Introduction
Peripheral neuropathy develops when nerves in the body’s extremities, such as the hands, feet and arms, are damaged. The symptoms depend on which nerves are affected. It is found mostly in old age people due to degeneration. Also, chronic diseases like diabetes can cause the same condition. As the name suggests, the peripheral nervous system is the network of nerves that lie outside the central nervous system which includes the brain and spinal cord.
It includes different types of nerves with their own specific functions, including:
- sensory nerves – responsible for transmitting sensations, such as pain and touch
- motor nerves – responsible for controlling muscles
- autonomic nerves – responsible for regulating automatic functions of the body, such as blood pressure and bladder function
When any one or more these nerves are damaged, the functions are compromised. The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged. Some cases may improve with time if the underlying cause is treated, whereas in some people the damage may be permanent or may get gradually worse with time.
Signs & symptoms
Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly.
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
In many cases, someone with peripheral neuropathy may have more than one of these types of peripheral neuropathy at the same time.
A combination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy).
Sensory neuropathy
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
Motor neuropathy
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)
Autonomic neuropathy
Symptoms of autonomic neuropathy can include:
constipation or diarrhoea, particularly at night
feeling sick, bloating and belching
low blood pressure,
positional vertigo
rapid heartbeat (tachycardia)
excessive sweating or a lack of sweating
problems with sexual function, such as erectile dysfunction in men
difficulty emptying your bladder of urine
loss of bladder/ bowel control
Mononeuropathy
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 most common type of mononeuropathy is carpal tunnel syndrome. The carpal tunnel is a small tunnel in the wrist. In carpal tunnel syndrome, the median nerve becomes compressed where it passes through this tunnel, which may cause tingling, pain or numbness in the fingers.
Causes
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
- Diabetes
- 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.
A few medicines may sometimes cause peripheral neuropathy as a side effect 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
Pathophysiology
The exact pathophysiology of peripheral neuropathy is contingent on the underlying disease. Although a wide assortment of distinct diseases can ultimately lead to peripheral neuropathies, the mechanisms in which peripheral nerves suffer injury exhibit similar patterns. These reactions include segmental demyelination, along with Wallerian and axonal degeneration.
Segmental Demyelination: This process refers to the process of degeneration of the myelin sheath, with sparing of the nerve axon. This type of reaction can present in mononeuropathies, sensorimotor, or principally motor neuropathies. These are often inflammatory and sometimes immune-mediated. About 20% of symmetrical peripheral neuropathies result from damage to the myelin. Examples include Charcot-Marie-Tooth and neuropathy associated with monoclonal gammopathy of undetermined significance.
Wallerian Degeneration: This occurs after a nerve axon degenerates due to a lesion or physical compression, the portion distal to the axon passively wastes away, likely due to lack of nutrients from the cell body. This reaction results in a focal mononeuropathy that is secondary to trauma or infarction of the nerve. Wallerian Degeneration is immunohistochemically distinct by the localization of neuropeptide Y-Y1 receptor markers.
Axonal Degeneration, also known as the dying-back phenomenon: This type of degeneration usually manifests as symmetrical polyneuropathy (around 80%) and tends to cause weakness, most notably weakness in dorsiflexion of the ankles and foot, with accompanied trophic changes to muscle. The axon degenerates in a pattern that starts distal and progresses proximally; this is thought to be because the most distal portion of the axon is particularly vulnerable due to its distance from the cell body which provides metabolic support. A proposed mechanism is that insult to the nerve causes impaired delivery of local axonal survival factors, resulting in an increased level of calcium intra-axonal leading to a calcium-dependent cytoskeletal breakdown. Examples of diseases causing axonal degeneration include 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
Treatments
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 different ways.
For example:
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:
steroids
immunosuppressants
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 recommended for neuropathic pain include:
amitriptyline
duloxetine
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.
For example:
muscle weakness
erectile dysfunction
constipation
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
Prognosis
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.
Complications
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
- Gangrene
- Serious heart and blood circulation problems – Cardiovascular autonomic neuropathy (CAN)
Disease & Ayurveda
Paadaharsha/Karapaadaharsha
Nidana
Causative factors for the vitiation of Kapha and Vaata
Purvaaroopa
Not mentioned
Samprapti
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.
Lakshana
Numbness and loss of touch sensation of feet/hand
Divisions
Not mentioned
Prognosis
Sadhyam in new and without any complications.
Yaapyam in chronic and complicated cases.
Chikithsa
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.
Samana
Lepanam with Rookshana dravyas
Snehanam
Swedanam
Sodhana
Ashtapanavasti
Anuvasanavasti
Agnikarma
Commonly used medicines
Maharasnadi kashayam
Sahacharadi kashayam
Dhanwantharam kashayam
Dhanadanayanadi kashayam
Punarnavadi Kashayam
Shaddharanam Churna
Ashtavargam
Aswagandhadi choornam
Guggulutiktakam ghrutam
Ksheerabalatailam avarthy
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Home remedies that may help to relieve uncomfortable numbness in the legs and feet include:
- Rest
- Icepack
- Heat
- Massage
- Exercise
- Supportive devices
- Epsom salt baths
- Mental techniques and stress reduction
- Sleep
- A healthy, balanced diet
- Alcohol reduction or avoidance
Diet
- 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.
Yoga
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.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
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.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK542220/#_article-25827_s5_
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.
Writer:
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.
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