Peripheral neuropathy (PN) means damaged nerves in the extremities. PN has multiple causes; the main one is diabetes. Other causes include inflammatory disorders (lupus, sarcoidosis, vaculitis,…) autoimmune disorders (Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP)), infectious diseses (HIV, Hepatitis C), B12 deficiency and many other causes.
Patient with PN present with numbness, tingling sensation and burning pain starting in the feet and progresses in an ascending way up the legs and into the arms. When PN progresses, it can cause weakness in the extremities; a gait disturbance, increase falls and reduction in wound healing.
Diagnosing PN includes good history and physical examination, nerve conduction study and an electromyography, metabolic work up (blood test) and/or nerve biopsy.
Treatment of PN has two folds. One is to identify the cause and see if it can be treated and corrected and another to treat the pain and other symptoms associated with it. Treating the cause depends on the cause. Treating the pain and paresthesia can be with anticonvulsants (Neurontin, Lyrica, Trileptal), antidepressant (Cymbalta, nortriptyline), opiates, tramadol, lidocaine patches, topical creams, and interventional procedures (sympathetic blocks, epidural injections and/or spinal cord stimulators). Furthermore, we also have other new modalities such as electrical anesthesia that can help improve the pain and the feeling in the feet.