Neuropathic Conditions:

Peripheral Neuropathy

What is peripheral neuropathy?
Peripheral neuropathy is a type of damage to the nervous system. Specifically, it is a problem with your peripheral nervous system. This is the network of nerves that sends information from your brain and spinal cord (central nervous system) to the rest of your body.

What causes peripheral neuropathy?
Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents. Others develop it because of an injury or another disorder.

In many cases, a different type of problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.

What are the risks for peripheral neuropathy?
These are risk factors for peripheral neuropathy:

  • Diabetes
  • Kidney disease
  • Hormone imbalance
  • Family history of peripheral neuropathy
  • Chemotherapy
  • Surgery

What are the symptoms of peripheral neuropathy?
The symptoms of peripheral neuropathy vary based on the type that you have and what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis.

How is peripheral neuropathy diagnosed?
The symptoms and body parts affected by peripheral neuropathy are so varied that it may be hard to make a diagnosis. If your healthcare provider suspects nerve damage, he or she will take an extensive medical history and do a number of neurological tests to determine the location and extent of your nerve damage.

Depending on what basic tests reveal, your healthcare provider may want to do more in-depth scanning and other tests to get a better look at your nerve damage. Tests may include:

  • CT scan
  • MRI scan
  • Electromyography (EMG) and nerve conduction studies

How is peripheral neuropathy treated?
Usually a peripheral neuropathy can’t be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.

In some cases, over-the-counter pain relievers can help. Other times, prescription medicines are needed. Some of these medicines antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.  Lidocaine injections and patches may help with pain in other instances. And in extreme cases, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.

Can peripheral neuropathy be prevented?
Lifestyle choices can play a role in preventing peripheral neuropathy. You can lessen your risk for many of these conditions by avoiding alcohol, correcting vitamin deficiencies, eating a healthy diet, losing weight, avoiding toxins, and exercising regularly. If you have kidney disease, diabetes, or other chronic health condition, it is important to work with your healthcare provider to control your condition, which may prevent or delay the onset of peripheral neuropathy.

Living with peripheral neuropathy
Even if you already have some form of peripheral neuropathy, healthy lifestyle steps can help you feel your best and reduce the pain and symptoms related to the disorder. You’ll also want to quit smoking, not let injuries go untreated, and be meticulous about caring for your feet and treating wounds to avoid complications, such as the loss of a limb.  In some cases, non-prescription hand and foot braces can help you make up for muscle weakness. Orthotics can help you walk better. Relaxation techniques, such as yoga, may help ease emotional as well as physical symptoms.

Complex Regional Pain Syndrome

What is complex regional pain syndrome?
Complex regional pain syndrome is a chronic condition that causes long-lasting pain. Normally, pain is short-term and resolves as the body heals. But with this condition, pain doesn't fade with time. Instead, ongoing pain might get worse instead of better as days and weeks pass.

What causes complex regional pain syndrome?
Experts aren't sure what causes complex regional pain syndrome, but they believe that nerve damage is involved. In most cases, the condition occurs after some type of injury to the affected area, although this is not always the case.  Doctor’s view this disease as an abnormal response by the body that magnifies the effects of the injury. The nerve endings that control pain in an area that has been injured may become overly sensitive to the chemical messengers carried by the sympathetic nervous system.

What are the symptoms of complex regional pain syndrome?
If you have complex regional pain syndrome, you may have these symptoms:  

  • Persistent, burning pain in an arm, leg, hand, foot, or another part of your body
  • Pain can be mild or severe
  • Swelling
  • Sweating
  • Dramatic changes in skin color and skin temperature

How is complex regional pain syndrome diagnosed?
No specific test exists to diagnose complex regional pain syndrome with certainty. Your healthcare provider can diagnose it based on your medical history (such as having an injury) and the symptoms you have. But because several other conditions can cause similar symptoms, a careful physical exam is important. Sometimes tests are done to rule out some of these other conditions.  Your healthcare provider may suggest a sympathetic nerve block to find out if your sympathetic nervous system is causing your pain. This involves injecting an anesthetic into the nerves near the spine. If the nerve block helps your pain, your provider may give you a series of nerve blocks for ongoing relief.

How is complex regional pain syndrome treated?
There is no cure for complex regional pain syndrome, but sometimes the symptoms get better or stop on their own. Some evidence suggests early treatment, particularly with physical therapy, can help limit the disorder.  Treatment focuses on relieving the pain, typically with one or more pain medicines, antidepressants, antiseizure medicines, or oral steroid drugs. Other options include sympathetic nerve blocks, physical therapy, or electrical stimulation of the spinal cord or certain nerves.

Living with complex regional pain syndrome
The outcome in complex regional pain syndrome can vary widely, so it is important that the condition is diagnosed and treated as soon as possible to give you the best chance for a full recovery. Be sure to follow your healthcare provider's instructions for taking pain medicines and attending physical therapy or exercising if this is part of your treatment plan.  Physical therapy and exercise that keeps the painful limb or body part moving can often improve blood flow and lessen symptoms. It can also help improve the affected limb’s flexibility, strength, and function. If needed, occupational therapy can help you learn new ways to work and do daily tasks.

Complex regional pain syndrome is a painful condition that can bring on emotional or psychological issues for those affected and their families. People with this condition might have depression, anxiety, or post-traumatic stress disorder, all of which can make the pain seem worse and make rehabilitation efforts harder. Be sure to let your healthcare provider know how you are feeling, as there are often ways to help.

Some other types of therapies have been used to treat other painful conditions, such as behavior changes, acupuncture, chiropractic treatment, and relaxation techniques such as biofeedback, progressive muscle relaxation, and guided motion therapy.

