Neuropathy means damage to nerves in the peripheral nervous system, and so affects nerves outside of the brain and spinal cord – it does not include nerve damage in the central nervous system.

Three main types of nerve can be involved in peripheral neuropathy:

• Autonomic nerves (not under conscious control, “automatic” or “involuntary” nerves)
• Motor nerves
• Sensory nerves.

Autonomic nerves regulate the automatic functions of the body – for example, heart rate and blood pressure, sweating, and so on. Motor nerves control the muscles of the body and are under our conscious control. And sensory nerves pass sensations from a part of the body to the brain, including information about cold, heat and pain.

Neuropathy may cause painful cramps, fasciculations (fine muscle twitching), muscle loss, bone degeneration, and changes in the skin, hair, and nails. Additionally, motor neuropathy may cause impaired balance and coordination or, most commonly, muscle weakness; sensory neuropathy may cause numbness to touch and vibration, reduced position sense causing poorer coordination and balance, reduced sensitivity to temperature change and pain, spontaneous tingling or burning pain, or skin allodynia (severe pain from normally nonpainful stimuli, such as light touch); and autonomic neuropathy may produce diverse symptoms, depending on the affected glands and organs, but common symptoms are poor bladder control, abnormal blood pressure or heart rate, and reduced ability to sweat normally.

Mononeuropathy

The most common cause of mononeuropathy is by physical compression of the nerve, known as compression neuropathy. Carpal tunnel syndrome and axillary nerve palsy are examples of this. The “pins-and-needles” sensation of one’s “foot falling asleep” (paresthesia) is caused by a compression mononeuropathy

What causes neuropathy?

Physical trauma, repetitive injury, infection, metabolic problems and exposure to toxins and some drugs can all lead to peripheral neuropathy. It is caused by, or associated with, several medical conditions:

• diabetes mellitus

• vasculitis:polyarteritis nodosa, Wegener’s granulomatosis, and Churg–Strauss syndrome

• immune-mediated diseases like rheumatoid arthritis, lupus erythematosus (SLE)

• infections:leprosy, lyme disease, HIV

• sarcoidosis,amyloidosis

• chemical agents,

• rarely, the sting of certain jellyfish, such as the sea nettle

• Nearly 40 drugs are known to cause neuropathy

Signs and symptoms of neuropathy

People often describe the pain of neuropathy as being a tingling or burning sensation. They also often describe a loss of sensation similar to what it would be like wearing a thin stocking or glove

An individual’s particular symptoms depend on the type of neuropathy and the type of nerves affected.

Neuropathy usually starts in the longest nerves – those that reach the toes. Three types of peripheral nerve can be affected by neuropathy: sensory, motor and autonomic.

Symptoms related to sensory nerve damage might include:

• Gradual onset of numbness and tingling in the feet or hands. This can spread to the legs and arms
• Burning pain
• Sharp, jabbing or electric-like pain
• Extreme sensitivity to touch
• Skin, hair or nail changes
• Lack of coordination.

If motor nerves are affected by neuropathy, the symptoms may include:²

• Muscle weakness or paralysis.

If autonomic nerves are affected, typical symptoms include:²

• Heat intolerance
• Bowel, bladder or digestive problems
• Dizziness or lightheadedness caused by changes in blood pressure.

Foot pain is the most common reason for people with diabetes to seek medical treatment for neuropathy, and loss of sensation can lead to injuries.

With neuropathy as a complication of diabetes, up to 50% of people affected may be completely asymptomatic – that is, they carry the nerve damage without noticing any symptoms. There may be signs of neuropathy that healthcare professionals notice, however, such as reduced ankle reflexes and painless foot injuries.

For the other half of people who do notice symptoms brought on by diabetic neuropathy, pain is the most troubling complaint, and the most common reason to seek medical treatment. Along with decreased sensation and “asleep numbness,” the symptoms they may describe – predominantly in the toes, feet, or legs – include:

• “Prickling” or “stabbing” pain
• “Burning” or “aching” pain.

The pain is often more troublesome at night, leading to disturbed sleep. Other descriptions for the pain include “sticking,” “lancinating” and “boring” – and people with diabetic neuropathy may complain of excessive sensitivity to touch.

How is it treated?

There are number of approaches to treat neuropathy.

• There are number of drugs that have helped  but each of these has long-term secondary side effects
• Nerve block Injections have giving immediate relief to the affected nerve, but the period of relief varies with each individual pathology
• Electro-Medicine
  • Recently this form of therapy has been getting a lot of notoriety as a reemergence of a lost art. Electro-Medicine has been around for over 50 years but because of the insurance industry refusing to pay for it or paying a very limited amount the utilization has dramatically declined. However, recent studies have shown this effective in treating neuropathies. Many pain clinics are currently promoting this type of therapy.
  • What is it, electromedicine is introduction of a large magnetic field within the body which creates a physiological change depending on how the equipment is set up. The equipment can be used for regeneration of nerve fibers, sedation of nerve fibers, or the reduction of inflammation and/or pain. In the case of neuropathy specific frequencies are used to remove the inflammatory response within the nerve tissue itself thereby decreasing the burning sensation or hypersensitivity to touch. In cases where there is numbness and loss of sensation, a different protocol is used to stimulate the nerve thereby increasing sensitivity and at times returning function to the nerve.
  • Every person has a different response to each and every modality, caution has be used as each modality can help, it can also irritate the condition so close supervision by properly trained physician is important.
  • I have  been involved in research and development in the areas of electromedicine/physical medicine for most of my career. I have taught and lectured in this area of medicine throughout my career.