Peripheral Neuropathy

What is Peripheral Neuropathy?

Welcome to Oregon Medical Centers. We are an integrated medical clinic that helps people with all sorts of medical condition including Peripheral Neuropathy. You may ask What is Peripheral Neuropathy?

Peripheral neuropathy refers to many different types of conditions that involve damage to the peripheral nervous system as well as peripheral nerves. The peripheral nervous system is a vast communication network that sends signals between the central nervous system (the brain and spinal cord) and to all other parts of the body. The peripheral nerves are the nerves that are outside of the brain and spinal cord. Interestingly the Peripheral nerves send many types of sensory information to the central nervous system (CNS), such as a message that the feet are cold. They also carry signals from the CNS (Central Nervous System) to the rest of the body. This is how the body communicates. These nerves also send signals to the muscles that tell them to contract, which is how we move, but there are different types of signals that help control everything from our heart and blood vessels, digestion, urination, sexual function, to our bones and immune system. The peripheral nerves are like the cables that connect the different parts of a computer or connect the Internet. When they malfunction, complex functions can grind to a halt. Not only that, but it can also lead to pain, numbness, tingling, loss of function, ability to move and loss of balance.

Peripheral Nerves that send signals in neuropathy is usually disrupted in three different ways:

  • loss of signals normally sent (like a broken wire)
  • inappropriate signaling when there shouldn’t be any (like static on a telephone line)
  • errors that distort the messages being sent (like a wavy television picture)

When these errors happen symptoms can range from mild to disabling and can lead to loss of function and doing normal day to day to day things. These symptoms can be mild to severe. Peripheral neuropathy is a degenerative condition and will continue to worsen over a period of time. The symptoms depend on the type of nerve fibers affected and the type and severity of damage. Symptoms may develop over days, weeks, or years and can continue to degenerate over time. Peripheral Neuropathy can be disabling and debilitating as the nerves continue to degenerate. Many times, people have to use a walker or a wheel chair as the nerves continue to degenerate over time.

Some forms of neuropathy involve damage to only one nerve (called mononeuropathy). Neuropathy affecting two or more nerves in different areas is called multiple mononeuropathy or mononeuropathy multiplex. More often, many or most of the nerves are affected (called polyneuropathy).

Sadly, more than 20 million people in the United States have been estimated to have some form of peripheral neuropathy, but this figure may be significantly higher because not all people with symptoms of neuropathy are tested for the disease and tests currently don’t look for all forms of neuropathy. Neuropathy is often misdiagnosed due to its complex array of symptoms.

How are the peripheral neuropathies classified?

More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis. Symptoms vary depending on the type of nerves—motor, sensory, or autonomic—that are damaged. Below, we will outline the difference between motor nerves, sensory nerves as well as autonomic nerves.

  • Motor nerves control the movement of all muscles under conscious control, such as those used for walking, grasping things, talking and general movement.
  • Sensory nerves transmit information such as the feeling of a light touch, temperature (heat, cold), pain, sharp, dull and other sensations such as feeling.
  • Autonomic nerves control organs to regulate activities that people do not control consciously, such as breathing, digesting food, and heart and gland functions.

Most neuropathies affect all three types of nerve fibers to varying degrees; others primarily affect one or two types. Doctors use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe different conditions.

About three-fourths of polyneuropathies are “length-dependent,” meaning the farthest nerve endings in the feet are where symptoms develop first or are worse. In severe cases, such neuropathies can spread upwards toward the central parts of the body. In non-length dependent polyneuropathies, the symptoms can start more toward the torso, or are patchy.

What are the symptoms of peripheral nerve damage?

Symptoms are related to the type of nerves affected! Motor nerve damage is usually associated with muscle weakness. In that it’s hard to walk or people have weakness of their feet and hands. Other symptoms include painful cramps, fasciculations (uncontrolled muscle twitching visible under the skin) and muscle shrinking (Atrophy). This is when people are forced to use a walker or a wheelchair due to the debilitating nature of peripheral neuropathy.

Sensory nerve damage causes various symptoms because sensory nerves have a broad range of functions.

