By Adam Shuster, DO Pain Management Consultants of SWFL –
Peripheral neuropathy is a common cause of pain across a wide spectrum of patients. Many patients are familiar with diabetic neuropathy. Neuropathic pain is often described as burning, tingling, stabbing, and is often worse at night. Patients may also suffer from numbness of the feet or legs. The symptoms tend to be in a stocking distribution.
Peripheral Neuropathy May Have Multiple Causes
Peripheral neuropathy may be caused by diabetes and other metabolic disorders, toxins, trauma, autoimmune disease, infection, and may be hereditary as well. Metabolic abnormalities include diabetes, but also vitamin deficiencies (thiamine and Vitamin B12). Toxins causing neuropathy include ethanol, arsenic, lead, and industrial solvents. Patients may develop neuropathy with chemotherapy, treatment for tuberculosis, or aniretroviral therapy. Trauma may lead to complex regional pain syndrome, formation of neuromas, and patients can have peripheral nerve damage. Various entrapment syndromes such as ulnar neuropathy or median neuropathy (causes carpal tunnel syndrome) are also common. Infections such as Lyme disease and HIV can lead to peripheral neuropathy.
Diagnosis of Peripheral Neuropathy
Diagnosis of peripheral neuropathy involves a work up by your doctor focusing on a detailed history and exam. A patient’s current medical problems and medications are also important. Labs may be necessary to rule out an infection, metabolic disorder, or neuropathy from toxins. The patient may undergo an autoimmune workup as well. Other important diagnostic tests include EMG and nerve conduction studies. This test is primarily performed by a neurologist, but some physiatrists can perform these tests as well.
Current Treatments Available
Treatment includes antiinflammatories, possibly steroids, treating the underlying medical condition, and sometimes narcotic pain killers. Other very important medications for treatment of neuropathy include antidepressants as well as antiepileptic medications. Nerve blocks may also be implemented. If treatment fails, spinal cord stimulation, or a “morphine pump” may be implemented.
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