber involved.[citation needed]In terms of sensory function, symptoms commonly include loss of function ("negative") symptoms, including numbness, tremor, impairment of balance, and gait abnormality.[24] Gain of function (positive) symptoms include tingling, pain, itching, crawling, and pins-and-needles. Motor symptoms include loss of function ("negative") symptoms of weakness, tiredness, muscle atrophy, and gait abnormalities; and gain of function ("positive") symptoms of cramps, and muscle twitch (fasciculations).[25]

In the most common form, length-dependent peripheral neuropathy, pain and parasthesia appears symmetrically and generally at the terminals of the longest nerves, which are in the lower legs and feet. Sensory symptoms generally develop before motor symptoms such as weakness. Length-dependent peripheral neuropathy symptoms make a slow ascent of leg, while symptoms may never appear in the upper limbs; if they do, it will be around the time that leg symptoms reach the knee.[26] When the nerves of the autonomic nervous system are affected, symptoms may include constipation, dry mouth, difficulty urinating, and dizziness when standing.[25]

The causes are grouped broadly as follows:

Peripheral neuropathy may first be considered when an individual reports symptoms of numbness, tingling, and pain in feet. After ruling out a lesion in the central nervous system as a cause, diagnosis may be made on the basis of symptoms, laboratory and additional testing, clinical history, and a detailed examination.

During physical examination, specifically a neurological examination, those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, although those with a pathology (problem) of the nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathies, such as GuillainBarr syndrome; or may show focal sensory disturbance or weakness, such as in mononeuropathies. Classically, ankle jerk reflex is absent in peripheral neuropathy.

A physical examination will involve testing the deep ankle reflex as well as examining the feet for any ulceration. For large fiber neuropathy, an exam will usually show an abnormally decreased sensation to vibration, which is tested with a 128-Hz tuning fork, and decreased sensation of light touch when touched by a nylon monofilament.[26]

Diagnostic tests include electromyography (EMG) and nerve conduction studies (NCSs), which assess large myelinated nerve fibers.[26] Testing for small-fiber peripheral neuropathies often relates to the autonomic nervous system function of small thinly- and unmyelinated fibers. These tests include a sweat test and a tilt table test. Diagnosis of small fiber involvement in peripheral neuropathy may also involve a skin biopsy in which a 3mm-thick section of skin is removed from the calf by a punch biopsy, and is used to measure the skin intraepidermal nerve fiber density (IENFD), the density of nerves in the outer layer of the skin.[24] Reduced density of the small nerves in the epidermis supports a diagnosis of small-fiber peripheral neuropathy.

Laboratory tests include blood tests for vitamin B-12 levels, a complete blood count, measurement of thyroid stimulating hormone levels, a comprehensive metabolic panel screening for diabetes and pre-diabetes, and a serum immunofixation test, which tests for antibodies in the blood.[25]

The treatment of peripheral neuropathy varies based on the cause of the condition, and treating the underlying condition can aid in the management of neuropathy. When peripheral neuropathy results from diabetes mellitus or prediabetes, blood sugar management is key to treatment. In prediabetes in particular, strict blood sugar control can significantly alter the course of neuropathy.[24] In peripheral neuropathy that stems from immune-mediated diseases, the underlying condition is treated with intravenous immunoglobulin or steroids. When peripheral neuropathy results from vitamin deficiencies or other disorders, those are treated as well.[24]

A range of medications that act on the central nervous system has been found to be useful in managing neuropathic pain. Commonly used treatments include tricyclic antidepressants (such as nortriptyline or amitriptyline), the serotonin-norepinephrine reuptake inhibitor (SNRI) medication duloxetine, and antiepileptic therapies such as gabapentin, pregabalin, or sodium valproate. Few studies have examined whether nonsteroidal anti-inflammatory drugs are effective in treating peripheral neuropathy.[38]

Symptomatic relief for the pain of peripheral neuropathy may be obtained by application of topical capsaicin. Capsaicin is the factor that causes heat in chili peppers. The evidence suggesting that capsaicin applied to the skin reduces pain for peripheral neuropathy is of moderate to low quality and should be interpreted carefully before using this treatment option.[39] Local anesthesia often is used to counteract the initial discomfort of the capsaicin. Some current research in animal models has shown that depleting neurotrophin-3 may oppose the demyelination present in some peripheral neuropathies by increasing myelin formation.[40]

Evidence supports the use of cannabinoids for some forms of neuropathic pain.[41]

Transcutaneous electrical nerve stimulation therapy may be effective and safe in the treatment of diabetic peripheral neuropathy. A recent review of three trials involving 78 patients found some improvement in pain scores after 4 and 6, but not 12 weeks of treatment and an overall improvement in neuropathic symptoms at 12 weeks.[42] Another review of four trials found significant improvement in pain and overall symptoms, with 38% of patients in one trial becoming asymptomatic. The treatment remains effective even after prolonged use, but symptoms return to baseline within a month of cessation of treatment.[43]

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Peripheral neuropathy - Wikipedia