NEUROPATHY

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Neuropathies may affect just one nerve (mononeuropathy) or several nerves

(polyneuropathy). Depending on the nerves involved, symptoms can range from

a mild tingling or numbness in your fingers or toes to searing hand or foot

pain. You may lose some of the feeling in your feet or hands. You might also

experience weakness or even paralysis of certain muscles, or problems with

your bowels or bladder.

These symptoms result from damage to the nerves that provide communication

between your brain and your muscles, skin, internal organs and blood

vessels. Peripheral neuropathy often affects people with diabetes and

autoimmune diseases such as rheumatoid arthritis and lupus Certain vitamin

deficiencies, some medications and alcoholism can also damage peripheral

nerves.

Treating the underlying condition can relieve some cases of peripheral

neuropathy. In other cases, treatment may focus on managing pain. But

peripheral nerves have a remarkable ability to regenerate themselves, and

new treatments using nerve growth factors or gene therapy may offer even

better chances for recovery in the future. Neurologic symptoms may occur in

the central nervous system, which consists of your brain and spinal cord, or

the peripheral nervous system, which links your spinal cord to all other

parts of your body. The extensive network of peripheral nerves helps your

muscles contract (motor nerves) and allows you to feel a range of sensations

(sensory nerves). In addition, the peripheral nerves help control some of

the involuntary functions of the autonomic nervous system, which regulates

your internal organs, sweat glands and blood pressure.

Unfortunately, peripheral nerves are fragile and easily damaged. Damage to a

peripheral nerve can interfere with the communication between the area it

serves and your brain, affecting your ability to move certain muscles or

feel normal sensations. Your symptoms will depend on what is causing your

neuropathy and on which nerve or nerves are involved.

If a sensory nerve is damaged, you'll likely experience pain, numbness,

tingling, burning or a loss of feeling. Often these symptoms begin

gradually. You may have a tingling sensation or numbness that starts in your

toes or the balls of your feet and spreads upward. Tingling also might begin

in your hands and extend up your arms. In some cases your skin may become so

sensitive that the slightest touch is agonizing. In others, you may have

numbness, or even a complete lack of feeling, in your hands or feet.

At times your symptoms may be barely noticeable. At other times, especially

at night, they may be almost unbearable. For some people symptoms are

constant.

These may include: The sensation that you're wearing an invisible glove or

sock Burning or freezing pain Sharp, jabbing or electric pain Extreme

sensitivity to touch, even light touch

If the nerves that control muscle contraction (motor nerves) are affected,

you may have weakness or paralysis of the muscles controlled by those

nerves. And if you have damage to nerves that control certain functions of

the autonomic nervous system, you may have bowel or bladder problems,

reduced sweating or You might also experience a sharp fall in your blood

pressure when you stand up, which may cause you to faint or feel

lightheaded.

A number of factors can cause neuropathies. When a single nerve is affected,

the most likely cause is trauma or some type of repetitive use that puts

pressure on the nerve. Nerve pressure can result from using a cast or

crutches, spending a long time in an unnatural position (such as typing at a

computer keyboard), or having a tumor or abnormal bone growth.

When several nerves are damaged, the cause is frequently diabetes. Other

common causes include alcoholism, inherited disorders and a deficiency of

certain vitamins, especially B vitamins.

Autoimmune diseases, including lupus and rheumatoid arthritis, kidney

disease, liver disease and an underactive thyroid can also damage peripheral

nerves. So can exposure to poisons, some toxic substances and certain

medications - especially those used to treat cancer. You may even inherit a

tendency to develop peripheral neuropathy.

Sometimes bacterial or viral infections may cause neuropathy. An acute

condition called Guillain-Barre syndrome frequently causes severe damage to

all or part of your peripheral nerves by destroying the myelin sheath that

covers nerve fibers. The myelin sheath acts as an insulator for your nerves

and helps conduct nerve impulses. Although the exact cause of Guillain-Barre

syndrome isn't known, approximately two-thirds of cases occur after a viral

infection.