  • Sadly, damage to large sensory fibers harms the ability to feel vibrations and touch, especially in the hands and feet. You may feel as if you are wearing gloves and stockings even when you are not. This damage may contribute to the loss of reflexes (as can motor nerve damage). Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons or maintaining their balance when their eyes are shut. People often can lose their balance and can fall down and this can complicate patient’s overall health and function with respect to activities of daily living.
  • The “small fibers” without myelin sheaths (protective coating, like insulation that normally surrounds a wire) include fiber extensions called axons that transmit pain and temperature sensations. Small-fiber polyneuropathy can interfere with the ability to feel pain or changes in temperature. People may burn themselves in scalding hot water and may not even realize it because they can’t feel the heat. This can lead to damage and infection as the ability to heal is slowed down because of the peripheral neuropathy.

Sadly, It is often challenging for medical providers to control, which can seriously affect a patient’s emotional well-being and overall quality of life. Neuropathic pain is sometimes worse at night, disrupting sleep. It can be caused by pain receptors firing spontaneously without any known trigger, or by difficulties with signal processing in the spinal cord that may cause you to feel severe pain (allodynia) from a light touch that is normally painless. For example, you might experience pain from the touch of your bedsheets, even when draped lightly over the body. This type of pain can be debilitating and can prevent you from living your best life. This type of pain can wake you up at night and then you have a hard time going back to sleep due to the intense pain.

Autonomic nerve damage affects the axons in small-fiber neuropathies. Common symptoms include excess sweating, heat intolerance, inability to expand and contract the small blood vessels that regulate blood pressure, and gastrointestinal symptoms. Although rare, some people develop problems eating or swallowing if the nerves that control the esophagus are affected.

There are several types of peripheral neuropathies, the most common of which is linked to diabetes. Another serious polyneuropathy is Guillain-Barre syndrome, which occurs when the body’s immune system mistakenly attacks the nerves in the body. Common types of focal (located to just one part of the body) mononeuropathy include carpal tunnel syndrome, which affects the hand and the wrist, and meralgia paresthetica, which causes numbness and tingling on one thigh. Complex regional pain syndrome is a class of lingering neuropathies where small fibers are mostly damaged.

These various types of peripheral neuropathy can be disabling and debilitating and prevent you from living your best life. After all, why are we here on this planet? We are here to live a great & beautiful life full of health and abundance and not be in pain and suffering from peripheral neuropathy. If you are suffering from peripheral neuropathy, give us a call at Oregon Medical Centers. We offer no charge consultations to see if our treatments can help you. We have two clinics, one in Salem, Oregon and the other in Aloha/Beaverton, Oregon. Stop suffering and see if our cutting-edge treatments can help you.

What are the causes of peripheral neuropathy?

Most instances of neuropathy are either acquired, meaning the neuropathy or the inevitability of getting it isn’t present from the beginning of life, or genetic. Acquired neuropathies are either symptomatic (the result of another disorder or condition; see below) or idiopathic (meaning it has no known cause).

Causes of symptomatic acquired peripheral neuropathy include:

