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Health

Tackling extremes of pain

One in ten Britons, mostly over-50s, suffer from peripheral neuropathy, a form of nerve damage affecting the extremities of the body. David Hughesreports

Peripheral neuropathy is one of those conditions that can creep up on you, with very mild symptoms disregarded for years, or it can suddenly spring on you in a few weeks, with very little warning.

Symptoms include numbness or tingling in the hands or feet, burning, stabbing or shooting pain in those affected areas, and muscle weakness, especially in the feet.

This can mean problems with balance and movement. Numbness in the feet make trips and falls – the main cause of accidents for older people – more likely, and because the brain is not receiving the usual signals from nerves in the feet, peripheral neuropathy can have a detrimental effect on cognitive performance as well.

Alzheimer’s, dementia and other neurological disorders become more likely with peripheral neuropathy.

The good news is that peripheral nerves have a great ability to heal. Finding the cause, if possible, is the first step, but there are a wide variety of approaches – from surgery to nutritional supplements – to help reduce pain and resolve the problem.

The most common underlying cause of peripheral neuropathy is diabetes, where high levels of blood sugar may damage the nerves over time. In such cases, treating the underlying cause can reduce or even reverse the symptoms of peripheral neuropathy. Other health conditions can also give rise to neuropathy (see box). In about 30 per cent of all cases, however, the underlying cause is unknown.

Early diagnosis is recommended, as the sooner peripheral neuropathy is identified, the better the chances of limiting or reversing the damage and any further complications.

Testing for peripheral neuropathy

First port of call is your GP, who will examine the affected area and ask about symptoms. Tests can include considering family health history, and examining strength and reflexes. Your GP can also arrange blood tests to check for potential causes such as diabetes or vitamin B12 deficiency.

It’s also possible that you might be taking medications which are known to increase the risk of peripheral neuropathy – even statins have been implicated here – and, if so, your GP may wish to discontinue them for a time to see if symptoms improve.

If such tests don’t identify a cause, you can be referred to a neurologist, who will be able to look in more detail through things like measuring the speed and strength of nerve signals through a nerve conduction test, where small metal electrodes are placed on the skin and the current between them measured (it’s a painless procedure).

Other tools include X-rays, CT scans and MRI scans. Among other things, these will help to determine if nerve pain is being caused by a trapped nerve along the spine, for example, which can cause numbness in the feet and lower legs. In such cases, either surgery to free up the nerve, or the services of an osteopath or chiropractor, may help resolve the problem.

Main types of peripheral neuropathy

Sensory neuropathy- damage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain. Symptoms include prickling and tingling sensations in the affected body part, numbness, a burning or sharp pain, and feeling pain from something that should not be painful at all, such as a light touch.

Motor neuropathy- damage to the nerves that control movement. Symptoms included muscle cramps, muscle weakness, wasting of muscles and foot drop – difficulty lifting up the front part of your foot or toes.

Automatic neuropathy– damage to the nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure. Symptoms include constipation or diarrhoea, nausea, low blood pressure, rapid heartbeat and excessive sweating.

Mononeuropathy- damage to a single nerve outside the central nervous system. Depending on which nerve is affected, symptoms can include double vision, weakness on one side of the face, and foot or shin pain. The most common type of mononeuropathy is Carpal Tunnel Syndrome, where the nerve passing through the wrist becomes compressed.

Treatment

Apart from physical manipulations to free trapped nerves, treatment for peripheral neuropathy will seek to address whatever might be causing it – an example being vitamin B12 and other supplements to restore a deficiency which has caused the problem. One thing to note about natural approaches such as vitamin supplements is that they tend to take between three and 12 months to show significant effects, so be patient. If the neuropathy is an outcome of diabetes, lifestyle changes (for type 2 diabetes) such as stopping smoking, exercising, maintaining a healthy weight, and cutting down on alcohol will help. Some types of neuropathy can be treated with anti-inflammatory medications, or immunosuppressants, which reduce the activity of the immune system.

As a major symptom of most types of peripheral neuropathy is pain, most approaches – particularly for the 30 per cent of cases where there is no known cause – will focus on reducing or eliminating that pain.

Neuropathic pain doesn’t respond particularly well to standard over-thecounter painkillers such as ibuprofen, so more powerful drugs like Tramadol are often deployed. They usually do reduce the pain, but also carry the risk of side-effects or addiction with long-term use, so peripheral neuropathy is definitely one of those areas where a look at natural health options to assist treatment might be a good idea

There’s no hard and fast evidence for natural methods ‘curing’ peripheral neuropathy, but acupuncture, for example, which stimulates circulation in the body, is often regarded as a useful route to reduce nerve pain.

Vitamin B12 and B1 supplements can be helpful – although be careful not to take high doses – and the antioxidant alpha-lipoic acid, available from most health food shops, has a good reputation, particularly for improving circulation to the feet.

Some essential oils, particularly Roman Lavender and Chamomile, have a long tradition of being used to soothe nerve pain, reduce inflammation and improve circulation. Again, give these approaches time to work and it’s worth checking with your GP before using complementary medicine, just in case it might clash with any medications already prescribed.

Health conditions that can be a cause

While diabetes is the most common cause of peripheral neuropathy, other health conditions that can cause it include:

Excessive alcohol drinking for years

Low levels of vitamin B12 or other vitamins

Physical damage to the nerves – such as from an injury or during surgery

An underactive thyroid gland (hypothyroidism)

Certain infections – such as shingles, Lyme disease, diphtheria, botulism and HIV

Inflammation of the blood vessels (vasculitis)

Chronic liver or kidney disease

Monoclonal gammopathy of undetermined significance (MGUS) – the presence of an abnormal protein in the blood

Certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer)

Charcot-Marie-Tooth (CMT) disease and other types of hereditary motor sensory neuropathy – genetic conditions that cause nerve damage, particularly in the feet

Having high levels of toxins in your body, such as arsenic, lead or mercury

Guillain-Barré syndrome – a rare condition that causes rapid onset of paralysis within days

Amyloidosis – a group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body

Conditions caused by overactivity of the immune system – such as rheumatoid arthritis, lupus or Sjogren’s syndrome.

Find out more

Download a useful Peripheral Neuropathy Fact Sheet from the US National Institute of Neurological Disorders: (www.ninds.nih.gov/Disorders/PatientCaregiver-Education/Fact-Sheets/PeripheralNeuropathy-Fact-Sheet)

For NHS information on peripheral neuropathy, see: (www.nhs.uk/conditions/peripheralneuropathy)

US Foundation for Peripheral Neuropathy, website: (www.foundationforpn.org).

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