Nerves conduct electrical impulses, thereby allowing messages to travel between the brain, muscles, skin, and other tissues in the body. The nerves that arise from the spine are called roots. They merge into larger bundles called trunks, and then divide back into smaller bundles called branches. The branches complete their course in the periphery, at the ends of the fingers and toes.

Genetic predisposition, diabetes, vascular disorders, certain medical treatments (including chemotherapy or radiation) and environmental factors (such as toxic metals or alcohol) may cause nerves to become sick, or neuropathic. Irrespective of the cause, neuropathic nerves are no longer able conduct current properly. Pain, weakness, numbness, or functional impairment can result.

Neuropathic pain is usually sharp or burning in character. With peripheral neuropathy, the pain and numbness usually occurs first in the feet. With more severe disease it can progress up into the legs or involve the hands. Numbness in the feet can be especially dangerous as skin sores may unknowingly occur. If the sores become deep, or remain open, ulcers can develop.

Weakness usually occurs first in the legs. If a trunk or root is involved, as in radiation induced plexopathy or diabetic neuropathy, the thigh may become weak. If weakness begins in the periphery, as with environmental, chemotherapy, or compressive neuropathies, the foot may be affected first. In either instance, walking and climbing stairs can be difficult. Neuropathy can also affect the arm resulting in weak grasp or shoulder function. When there is a loss of ability to do something, irrespective of the reason, it is called functional impairment.

Fortunately, specialized tests called Electrodiagnostic Studies measure for the presence of sensory and motor nerve fiber damage. Thermography evaluates sympathetic nerve fibers, which are responsible for transmitting burning pain, skin temperature, and cold sensations. Once disease or injury is identified, there are many treatments that can be made available. What's even better is that as a rule these do not require any surgery, and they are generally effective.

Nutrition is the cornerstone of treatment for any neuropathic condition. The right diet —one high in fruits and vegetables, corrective for mineral or vitamin deficiencies and replenishing of omega 3 free fatty acids — provides nerves the fighting chance they need to both survive and repair themselves. Special blood tests can evaluate which nutritional components are deficient, if any.

Improving blood flow to the legs is another useful technique for treating peripheral neuropathy. Quite often there is associated vascular disease that can be diagnosed with simple blood pressure studies and treated effectively with medication. The net result is more oxygen to the nerves and therefore enhanced function.

Physical therapy utilizing various forms of electrical stimulation, heat and exercise can also be effective for pain management and enhancing function. Restorative therapy is best received in a supervised environment as in some instances inappropriately applied modalities or excessive exercise can worsen the condition.

Various medications are available as well. Examples include:
  ·   anti-epileptic drugs that stabilize nerve membranes and reduce excitability,
  ·   anti-depressants that elevate the pain threshold,
  ·   non-steroidal anti-inflammatory drugs that reduce inflammation.

While these represent only a few of the alternatives available for managing neuropathy, keep in mind that there are other responsible choices toward a healing path, including:
  ·   participation in support groups such as the Palmetto Post-Polio and Peripheral
     Neuropathy Support Group in Greenville, SC,
  ·   reducing total load (eliminating those things that don't maximize wellness),
  ·   maintaining an active dialogue with your physician.




Links:
Piedmont Physical Medicine & Rehabilitation

Diabetic Neuropathy

Peripheral Neuropathy: Sympathetic Fibers

Peripheral Neuropathy Home

Management of Peripheral Neuropathy