Advisory by Belinda Tan, Guardian Pharmacist
Neuropathy refers to a general disorder of the nerves. It is not a single disease, but a complication that arises from various underlying medical conditions. Though neuropathy is often used interchangeably with the terms “peripheral neuropathy” or “polyneuropathy”, they are distinct.
Common causes of neuropathy
Diabetes mellitus is one of the most common causes of neuropathy. Besides diabetes, other medical conditions that can lead to the nerve disorder include autoimmune disorders, tumours or infections. Side effects from medications, nutritional imbalances and exposure to toxins (e.g. alcohol or drug abuse) are some other common causes of neuropathy. Certain neuropathies can also run in the family.
Neuropathies can also be idiopathic - meaning that no specific cause is identified despite extensive investigation being conducted in this area.
Signs & symptoms of neuropathy
Three types of nerves can be affected by neuropathy: sensory, autonomic, and motor nerves. The symptoms of neuropathy experienced depend on the type of nerve(s) affected, the degree to which they are affected, and the locality.
Sensory nerves regulate sensation and our sense of touch. Neuropathy often produces spontaneous sensations known as paresthesias, resulting in numbness, burning sensations, tingling, or pinching. In some cases, sharper, stabbing pains has been described as electric-like shocks. Sensations of parasthesias are usually worse at night, and sometimes can be painful and severe.
Motor nerves regulate the use of our muscles. When motor nerves are damaged, one may experience weakness in the arms and legs. Muscle cramps can also be common. Leg symptoms include encountering difficulty in walking or running, feeling a heavy weight in the legs, tiring easily, or stumbling. Arm symptoms include difficulty in holding or carrying objects.
Autonomic nerves control the functions of the internal organs. Autonomic nerve damage can potentially result in intestinal disturbances such as constipation or diarrhea, thinning of the skin (which makes one prone to bruising and impaired healing), sexual dysfunction, a drop in blood pressure (which can make one dizzy when standing up), and many other symptoms.
As every individual's experience with neuropathy can differ, it is strongly advised for you to visit your physician as soon as possible if you suspect that you are experiencing symptoms of neuropathy.
Management of neuropathy
Neuropathy is managed by treating the underlying medical condition that causes it, and alleviating the symptoms that are related to the disease. For example, in neuropathy caused by alcohol or drug abuse, reducing exposure to the toxins that result in nerve damage is the most important step in treating the condition and preventing further deterioration.
For patients who have diabetes mellitus, strictly controlling one’s blood glucose may help to maintain nerve function. It is important to note that established symptoms of diabetic neuropathy are generally not reversible, even after intensive glucose control is achieved. Therefore, prevention of neuropathy is extremely important for diabetic patients, rather than reliance on treatment once symptoms surface.
Diabetics should combine good glucose control with foot care. As part of a daily regimen, patients should inspect their feet for the presence of dry or cracking skin, fissures, formation of plantar calluses (thickening of the soles of their feet), and signs of infection between their toes or around their toe nails. Regular foot examinations by a trained healthcare provider should also be conducted to detect early neuropathy in diabetics. Foot care is essential in preventing infection and ulceration, which in turn can lead to complications such as necrosis of the foot and even amputation.
Treatment options for neuropathic pain include a number of antidepressants (e.g. amitriptyline, duloxetine, venlafaxine) because they work on areas of the brain that process pain, and anticonvulsants (e.g. pregabalin, gabapentin) as they help with overactive nerves. Breakthrough pain may be managed by the simultaneous use of painkillers.. Over the counter pain medicines like paracetamol and ibuprofen may be used for mild symptoms while more severe symptoms can be relieved by prescription painkillers (e.g. opioids).
Physical, relaxation, or massage therapy may also help with neuropathic pain, depending on the underlying cause of neuropathy. Sometimes, people have to try a few different options or combinations of treatment, before finding the one that works best.Surgery may also be recommended for people with neuropathic pain due to compression or pressure on the nerves (e.g. carpal tunnel syndrome).