Unfortunately, it's not always easy to pinpoint the cause of peripheral

neuropathy. In fact, if your neuropathy isn't associated with diabetes, it's

very possible the cause may never be found.

You're more likely to develop peripheral neuropathy if you have an

autoimmune disease such as lupus or rheumatoid arthritis, or if your immune

system is compromised by human immunodeficiency virus (HIV) or AIDS. Other

medical conditions, including kidney and liver disease, can also put you at

risk for nerve damage.

See your doctor regularly if you have diabetes, a compromised immune system

or any other chronic medical condition.

If you have a cut or sore on your foot that doesn't seem to be healing after

about 10 days, is infected or getting worse, see your doctor promptly,

especially if you have diabetes. Even minor sores that don't heal can turn

into ulcers. In the most severe cases, untreated foot ulcers may become

gangrenous (the tissue dies) and require surgery or even amputation of your

foot.

Seek medical care right away if you notice any unusual tingling, weakness or

pain in your hands or feet. Early diagnosis and treatment offer the best

chance for controlling your symptoms and preventing further damage to your

peripheral nerves. If your symptoms are interfering with your sleep or you

feel depressed, your doctor may be able to suggest treatments that can help.

The following suggestions can help you manage peripheral neuropathy:

Take care of your feet, especially if you have diabetes. Tight shoes and

socks can worsen pain and tingling, and may lead to sores that won't heal.

Wear soft, loose cotton socks and padded shoes. You can use a semicircular

hoop (available in medical supply stores) to keep bed covers off hot or

sensitive feet.

Soak your feet or hands in cold water. If you have burning pain, cool your

feet or hands in cold, but not icy, water for 15 minutes twice a day. This

is particularly useful at night. After soaking, rub on petroleum jelly to

soften your skin.

Exercise. Ask your doctor about an exercise routine that's right for you.

Regular exercise may reduce neuropathy pain and can help control blood sugar

levels.

Reduce your consumption of alcohol or avoid alcohol completely. Even if your

neuropathy isn't caused by alcohol use, as few as four drinks a week can

make any neuropathy worse.

Limit caffeine. Try to avoid foods or drinks high in caffeine, including

coffee, chocolate and sodas. Caffeine can make pain worse.

Eat healthy meals. If you're at high risk for neuropathy or have a chronic

medical condition, healthy eating is especially important. Emphasize low-fat

meats and dairy products and include lots of fruits, vegetables and whole

grains in your diet.

Quit smoking. If you smoke, talk to your doctor about ways to quit. Smoking

can make your symptoms worse.

Massage your hands and feet (or have someone massage them for you). Massage

helps improve circulation, stimulates nerves and may temporarily relieve

pain.

Living with chronic pain or disability presents daily challenges. Some of

these suggestions may make it easier for you to cope:

Set priorities. Decide which tasks you need to do on a given day, such as

paying bills or shopping for groceries, and which can wait until another

time. Stay active, but don't overdo.

Get out of the house. When you have severe pain, it's natural to want to be

alone. But this only makes it easier to focus on your pain. Instead, visit a

friend, go to a movie or take a walk.

Seek and accept support. It isn't a sign of weakness to ask for or accept

help when you need it. In addition to support from family and friends,

consider joining a chronic pain support group. Although support groups

aren't for everyone, they can be good places to hear about coping techniques

or treatments that have worked for others. You'll also meet people who

understand what you're going through. To find a support group in your

community, check with your doctor, a nurse, or the county health department.

Prepare for challenging situations. If something especially stressful is

coming up in your life, such as a move or a new job, knowing what you have

to do ahead of time can help you cope.

Talk to a counselor or therapist. Insomnia, depression and impotence are

possible complications of peripheral neuropathy. If you experience any of

these, you may find it helpful to talk to a counselor or therapist in

addition to your primary care doctor. There are treatments that can help.