FAQ about peripheral neuropathy

What is peripheral neuropathy?

Peripheral neuropathy is a condition caused by damage to the nerves that primarily affects the feet. It causes a variety of symptoms including pain, burning, numbness and “electric shock sensations.” Other neuropathy sufferers may experience tightness in the feet, a cold sensation or a feeling of walking on rocks, marbles or sandpaper. Many people with neuropathy have balance problems and have difficulty walking. There are over 40 known causes of neuropathy. Diabetes is often associated with the condition but other causes include spinal problems, nutritional imbalances, autoimmune diseases, adverse reaction to medications, including chemotherapy, alcoholism, inherited diseases, exposure to toxins, including lead and arsenic and HIV/AIDS. In most instances, neuropathy is not curable and the goal of treatment to ease discomfort, restore sensation and slow down the progression of the condition.

Why do I experience more discomfort at night?

It is quite common to experience more discomfort in the evening. There are two contributing factors for this phenomenon. In the evening, especially at bedtime, there are less distracting factors. During our waking hours we are often diverted from pain as we are involved in various activities such as work, watching television, etc. At bedtime with less outside stimuli to distract us, we tend to focus more on the discomfort of the neuropathy symptoms.  It is also postulated that in the evening when we are more sedentary, there is less production of a chemical in our blood stream, called nitric oxide. Nitric oxide aids in circulation to our tissues, including nerves. With less circulating nitric oxide, our nerves receive less of blood supply which can exacerbate the condition.

Why do I have balance problems?

The sensory nerves that supply the feet are responsible for what is termed, proprioception.  Proprioception is the ability to sense position. People who have healthy nerves can sense their position even in dark and in unfamiliar situations. Many neuropathy sufferers lose this ability as a result of nerve damage. The consequences of diminished proprioception are a lack of balance with associated walking difficulties.

How is neuropathy treated?

Unfortunately in the majority of cases neuropathy cannot be cured. The objective of treatment is to try to reduce the discomfort, restore sensation and slow the progression of the condition. Common prescription medications include Neurontin, Lyrica and Cymbalta. These medications have limited success in reducing discomfort and they do not restore sensation. Additionally these drugs may cause a number of uncomfortable side effects.

Nutritional supplements such as Vitamin B6, B12, folic acid, alpha lipoic acid and acetyl-l-carnitine have been shown to be helpful in reducing neuropathy symptoms and they are safer than the prescription medications. Topical creams, lotions, patches and botanical preparations, can temporally relieve pain, burning and tingling.

Physical modalities such as cold laser, infrared, electrical stimulation and massage therapy are used in the treatment of neuropathy. Eastern disciplines such as acupuncture and acupressure may also ease discomfort.   For advanced neuropathy such as CIPD (chronic inflammatory demyelinating polyneuropathy) more aggressive treatment is utilized including IVIG or immunoglobulin therapy.