An estimated 30 million people in the United States suffer from some form of peripheral neuropathy. It involves damage to the network of nerves in the peripheral nervous system.
Nerve pain is caused by damage to the nerves that send pain signals to the brain.
Diabetes is the most common cause of peripheral neuropathy. Other causes of neuropathy include vitamin deficiencies, medications, chemotherapy, tumors, kidney disease, exposure to poison, human immunodeficiency virus (HIV), alcohol abuse, liver disease, infections, repetitive stress and many other conditions. Read on…
If not treated, you can have worsening of neuropathy or permanent nerve damage. Moreover, neuropathy can be a symptom of a serious underlying health problem… which can lead to disability or death if not treated. You need to see your doctor or health care professional and get help immediately… if you notice neuropathy symptoms, such as, numbness, tingling, burning or pain in your hands or feet. The sooner you can get treatment, the greater the chance of controlling your neuropathy symptoms and preventing further damage to your peripheral nerves.
Nerve Pain and Peripheral Neuropathy: Consequences and Costs
According to the Foundation for the Peripheral Neuropathy, an estimated 30 million people in the United States suffer from some form of peripheral neuropathy (PN).
- Up to 70% of diabetics have PN. Diabetic peripheral neuropathy (DPN) is the most common type of nerve damage.
- Up to 40% of people who receive chemotherapy to treat cancer have PN
- Up to 33% of people who have human immunodeficiency virus (HIV) have PN.
Diabetic peripheral neuropathy (DPN) is a common cause of non-traumatic limb amputations. About 200,000 diabetes-related amputations occur every year in the US, according to the American Journal of Managed Care (2018).
The estimated total healthcare costs in the United States are $1.4 trillion per year, according to the Centers for Disease Control and Prevention (CDC).
For most people, pain is the main reason for seeking healthcare. The direct medical costs for treatment of acute and chronic pain have been estimated to be more than $100 billion per year, according to the American Journal of Managed Care.
The total direct medical costs for the treatment of diabetic peripheral neuropathy and its complications are $10.91 billion per year.
In the United States workforce, the indirect costs associated with chronic pain have been estimated to total $100 billion per year; absences from work and reduced productivity while at work contribute to this cost.
Impact of Nerve Pain and Peripheral Neuropathy On Quality of Life
Numerous studies have shown that quality of life is significantly reduced in patients with chronic nerve pain and peripheral neuropathy. Their pain interfered with:
- Sleep
- Mobility
- Work
- Enjoyment of life
- Recreational activities
- Social activities
- General activities
According to the American Journal of Managed Care, people with neuropathic pain are more likely to have increased anxiety, depression and pain-related sleep deprivation. These conditions can greatly interfere with their ability to function.
Peripheral Neuropathy: Nerve Pain and Nerve Damage
Peripheral neuropathy involves damage to the network of nerves in the peripheral nervous system.
The central nervous system consists of the brain and the spinal cord. In contrast, the peripheral nervous system includes the vast networks of nerves that branch out from the brain and the spinal cord and extend to other parts of the body, including the muscles and organs.
The peripheral nerves send many types of sensory information to the central nervous system. They also carry signals from the brain and spinal cord to the rest of the body.
The brain, spinal cord and peripheral nerves control everything that happens in our body. They control everything from our muscles, heart and blood vessels, digestion, sexual function, urination, skin sensation and many other complex functions.
It’s not surprising that when peripheral nerves are damaged, they malfunction and cause many problems.
In neuropathy, nerve signaling is disrupted in three ways:
- Loss of signals normally sent
- Inappropriate signaling when there shouldn’t be any
- Distortion of the signals sent
Common Symptoms of Peripheral Neuropathy
More than 100 types of peripheral neuropathy have been identified. The symptoms vary depending on the type of nerves that are damaged.
- Motor nerves control the movement of all muscles.
- Sensory nerves send information, such as, pain, touch or temperature.
- Autonomic nerves control functions, such as, blood pressure, breathing, heart rate, digestion and bladder.