Trigeminal Neuralgia

What is Trigeminal Neuralgia (Tic douloureux)?
Trigeminal neuralgia is a type of nerve pain that affects your face. You may feel an intense burst of pain in part of your face, usually one side of the jaw or cheek. The pain may be burning or sharp and so severe that you can’t eat or drink.  A flare-up begins with tingling or numbness in the area. Then pain starts to come and go, often in bursts that last anywhere from a few seconds to 2 minutes. During a flare of the condition, these bursts of pain may become more and more frequent until the pain almost never stops. Although the intensity of the pain can make it hard to get through your day, it’s not life-threatening.  This chronic pain condition can flare up for a few weeks or months. Then the pain disappears for a while, sometimes years.

Diagnosis
To diagnose trigeminal neuralgia, your healthcare provider will typically take your medical history and do a physical exam. Giving your healthcare provider details of the pain, like where and when it happens, may help with making a diagnosis. Imaging tests might be used to try to rule out other causes of pain.

Treatment
Most common over-the-counter and prescription pain medicines don’t work for people with this condition. Treatment for trigeminal neuralgia may include:

  • Anticonvulsant medicine
  • Tricyclic antidepressants
  • Acupuncture
  • Biofeedback
  • Stereotactic radiosurgery
  • Radiofrequency ablation

Managing trigeminal neuralgia
Although not fatal, the pain and anticipation of the pain can interfere with your life. Working closely with your healthcare provider will help you find the best pain management approaches for you. Alternative therapies, like acupuncture and biofeedback have also been shown to help.

Headaches

What is a headache?
A headache is pain or discomfort in the head or face. Headaches vary greatly in terms of the location and intensity of the pain, and how often the headaches occur.

Different types of headaches include:

Migraine
In this type of headache, symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur with migraines. Migraines also have distinct phases. Not all people have each phase, however. The phases of a migraine headache may include:

  • Premonition or prodromal phase. A change in mood or behavior may occur hours or days before the headache.
  • Aura phase. A group of visual, sensory, or motor symptoms can precede the headache. Examples include vision changes, hallucinations, numbness, changes in speech, and muscle weakness.
  • Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
  • Resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and trouble concentrating. Some people feel refreshed after an attack, others do not.

Tension headaches
Tension headaches are the most common type of headache. Stress and tight muscles are often factors in tension-type headaches. These are common symptoms of a tension-type headache:

  • Slow onset of the headache
  • Head usually hurts on both sides
  • Pain is dull or feels like a band or vice around the head
  • Pain may involve the back part of the head or neck
  • Pain is mild to moderate, but not severe
  • Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

Cluster headaches
Cluster headaches usually occur in a series that may last weeks or months.

These are the most common symptoms of a cluster headache:

  • Severe pain on one side of the head, usually behind one eye
  • The eye that is affected may be red and watery with a droopy lid and small pupil
  • Swelling of the eyelid
  • Runny nose or congestion
  • Swelling of the forehead

How is a headache diagnosed?
Your doctor will want to do a comprehensive medical evaluation and diagnostic testing. He or she will also ask about your medical history, and do physical exam and certain tests.  If your doctor suspects migraine or tension-type headaches and the neurological exam is normal, no further testing may be needed. However, if it is not a primary headache, then other tests may be done to find the cause.

How are headaches treated?
Effective headache management depends on finding what type of headache you have and may include:

  • Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
  • Changing eating habits
  • Exercise
  • Resting in a quiet, dark environment
  • Botox injections, for migraine headaches
  • Medicines, as recommended by your healthcare provider
  • Stress management

Migraine and cluster headaches may need specific medicine management including:

  • Abortive medicines. Medicines prescribed by your healthcare provider act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.
  • Rescue medicines. Medicines bought over-the-counter, such as pain relievers, to stop the headache.
  • Preventive medicines. Medicines prescribed by your healthcare provider taken daily to reduce the onset of headaches.

Shingles

What is shingles?
Shingles, or herpes zoster, is a common infection of the nerves. It is caused by a virus. Shingles triggers a painful rash or small blisters on an area of skin. It can appear anywhere on the body, but it typically appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.

What causes shingles?
Shingles is caused when the chickenpox virus is reactivated. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Shingles is more common in people with weakened immune systems, and in people over the age of 50.

What are the symptoms of shingles?
Symptoms may include:

  • Skin sensitivity, tingling, itching, and/or pain in the area of the skin before the rash appears
  • Rash, which typically appears after 1 to 5 days once symptoms begin and initially looks like small, red spots that turn into blisters
  • Blisters typically scab over in 7 to 10 days and clear up within 2 to 4 weeks 

How is shingles diagnosed?
Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.  Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.

How is shingles treated?
There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:

  • Creams or lotions to help relieve itching
  • Cool compresses applied to affected skin areas
  • Antiviral medicines (such as acyclovir, valacyclovir, and famciclovir)
  • Steroids
  • Antidepressants
  • Anticonvulsants

What are the complications of shingles?
Symptoms of shingles usually don’t last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:

  • Postherpetic neuralgia (PHN). The most common complication of shingles is called postherpetic neuralgia (PHN). This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
  • Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.

Can shingles be prevented?
There is a vaccine available to prevent shingles. The vaccine is called Zostavax. It’s advised for healthy adults 60 years of age and older, though there is some literature that supports starting the vaccine in patients 50 years of age and older. Talk with your healthcare provider about the most appropriate time for you to get vaccinated. The vaccine has been found to reduce the number of episodes of shingles and the incidence of PHN in older adults.

Other Conditions

  • Phantom Limb Pain