  • The most common cause of peripheral neuropathy can be due to Physical injury (trauma) of acquired single-nerve injury. Injury from automobile accidents, falls, sports, and medical procedures can stretch, crush, or compress nerves, or detach them from the spinal cord. Less severe traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves and slipped discs between vertebrae can compress nerve fibers where they emerge from the spinal cord. Arthritis, prolonged pressure on a nerve (such as by a cast) or repetitive, forceful activities can cause ligaments or tendons to swell, which narrows slender nerve pathways. Ulnar neuropathy and carpal tunnel syndrome are common types of peripheral neuropathy from trapped or compressed nerves at the elbow or wrist. In some cases, there are underlying medical causes (such as diabetes) that prevent the nerves from tolerating the stresses of everyday living.
  • The leading cause of peripheral Neuropathy and polyneuropathy in the United States is Diabetes. Have you ever heard of Diabetic Neuropathy? This is neuropathy due to Diabetes. Sadly about 60 - 70 percent of people with diabetes have mild to severe forms of damage to sensory, motor, and autonomic nerves that cause such symptoms as numb, tingling, or burning feet, one-sided bands or pain, and numbness and weakness on the trunk or pelvis. These type of people have difficulties with walking and doing normal activities and can fall down due to loss of balance due to this type of peripheral neuropathy. This can be heart-wrenching to not only the person having the diabetic neuropathy, but also their family and friends.
  • Diabetes, smoking, and narrowing of the arteries from high blood pressure or atherosclerosis (fatty deposits on the inside of blood vessel walls) can lead to peripheral neuropathy. Vascular and blood problems that decrease oxygen supply to the peripheral nerves can lead to nerve tissue damage. Blood vessel wall thickening and scarring from vasculitis can impede blood flow and cause patchy nerve damage in which isolated nerves in different areas are damaged—called mononeuropathy multiplex or multifocal mononeuropathy.
  • Sjögren’s syndrome, lupus, and rheumatoid arthritis are some systemic autoimmune diseases that cause neuropathic pain. These are Systemic (body-wide) autoimmune diseases, in which the immune system mistakenly attacks a number of the body's own tissues, and can directly target nerves or cause problems when surrounding tissues compress or entrap nerves.
  • Damage to the motor fibers that go to the muscle includes visible weakness and muscle shrinking seen in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Autoimmune diseases that attack nerves only are often triggered by recent infections. They can develop quickly or slowly, while others become chronic and fluctuate in severity. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively. In other autoimmune neuropathies the small fibers are attacked, leaving people with unexplained chronic pain and autonomic symptoms. People with these types of neuropathies have significant pain and have difficulty functioning and doing activities of daily living without pain. Although you can take pain pills to cover the symptoms, sadly these pills don’t correct the problem.
  • Hormonal imbalances can disturb normal metabolic processes, leading to swollen tissues that can press on peripheral nerves, is another cause of neuropathy.
  • Kidney and liver disorders can lead to abnormally high amounts of toxic substances in the blood that can damage nerve tissue. Most individuals on dialysis because of kidney failure develop varying levels of polyneuropathy.
  • Nutritional or vitamin imbalances, alcoholism, and exposure to toxins can damage nerves and cause neuropathy. Vitamin B12 deficiency and excess vitamin B6 are the best known vitamin-related causes. Several medications have been shown to occasionally cause neuropathy.
  • Certain cancers and benign tumors cause neuropathy in various ways. Tumors sometimes infiltrate or press on nerve fibers. Paraneoplastic syndromes, a group of rare degenerative disorders that are triggered by a person's immune system response to a cancer, can indirectly cause widespread nerve damage.
  • Chemotherapy drugs used to treat cancer cause polyneuropathy in an estimated 30 to 40 percent of users. Only certain chemotherapy drugs cause neuropathy and not all people get it. Chemotherapy-induced peripheral neuropathy may continue long after stopping chemotherapy. Radiation therapy also can cause nerve damage, sometimes starting months or years later.
  • Infections can attack nerve tissues and cause neuropathy. Viruses such as varicella-zoster virus (which causes chicken pox and shingles), West Nile virus, cytomegalovirus, and herpes simplex target sensory fibers, causing attacks of sharp, lightning-like pain. Lyme disease, carried by tick bites, can cause a range of neuropathic symptoms, often within a few weeks of being infected. The human immunodeficiency virus (HIV), which causes AIDS, can extensively damage the central and peripheral nervous systems. An estimated 30 percent of people who are HIV-positive develop peripheral neuropathy; 20 percent develop distal (away from the center of the body) neuropathic pain.

Genetically-caused polyneuropathies are rare. Genetic mutations can either be inherited or arise de novo, meaning they are completely new mutations to an individual and are not present in either parent. Some genetic mutations lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood. Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy, is one of the most common inherited neurological disorders.

The small-fiber neuropathies that present with pain, itch, and autonomic symptoms also can be genetic. As our understanding of genetic disorders increases, many new genes are being associated with peripheral neuropathy.

How is peripheral neuropathy diagnosed?

This bewildering array and variability of symptoms that neuropathies can cause often makes diagnosis difficult. A diagnosis of neuropathy typically includes:

  • Medical history. Our Medical Providers at Oregon Medical Centers will ask questions about symptoms and any triggers or relieving factors throughout the day, work environment, social habits, exposure to toxins, alcohol use, risk of infectious diseases, and family history of neurological diseases.
  • Physical and neurological exams. Our Medical Providers at Oregon Medical Centers will look for any evidence of body-wide diseases that can cause nerve damage, such as diabetes. A neurological exam includes specific tests that may identify the cause of the neuropathic disorder as well as the extent and type of nerve damage.
  • Body fluid tests. Various blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, infections and signs of abnormal immune system activity. Less often other body fluids are tested for abnormal proteins or the abnormal presence of immune cells or proteins associated with some immune-mediated neuropathies. Additional tests may be ordered to help determine the nature and extent of the neuropathy.

