We think of the nervous system as being divided into two branches: Central - the brain and spinal cord - and peripheral - all the other nerves. Information about the body is transmitted by the peripheral nerves to the spinal cord and brain, where it is processed into a very complex understanding of our environment, how our body is doing and where our body is in space.
Damage to the peripheral nerves causes faulty information to be sent to the brain, and the brain interprets this in various ways. Instead of the normal sensations that simply give us the information we need, we may feel some combination of burning, cold, tingling, electric shocks or numbness. These feelings may be increased with touch, cold or heat.
The most common forms of peripheral neuropathy involve damage to nerves most distant from the brain - that is, those in the hands and feet. Symptoms usually appear gradually and symmetrically - in a stocking-glove pattern.
Effects of peripheral neuropathy
Despite the discomfort and disruption of life it causes, the pain itself is not dangerous. It’s a sort of neurological noise created by damaged nerves - and there are many ways to calm this noise.
As is the case with any chronic pain, peripheral neuropathy can affect all aspects of a person’s life - including activity level, sleep, mood and relationships with others. If the pain cannot be completely controlled, these problems must also be addressed.
Treating peripheral neuropathy
It’s best to seek care as soon as symptoms develop. This offers the best chance for controlling symptoms and preventing further damage to nerves.
The first task of a health care provider is to rule out treatable causes.
This could include labs to check for diabetes, thyroid function, B12 and folate deficiencies and toxic exposures (including alcohol). Pressure on nerves and circulation problems must be ruled out, as well.
If no treatable cause is found, or if treatment is not completely successful, it’s best to try a variety of approaches. Unfortunately, there are no “magic bullets.” However, if each of several treatments provides some relief, people with peripheral neuropathy will be comfortable enough to go on about their lives.
Physical therapy can be very useful in retraining the nervous system to become used to these abnormal sensations and to not constantly sound the alarm. It’s also extremely useful to maintain general fitness, so an individual does not end up with other problems that could increase pain.
Meditation is a skill that can be learned by anyone who makes the commitment. It’s very helpful in learning to see neuropathic pain for what it is - disruptive noise that can be tuned out.
The medications that are most effective fall into four main classes: anti-seizure medications, tricyclic antidepressants, SNRI antidepressants and medications that are used on the skin (topicals). Pain specialists may add other medications to the mix. In fact, to maximize benefits, and to keep side effects from any one medication at a minimum, several different medications are often used.
Anti-seizure medications work by calming the nerve cells that are transmitting the pain or other bothersome sensations.
Tricyclic and SNRI antidepressants increase neurotransmitters that help our nervous systems to appropriately block sensations that are not causing us harm. Topical medications, such as lidocaine and capsaicin, can be very helpful if the affected area is not too large.
In cases that do not respond to medical treatment, pain specialists may consider the use of nerve blocks or a spinal cord stimulator.
Preventing peripheral neuropathy
The best way to prevent peripheral neuropathy is to carefully manage any medical condition that puts one at risk. This means controlling blood sugar, seeking treatment for problems with alcohol, eating a balanced diet that is rich in fruits and vegetables, getting plenty of exercise and avoiding toxins.
Gail Trenfield-Joyner is a nurse practitioner at St. Patrick Hospital and Health Sciences Center.
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