PERIPHERAL NEUROPATHY

The term "Neuropathy" is derived from the root words "neuro-" (which means "nerve") and "-pathy" (which is short for "pathology", meaning abnormality or disease).

In fact, neuropathies are really abnormalities involving the nerves furthest from the spinal cord--which means they affect primarily the nerves in the feet and hands.

Patients often describe the symptoms associated with their neuropathy as numbness, hypersensitivity (an increase in sensitivity relative to a stimulus), allodyinia (inappropriate sensations relative to a stimulus), burning, tingling, crawling, or numbness (the lack of normal sensation), altered muscle function and coordination (when the neuropathy affects the muscular nerves), altered perspiration and circulation (when the neuropathy affects the nerves that control these functions.)

In some cases where numbness occurs (perhaps the most common symptom of neuropathy, the condition may be so profound that surgeries can be performed on the patient with no anesthesia required.

Peripheral neuropathies can be caused by a wide variety of conditions, including:

Today, though, diabetes and alcoholism are by far the most common causes of peripheral neuropathy.

Treatment for neuropathies varies with the types of symptoms a patient exhibits, the severity of those symptoms, and the cause of the neuropathy. But generally speaking, most attempts at treatment begin with topical agents, such as capsaicin, the active ingredient that gives spicy foods their burn. It's been shown that this treatment offers great help to many patients with neuropathy. Other topical medications that may be of use are the so-called "sports" creams, which simply act as mild skin irritants, to fool the brain into perceiving the irritation to the skin, and not perceive the neuropathy.

When topical medications fail, several very different types of oral medications have been shown to be helpful, beginning with B-complex vitamin supplements.

First in line in the prescription medication family are usually the anti-depressants known as tri-cyclic antidepressants. Examples include amitryptyline, imipramine, desipramine, and trazadone. Anticonvulsant medications (such as carbamazepine and phenytoin), and aldose reductase inhibitors (such as sorbinil, tolrestat, and epalrestat) are also helpful, the latter particularly so with diabetic neuropathies. Anaesthetics such as mexiletine (given orally), and lidocaine (usually given IV) and the adrenergic agonist clonidine (administered by a transdermal patch) offer other approaches.

In some severe, difficult-to-treat cases, surgical techniques may be of value.