Neuropathy (Peripheral Neuropathy, Peripheral Neuritis)

Inflammation involving nerves that serve parts of the body outside the brain and spinal cord are referred to as peripheral neuropathy or neuritis. Because the inflammation interferes with the transmission of messages along these nerves, symptoms, in addition to pain, may include numbness, weakness, and tingling sensations.

Mild peripheral neuropathy may arise from poor posture, repetitive motions, or activities that require maintaining a cramped position for long periods, such as squatting while gardening. Nerve damage from an accident or surgery, an infection, alcoholism, and lead poisoning and exposure to other toxic agents can cause persistent or severe neuropathy. Another cause, especially in the lower legs, feet, and hands, is diabetes.

Other disorders commonly associated with neuropathy include hardening of the arteries (arteriosclerosis), AIDS, multiple myeloma and certain other types of cancers, and disorders such as rheumatoid arthritis, scleroderma, Lyme disease, and lupus. Shingles can cause neuropathy that lasts for a year or more after die rash clears up.

Certain medications can cause neuropathy, especially isoniazid (Nydrazid), used to treat tuberculosis; phenytoin (Dilantin), an anticonvulsant; and some anticancer agents. Other causes include nutritional deficiencies, such as those that develop in alcoholics; or chronic overdoses of B vitamins, especially vitamin B6.

Diagnostic Tests and Procedures

The diagnostic challenge is to track down the underlying cause. This starts with a complete physical examination that includes blood and urine tests, and possibly X-rays to detect bone changes impinging on nerves. A neurologic workup may be done to check reflexes and look for any muscle weakness or atrophy and unpaired sensory function. Nerve tests may include electromyography and nerve conduction studies, which can pinpoint the nerves causing the symptoms.

Medical Treatments

Neuropathy resulting from an accident or nerve damage during surgery will improve or disappear as healing takes place. Similarly, nerve pain caused by an infection or toxic agent usually goes away after recovery.

Studies have shown that diabetic neuropathy can be prevented or even reversed by maintaining normal levels of blood glucose. Circulation to areas affected by arteriosclerosis or other obstructions also may improve with treatment of the underlying cause.

Taking corticosteroids or other drugs that suppress inflammation and the immune system sometimes prompts healing of nerve damage due to rheumatic disorders such as rheumatoid arthritis, lupus, and scleroderma.

High doses of intravenous antibiotics may help to ease symptoms of chronic Lyme disease, but will not always halt neuropathy. Even so, nerve pain that is linked to the disease usually lessens with time. Halting high doses of vitamin B, can prevent further nerve deterioration caused by the excess, but it may not reverse existing damage.

Alternative Therapies

Prompt diagnosis and medical treatment of underlying causes of persistent neuropathy are essential. Meanwhile, the following alternative therapies may help to alleviate symptoms.

Acupuncture. This technique is one of the most effective alternative therapies for alleviating nerve pain, especially the kind that often follows shingles.

Alexander Technique. Neuropathy stemming from poor posture and work habits may be reversed by correcting the faulty body mechanics.

Aromatherapy. Massaging the painful area with oil of peppermint is said to alleviate nerve pain.

Herbal Medicine. A poultice, made with fresh chopped or grated horseradish mixed with water to form a paste, creates a sensation of heat that may counter neuropathy temporarily. Some herbalists also suggest black cohosh, or squaw root, especially if pain is caused by rheumatoid arthritis or other inflammatory conditions. It is available as a tea, tincture, or powder capsules.

Massage. Neuropathy that is caused by muscle contractions or impinged nerves may be alleviated by massage and other manipulative techniques.

Physical and Occupational Therapy. These adjuncts to conventional medicine are especially beneficial in dealing with progressive or permanent nerve damage, because the therapists can teach ways to compensate for lost mobility. They may also recommend splints, braces, and other devices to ease the pain of compressed nerves.

Self-Treatment

If you develop mild symptoms of peripheral neuropathy, such as "pins and needles" tingling or numbness, try to analyze your body mechanics for a possible cause. Take frequent breaks from tasks that place extra or repetitive stress on one part of the body.

Lifestyle changes can also prevent or alleviate conditions that contribute to neuropathy. Avoid self-treatment with megadose vitamins, use alcohol only in moderation, and if you smoke, make every effort to stop.

Other Causes of Nerve Pain

An unusual type of neuropathy called phantom limb pain sometimes occurs following amputation; the person experiences pain, tingling, or other sensations at the site of the missing limb. Multiple sclerosis and other neuromuscular disorders that produce muscle contractures can cause neuropathy, as can a stroke or other brain damage.