Neuropathy, also called neuralgia, means nerve disease or damage. Nerves are made of fibers that affect pain sensation, movement, and balance. Peripheral nerves take messages from the brain and spinal cord to muscles, organs, and other body tissues. Damage may mean being more sensitive to things that are painful (such as pinpricks) or not painful (such as light touch). The first is called hyperalgesia; the second, hyperesthesia. Allodynia is pain caused by something that’s not normally painful. From 1.6% to 8.2% of the general population have neuropathy.
Many causes exist, including direct injury and pressure on nerves. Metabolic causes include diabetes mellitus, malnutrition, and porphyria. Others are vitamin B deficiencies. Inflammatory causes are lupus, Sjögren’s syndrome, polyarteritis nodosa, acute and chronic inflammatory demyelinating polyneuropathy, sarcoid, and multiple sclerosis. Infectious causes are HIV/AIDS, herpesvirus, varicella-zoster virus (postherpetic neuralgia), Lyme disease, leprosy, and syphilis. Rare cancer of nerves can also cause neuropathy. Alcohol, chemotherapeutic drugs, isoniazid, metronidazole, and heavy metals (arsenic) are other causes of neuropathy.
Symptoms depend on the nerves and fibers affected. Numbness and tingling in feet and hands may start slowly and spread to legs and arms. People may have burning, hot or cold, “icy hot,” pins and needles, stinging, shooting (lancinating), or sharp feelings. Extreme sensitivity to even light touch can occur. Affected limbs may be numb and weak. Muscle tissue may be lost (muscle atrophy) if the neuropathy has been present for a prolonged period. Spinal cord involvement may mean the urinary bladder and bowel problems.
The health care provider makes a preliminary diagnosis from the medical history and physical examination. Laboratory tests, magnetic resonance imaging (MRI) of the brain and spinal cord and special tests including nerve conduction studies and electromyography (EMG), nerve biopsy, and lumbar puncture may be done to confirm the diagnosis and determine the cause. The health care provider may suggest seeing specialists (neurologist, physical therapist, pain management specialist) for additional evaluation and treatment.
Symptoms often improve with time, especially if causes can be treated. For example, better control of blood sugar (glucose) can lower the risk of diabetic neuropathy. Vitamin B12 supplements can help with vitamin B12 deficiency. Medicines used for treatment of painful neuropathy include antidepressants, antiepileptics, and analgesics. Counseling may help deal with psychologic issues that make pain worse. Physical therapy helps, especially for chronic neck and low back pain. Acupuncture and biofeedback can also be tried. Surgery and nerve blocks are options mostly for people having pain from spinal cord injury. Surgery is usually used when other treatments don’t work.
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