The peripheral nervous system is the network of nerves that lie outside the central nervous system. Peripheral neuropathy is a condition where nerves in extremities are damaged. The symptoms depend on which nerves are affected. It is seen mostly in aged people with marked degeneration. Also, chronic diseases like diabetes can lead to it. When any one or more of the peripheral nerves are damaged, the functions are altered. The severity and prognosis of peripheral neuropathy vary, depending on the underlying cause and which are the nerves damaged. Some cases may improve with time and with proper treatment, but in some people the damage will be permanent or may get gradually worse with time.
Signs & symptoms
Signs and symptoms can start quickly or slowly. They are different in different cases.
The main types of peripheral neuropathy include:
- sensory neuropathy – damage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain
- motor neuropathy – damage to the nerves that control movement
- autonomic neuropathy – damage to the nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure
- mononeuropathy – damage to a single nerve outside of the central nervous system
A combination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy).
Symptoms of sensory neuropathy can include:
pins and needles in the affected body part
numbness and less ability to feel pain or changes in temperature, particularly in your feet
a burning or sharp pain, usually in the feet
feeling pain from something that should not be painful at all, such as a very light touch
loss of balance or co-ordination caused by less ability to tell the position of the feet or hands
Symptoms of motor neuropathy can include:
twitching and muscle cramps
muscle weakness or paralysis affecting one or more muscles
thinning (wasting) of muscles
difficulty lifting up the front part of your foot and toes, particularly noticeable when walking (foot drop)
Symptoms of autonomic neuropathy can include:
constipation or diarrhoea, particularly at night
feeling sick, bloating and belching
low blood pressure,
rapid heartbeat (tachycardia)
excessive sweating or a lack of sweating
problems with sexual function, like erectile dysfunction in men
difficulty emptying your bladder of urine
loss of bladder/ bowel control
Depending on the specific nerve affected, symptoms of mononeuropathy can include:
altered sensation or weakness in the fingers
double vision or other problems with focusing your eyes, sometimes with eye pain
weakness of one side of your face (Bell’s palsy)
foot or shin pain, weakness or altered sensation
The commonest mononeuropathy is carpal tunnel syndrome. The carpal tunnel is tube like structure in the wrist. In carpal tunnel syndrome, the median nerve is compressed which may cause tingling, pain or numbness in the fingers.
It can be any underlying disease or certain medication. In some cases, exact cause cannot be identified.
Following diseases and health conditions can cause neuropathy
- excessive alcohol
- low levels of vitamin B12 or other vitamins
- physical damage to the nerves, such as from an injury or during surgery
- an underactive thyroid gland
- certain infections, such as shingles, Lyme disease, diphtheria, botulism, and HIV
- inflammation of the blood vessels
- chronic liver disease or chronic kidney disease
- the presence of an abnormal protein in the blood (monoclonal gammopathy of undetermined significance, or MGUS)
- certain types of cancer, such as lymphoma, a cancer of the lymphatic system, and multiple myeloma, a type of bone marrow cancer
- Charcot-Marie-Tooth disease and other types of hereditary motor sensory neuropathy, genetic conditions that cause nerve damage, particularly in the feet
- having high levels of toxins in the body, such as arsenic, lead or mercury
- Guillain Barre syndrome, a rare condition that causes rapid onset of paralysis within days
- Amyloidosis, a group of rare but serious health conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body
- Auto-immune diseases such as rheumatoid arthritis, SLE, Sjogren’s syndrome or coeliac disease.
Side effects of some medications in some people. These include:
- some types of chemotherapy for cancer, especially for bowel cancer, lymphoma or myeloma.
- some antibiotics, if taken for months, such as metronidazole or nitrofurantoin
- phenytoin, an antiepileptic drug, if taken for a long time
- amiodarone and thalidomide
The pathophysiology of peripheral neuropathy depends upon the underlying disease. Many diseases can ultimately lead to peripheral neuropathies, but the mechanisms in which peripheral nerves suffer injury show similar patterns. They include segmental demyelination, Wallerian and axonal degeneration.