Common symptoms of peripheral neuropathy include:
- Numbness or tingling in your feet or hands; these sensations can spread to the legs or arms
- Sharp, stabbing, throbbing or burning pain
- Extreme sensitivity to touch
- Severe pain from things that are normally painless, such as, being covered by bedsheets
- Inability to feel pain, pressure, vibrations, temperature or touch
- Inability to coordinate movements, such as, walking or fastening buttons
- Loss of position sense and inability to maintain balance when eyes are shut
- Muscle weakness or loss of muscle control
- Muscle twitching, spasms or cramps
- Feeling as if you’re wearing gloves or socks when you’re not
- Heat intolerance
- Excessive sweating or inability to sweat
- Bowel, bladder or digestive problems
- Erectile dysfunction in men and sexual function problems in women
- Low blood pressure, dizziness, lightheadedness or fainting
Underlying Health Problems and Causes of Peripheral Neuropathy
In some cases of neuropathy, no cause can be identified (idiopathic). However, many conditions and injuries can cause neuropathy, including:
Autoimmune diseases – The immune system mistakenly attacks the body’s own tissues. These include lupus, rheumatoid arthritis, Sjogren’s syndrome, Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy.
Diabetes – It’s the leading cause of polyneuropathy in the US. Up to 70% of diabetics develop some type of neuropathy. Damage to sensory, motor and autonomic nerves causes muscle weakness, numbness, tingling or burning feet.
Infections — These include hepatitis B and C, leprosy, Lyme disease, shingles, Epstein-Barr virus, human immunodeficiency virus (HIV) and diphtheria.
Inherited disorders — Charcot-Marie-Tooth disease is the most common hereditary type of neuropathy.
Bone marrow disorders — These include monoclonal gammopathies (an abnormal protein in the blood), myeloma (a form of blood cancer) and lymphoma (cancer of the lymphatic system).
Kidney and liver disorders – These diseases can lead to abnormally high amounts of toxic substances in the blood that can damage nerve tissues. Most individuals on dialysis (due to kidney failure) develop varying levels of polyneuropathy.
Tumors — Cancerous (malignant) and non-cancerous (benign) tumors can develop on the nerves or press on nerve fibers. Paraneoplastic syndromes (a group of rare degenerative disorders that are triggered by the body’s immune system response to a cancer) can cause widespread nerve damage indirectly.
Chemotherapy and radiation — Some treatments for cancer (chemotherapy) and radiation therapy can damage peripheral nerves. Up to 40% of people getting chemotherapy develop neuropathy, which may continue long after stopping treatments. Nerve damage from radiation therapy can sometimes start months or years after treatments.
Exposure to poisons — Toxic substances, including solvents and other industrial chemicals as well as lead, mercury and other heavy metals can cause nerve damage.
Medications — Some antibiotics, anti-seizure and HIV medications can cause peripheral neuropathy.
Physical injury or repetitive stress – Injuries from motor vehicle accidents, falls, fractures or sports injuries can damage peripheral nerves. Broken bones can exert damaging pressure on neighboring nerves. Slipped disks between vertebrae can compress nerve fibers from the spinal cord. Nerve pressure can result from repetitive stress of computer work and other activities causing carpal tunnel syndrome.
Vascular and blood problems — Blood clots, inflammation and other blood vessel disorders can decrease blood flow to the arms and legs. In turn, this can lead to nerve damage or nerve cell death. Vascular problems caused by diabetes, smoking or atherosclerosis (fatty deposits on the inside of blood vessel walls) can lead to neuropathy. Blood vessel wall thickening and scarring from vasculitis can impede blood flow and cause nerve damage as well as neuropathy.
Alcohol abuse — Poor dietary choices made by people abusing alcohol can lead to thiamine (vitamin B1) and other vitamin deficiencies crucial for healthy nerve function. Neuropathy may also be caused directly by alcohol toxicity to peripheral nerves.
Vitamin deficiencies or imbalances – Adequate levels of vitamins, such as, B1 (thiamine), B6 (pyridoxine), B12 (cobalamin) and B3 (niacin) as well as vitamin E are crucial to nerve health. Vitamin B12 deficiency due to eating disorders, malnutrition, malabsorption, pernicious anemia, gastrointestinal or weight loss surgeries can lead to neuropathy and other neurological consequences.
Complications of Peripheral Neuropathy
- Burns and skin trauma — You may not feel pain or temperature changes on parts of your body that are numb.
- Wounds and infections — Due to nerve damage and reduced sensation, your feet and other areas can become injured and the resulting wound can get infected without you noticing.
- Amputations — Diabetic peripheral neuropathy (DPN) is common. Up to 70% of diabetics have neuropathy. DPN is a common cause of non-traumatic limb amputations from non-healing ulcers. About 200,000 diabetes-related amputations occur every year in the US, according to the American Journal of Managed Care (2018).
- Falls – Weakness, numbness, loss of position sense and loss of sensation can lead to lack of balance and frequent falls.
See Your Healthcare Provider Immediately and Get Help As Soon As You Notice Neuropathy Symptoms: You Can Prevent Permanent Nerve Damage
If not treated, you can have worsening of neuropathy or permanent nerve damage.
