A neuropathy is a condition in which the peripheral nerves (the nerves in your body, aside from your spinal cord and brain) are damaged and/or not working correctly. There are many different types of neuropathies and just as many different ways to categorize them, including by the type of nerve damaged, the cause(s) of the nerve damage, and the pattern of nerve damage. Please see the chart below for the most common types of neuropathies.
Approximately 21 million Americans are affected by peripheral neuropathy. Diabetes is the leading cause of peripheral neuropathy. 30% of Neuropathies are idiopathic, meaning, without a known cause. Please note that some forms of neuropathies can be fatal.
Peripheral is a term used for the most distal nerves (farthest away from the spinal cord and brain) in our body, including those in our feet or hands.
A polyneuropathy is a neuropathy pattern, termed distal symmetric, whereby the nerve damage initially starts in both feet and may progress to involve the feet, calves, and fingers/hands. Another word for this pattern is a Stocking or Glove Neuropathy. Many patients with polyneuropathy may not even have any symptoms; in this case, the diagnosis is made by a physical examination or a laboratory test (noninvasive, non-aversive test called Neuralscan, done in our office, or the more traditional electromyography (EMG) and nerve conduction velocity test (NCV)). Some patients with polyneuropathy have only numbness, “tingling,” and/or “pins and needles.” Patients with polyneuropathy may also experience pain; 26% of patients with diabetic neuropathy have pain.
Signs and Symptoms
While every person’s experience with peripheral neuropathy can be as unique as the individual themselves, there are some common neuropathy signs and symptoms shared by most individuals. The symptoms of diabetic or peripheral neuropathy start in the toes and feet (right and left). In some patients, the symptoms gradually rise up the calves and into the knees. This is called a stocking pattern. Then, in some, the symptoms may also begin in the fingers and hands — causing a stocking and glove pattern. It cannot be predicted how anyone patient’s symptoms will spread. In some patients, the pain does not spread beyond the toes or feet and there is no progression; in others, the progression to calves and hands occurs rapidly, in a matter of months; in other cases, the spread is very gradual, over many years. There are three categories of nerves and up to five specific peripheral nerves that may be affected, and symptoms depend on these nerves and their location:
Patients who develop pain with peripheral neuropathy describe the pain using a variety of words, including “burning,” “throbbing,” “deep ache”, “raw skin,” “skin sensitivity,” “sharp,” “electric-like,” “pins and needles,” “freezing cold,” “like walking on ground glass,” “itchy,” and others. Some patients say they don’t have pain but have unpleasant and irritating sensations (dysesthesirs), which may include “buzzing,” “like bugs crawling,” and “aching. Some people feel like they have socks on, even though they are barefoot. Over time, this feeling can spread to the legs and hands.
The inability to move normally, termed motor function, may develop. Patients can develop trouble with their sense of positioning; and therefore, may have difficulty with their gait or balance. For example, patients may develop difficulties with balance and find it harder and harder to walk. Their legs feel heavy and they may have to drag themselves up the stairs.
Some patients have constant pain, day and night, whereas others only have noticeable pain at bedtime. Often, patients may complain that the pain interferes with their sleep and they may develop Restless Leg Syndrome and or Insomnia (difficulty sleeping). As with all chronic pain, patients with painful peripheral neuropathy may also develop depression.
Diagnosing peripheral neuropathy
Most often, a doctor should be able to diagnose peripheral neuropathy solely on a patient’s description of his/her symptoms and a simple neurological examination. Sometimes, however, a doctor may order special nerve tests. We do have treatments that address some of these conditions, that we can discuss.
Importantly, in many peripheral neuropathy patients (especially those with new onset or very peripheral symptoms), the more traditional EMG/NCV tests are completely normal. In addition, EMG/NCV are painful tests: a neurologist sticks a needle in the muscle and sends electric shocks along the nerves to measure how well nerves are working.
A more accurate and superior neurological test, Neuralscan, is utilized in our clinic. It is essentially not painful and measures how well the patient feels electrical sensations at a very low threshold.
Types of nerves tested are:
- Sensory Nerves: affect sensation (pressure, chemical, temperature)
- Autonomic Nerves: affect internal organ functions
- Motor Nerves: effect muscles and permit voluntary movement