Segmental Demyelination: This is the degeneration of the myelin sheath, without any change in the nerve axon. They are often inflammatory and sometimes immune-mediated.
Wallerian Degeneration: Here, a nerve axon degenerates due to a lesion or physical compression, the portion distal to the axon passively wastes away, for example in cases of lack of nutrients from the cell body. Wallerian Degeneration shows the localization of neuropeptide Y-Y1 receptor markers.
Axonal Degeneration, also known as the dying-back phenomenon: It causes weakness, most notably weakness in dorsiflexion of the foot, with atrophy of the muscle. The axon degeneration starts distally and progresses proximally. Examples of diseases causing axonal degeneration are diabetes, HIV, HCV, and Guillain-Barre syndrome.
A number of tests may be used to diagnose peripheral neuropathy and its underlying cause.
- a nerve conduction test (NCS)
- electromyography (EMG)
- blood tests
- Lumbar puncture
- Nerve biopsy
- X ray
- CT scan
- MRI scan
Treatment for peripheral neuropathy may include treating any underlying cause or symptoms.
Treating the underlying cause
There are many different causes of peripheral neuropathy. They can be treated in many ways.
diabetes can sometimes be controlled by diet, medicines and lifestyle changes.
Vitamin B 12 deficiency can be treated with supplements.
peripheral neuropathy caused by a medicine may improve if the medicine is stopped
Some types of peripheral neuropathy may be treated with medicines, such as:
injections of immunoglobulin
Relieving nerve pain
Medicine to treat nerve pain (neuropathic pain) includes prescribed medications other than most common analgesics. Unlike most other types of pain, neuropathic pain does not usually get better with common painkillers, such as paracetamol or ibuprofen, and other medicines are often used. Some of them are also anti-depressants or anti-epileptic drugs.
These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect.
The main medicines used to treat for neuropathic pain include:
pregabalin and gabapentin
Capsaicin cream – Rubbing capsaicin cream on the painful area of skin 3 or 4 times a day may be beneficial.
Tramadol – it is a powerful painkiller related to morphine, with known serious side effects, that can be used to treat neuropathic pain that does not respond to other treatments
Treating other symptoms
Other problems associated with peripheral neuropathy may be treatable with medicines or therapies.
sluggish digestion due to slower peristalsis
In some cases, more invasive treatments are done, such as:
botulinum toxin injections for hyperhidrosis
a urinary catheter for bladder problems
Neuropathy is not a fatal condition in most of the cases. But an early diagnosis of the underlying cause and proper treatment will improve the chance that nerve damage can be slowed or repaired.
Peripheral neuropathy can sometimes cause other medical problems and complications. It depends upon the underlying cause of the peripheral neuropathy. Most evident complications of peripheral neuropathy are:
- Diabetic foot ulcer
- Serious heart and blood circulation problems – Cardiovascular autonomic neuropathy (CAN)
Disease & Ayurveda
Causative factors for the vitiation of Kapha and Vaata
When the vitiated Kapha causes obstruction and Vaata causes degeneration, and both of these get lodged in feet or any of the extremities, disease called Paadaharsha manifests.
Numbness and loss of touch sensation of feet/hand
Sadhyam in new and without any complications.
Yaapyam in chronic and complicated cases.
Treatment of Karapaadaharsha aims in controlling the Vaata. If there is aavarana, it should be removed with Rookashana therapies. If there is only dhaatukshaya causing Vaatakopa, brumhana with snigdha therapies are advised.
Lepanam with Rookshana dravyas
Commonly used medicines
Home remedies that may help to relieve uncomfortable numbness in the legs and feet include:
- Supportive devices
- Epsom salt baths
- Mental techniques and stress reduction
- A healthy, balanced diet
- Alcohol reduction or avoidance
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Regular stretching and cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
*These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake. Ayurveda Supplement with GMP Certification from India.
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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