Physiologic tests of nerve function

  • Nerve conduction velocity (NCV) tests measure signal strength and speed along specific large motor and sensory nerves. They can reveal nerves and nerve types affected and whether symptoms are caused by degeneration of the myelin sheath or the axon. During this test, a probe electrically stimulates a nerve fiber, which responds by generating its own electrical impulse. An electrode placed further along the nerves pathway measures the speed of signal transmission along the axon. Slow transmission rates tend to indicate damage to the myelin sheath, while a reduction in the strength of impulses at normal speeds is a sign of axonal degeneration. Inability to elicit signals can indicate severe problems with either.
  • Electromyography (EMG) involves inserting very fine needles into specific muscles to record their electrical activity at rest and during contraction. EMG tests irritability and responsiveness, detects abnormal muscular electrical activity in motor neuropathy, and can help differentiate between muscle and nerve disorders.

Radiology imaging tests

  • Magnetic resonance imaging (MRI) of the spine can reveal nerve root compression (“pinched nerve”), tumors, or other internal problems. MRI of the nerve (neurography) can show nerve compression.
  • Computed tomography (CT) scans of the back can show herniated disks, spinal stenosis (narrowing of the spinal canal), tumors, bone and vascular irregularities that may affect nerves.

Muscle and nerve ultrasound is a noninvasive technique for imaging nerves and muscles for injury such as a severed nerve or a compressed nerve. Ultrasound imaging of the muscles can detect abnormalities that may be related to a muscle or nerve disorder. Certain inherited muscle disorders have characteristic patterns on muscle ultrasound.

What treatments are available?

Treatments depend entirely on the type of nerve damage, symptoms, and location. The Medical Providers at Oregon Medical Centers in Salem and Aloha/Beaverton, Oregon will explain how nerve damage is causing specific symptoms and how to minimize and manage them. With proper education, some people may be able to reduce their medication dose or manage their neuropathy without medications. Definitive treatment can permit functional recovery over time, as long as the nerve cell itself has not died. As long as the nerve is not completely dead, Regenerative Medicine can help regenerate, restore and rejuvenate the peripheral nerves.

Addressing neuropathy's causes. Correcting underlying causes can result in the neuropathy resolving or regenerating. At Oregon Medical Centers we believe in correcting the cause of the condition versus giving drugs. If a condition such as peripheral neuropathy can be treated effectively without drugs or surgery, that is the route that will be chosen. Many people are sick and tired of taking drugs that don’t work with side effects. Many people are more interested in not having to take the drug and they want the help to fix the cause of the peripheral neuropathy versus masking this condition with drugs. As noted earlier, Peripheral neuropathy is a degenerative condition. Oregon Medical Centers has had excellent results in helping people that have Peripheral Neuropathy without drugs or surgery. Oregon Medical Centers uses special Regenerative Medicine Procedures to help regenerate, repair and restore the peripheral nerves that are damaged. Additional patient education and Nerve health and resistance can be improved by healthy lifestyle habits such as maintaining optimal weight, avoiding toxic exposures, eating a balanced non-inflammatory diet, and correcting vitamin deficiencies. Smoking cessation is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms. Exercise can deliver more blood, oxygen, and nutrients to far-off nerve endings, improve muscle strength, and limit muscle atrophy. Self-care skills in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and often create conditions that encourage nerve regeneration with Regenerative Medicine.

Inflammatory and autoimmune conditions leading to neuropathy can be controlled by leading more natural and non-invasive methods such as Regenerative Medicine, and a change in a more healthy life-style. Oregon Medical Centers offer cutting edge and new technologies in helping our patient that have Peripheral Neuropathy back to living a great life full of health and abundance.

If you are suffering from Peripheral Neuropathy, give our clinic a call. We have two clinics, one in Salem, Oregon and the other in Aloha/Beaverton, Oregon. Call us for a no charge consultation to see if our cutting-edge treatment is right for you. Call: 503-390-1552 in Salem Oregon and 503-642-2845 in Aloha. Let us help you live a great and beautiful life full of health and abundance.