Moreover, neuropathy can be a symptom of a serious underlying health problem… which can lead to disability or death if not treated.
You need to see your doctor or health care professional and get help immediately… if you notice neuropathy symptoms, including unusual weakness, tingling, numbness, burning or pain in your hands or feet.
The sooner you can get treatment, the greater the chance of controlling your neuropathy symptoms and preventing further damage to your peripheral nerves.
Ways Your Physician or Health Care Provider Can Determine Cause of Neuropathy As Well As Type and Extent of Nerve Damage
Your treatment can only begin after your physician or health care provider determines the medical condition(s) or health issues causing your neuropathy. (S)he also needs to determine the type and extent of damage to your nerves.
#1. History and Physical Exam
Your physician or health care provider will conduct a thorough history and physical exam. (S)he will review your symptoms and ask you questions, including:
- Current and past medications
- Exposure to toxic substances
- Any history of trauma or injuries
- Your work and tasks involving repetitive motions
- Family history of diseases
- Your diet
- Alcohol abuse
#2. Neurologic Exam
Your physician or health care provider will check neurological function, including your:
- Reflexes
- Balance and coordination
- Ability to feel touch, temperature and other sensations
- Muscle strength and tone
#3. Blood Work and Other Tests
Your physician or health care provider will also order blood work and imaging tests.
- Blood work can reveal vitamin deficiencies, mineral and electrolyte imbalances, levels of substances or presence of antibodies.
- Lab results can indicate potential kidney problems, diabetes, liver disorders, thyroid problems, toxic substances, antibodies to certain viruses or autoimmune diseases.
- Tests, such as, magnetic resonance imaging (MRI), CAT scan or ultrasound can reveal tumors, pinched nerves or nerve compression.
- Your body’s ability to sweat may be tested.
- Your sensitivity to touch, pressure, vibration, hot or cold temperature may be tested.
- If your physician or health care provider suspects that a genetic condition is causing your neuropathy, a genetic test may be ordered.
#4. Electrodiagnostic Assessment
Your physician or health care provider might send you to a nerve specialist to find the location and degree of nerve damage.
- Nerve conduction study (NCS) may be done to study conduction of motor and sensory nerves.
- Needle electromyography (EMG) may be done to determine muscle health and function.
#5. Tissue biopsies
Nerve, muscle or skin biopsy may be needed to confirm your diagnosis.
Treatment and Management of Peripheral Neuropathy
Early diagnosis and treatment can stop the progression of neuropathy.
Your long-term outcome depends on what’s causing your neuropathy. If the underlying cause of your neuropathy is treatable, then managing the condition might stop the neuropathy or prevent it from getting worse.
If the underlying cause of your neuropathy can’t be treated, then managing the symptoms of neuropathy might improve your quality of life.
Your physician or health care provider may consider the following treatment options for neuropathy:
- Medicines can be used to control neuropathic pain, including:
- Anti-depressants, such as, Duloxetine or Nortripyline.
- Anti-seizure medicines, such as, Gabapentin and Pregabalin.
- Topical patches and creams containing lidocaine or capsaicin.
- Narcotic medications are not usually used for neuropathic pain.
- Physical therapy can help you increase your strength, balance and range of motion.
- Occupational therapy can help you manage safety issues related to neuropathy. Braces and tools for activities of daily living may be recommended.
- Mechanical aids, such as, braces, casts, splints and specially-designed shoes can help reduce pain and increase safety.
- Surgery may be needed for patients with tumors, compression-related neuropathy (such as, a herniated disc) or nerve entrapment disorders (such as, carpal tunnel syndrome).
- Acupuncture, massage, meditation, yoga, behavioral therapy and psychotherapy can help manage neuropathic pain.
- A dietitian can help you create a healthy diet plan to prevent vitamin and nutritional deficiencies. Multi-vitamins and nutritional supplements may also be recommended to correct deficiencies faster.
- Adopting healthy living habits, including exercise, losing weight, quitting smoking and limiting alcohol use may help control neuropathic pain.
Hope for Recovery and Reversal of Peripheral Neuropathy
The sooner you can get treatment for the underlying condition for your neuropathy, the greater the chance of preventing, slowing or repairing damage to your nerves.
Once established, neuropathy is hard to reverse.
The problem is that most people dealing with neuropathy wait too long to seek treatment. By the time the underlying cause of their neuropathy is diagnosed and treated, they’re already dealing with permanent nerve damage.
So, most people end up living with neuropathy for the rest of their lives.
If it’s possible, recovery can take months or even years.
Can neuropathy be reversed and nerve damage repaired?
If the underlying cause of the neuropathy can be treated, then it’s possible that the neuropathy can be reversed and the nerve damage can be repaired.
For example…
If vitamin deficiency is the cause of neuropathy, then nutritional and vitamin supplementation can reverse neuropathic symptoms. If treatment is not too late, nerve damage can potentially be repaired.
The good news?
Ongoing research on recovery and reversal of peripheral neuropathy shows promising results…
Why does this matter?
There’s growing scientific evidence of increased risk of peripheral neuropathy for people with prediabetes and metabolic syndrome as well as type 1 diabetes and type 2 diabetes.
Furthermore, several studies show that people with prediabetes and metabolic syndrome have increased risk of peripheral neuropathy BEFORE the onset of apparent diabetes.
Here’s some background information about prediabetes and metabolic syndrome…
Prediabetes represents the earliest stage of glucose regulation problems before the development of overt type 2 diabetes.
Metabolic syndrome is a cluster of metabolic problems in overweight and obese individuals; they can also occur in normal weight individuals:
- Abdominal obesity or belly fat
- High blood pressure
- Elevated serum triglycerides
- Reduced high-density lipoprotein (HDL) cholesterol
- Insulin resistance which leads to hyperglycemia in diabetes and prediabetes
Here’s what you need to know…
Studies have shown that unmyelinated cutaneous nerve fibers (axons) are vulnerable to physical and metabolic injury, but they’re also capable of rapid regeneration (nerve growth).
These nerve fibers get damaged in peripheral neuropathy associated with diabetes as well as prediabetes and metabolic syndrome.
Fortunately, there’s growing evidence that nerve fibers can regenerate or grow. This is how nerve damage can be improved or reversed in neuropathy…
Research done by Polydefkis M, Hauer P, Sheth S, et al (Brain 2004) have shown that individuals with diabetes have reduced regeneration of nerve fibers (axons). Regeneration is further reduced among those with diabetic peripheral neuropathy.
Studies done by Smith AG, Russel J, Feldman EL, et al (Diabetes Care 2006) on lifestyle-based strategies aimed at improving diet, increasing exercise and reducing weight showed promising results. Metabolic improvement was associated with nerve fiber improvement. In turn, the degree of nerve fiber improvement was significantly correlated with improvement in neuropathic pain.
Another study done by the research team of Singleton JR, Marcus RL, Lessard MK, et al (Annals of Neurology 2015) showed that at baseline, patients with metabolic syndrome have reduced regenerative capacity comparable with diabetic patients. After the lifestyle modification regimen, significant improvement was observed in nerve fiber (axon) regeneration rate.
Those who achieved greater improvement in metabolic syndrome criteria experienced greater degree of nerve fiber regeneration. These findings suggest that lifestyle modification exerts its positive effects in part through improvement in the ability of nerve fibers (axons) to regenerate.
These findings indicate that growth or regeneration of sensory nerve fibers is an important factor in recovery from neuropathy.
Taken together…
These studies show that lifestyle-based strategies aimed at improving diet, increasing exercise and reducing weight can lead to regeneration or regrowth of nerve fibers.
Therefore, strategies that promote nerve fiber growth may lead to successful reversal of nerve damage and recovery from neuropathy.
These findings can offer hope for millions of people dealing with peripheral neuropathy (PN) in the United States…
- About 30 million people in the United States suffer from PN, according to the Foundation for the Peripheral Neuropathy.
- According to the American Diabetes Society, 34.2 million Americans have diabetes in 2018. Up to 70% of diabetics have PN.
- Diabetic peripheral neuropathy (DPN) is a common cause of non-traumatic limb amputations. About 200,000 diabetes-related amputations occur every year in the US, according to the American Journal of Managed Care (2018).
These findings can also offer hope for millions of people with prediabetes and metabolic syndrome since they have increased risk of peripheral neuropathy…
About 47 million people in the United States have metabolic syndrome, according to the Third National Heath and Examination Survey (NHANES III) criteria.
According to the 2020 report from the Centers for Disease Control and Prevention (CDC), 88 million Americans age 18 and older have prediabetes. It’s really common, but more than 80% of people don’t know they have it. You won’t know if you have prediabetes unless you are tested.
By improving diet, increasing exercise and reducing weight, people can prevent, control or even reverse metabolic syndrome and prediabetes. In turn, living a healthy lifestyle can prevent development of significant health risks associated with peripheral neuropathy as well as diabetes.