Pain Management, Chronic Pain, Lower Back Pain Relief, Carolina Pain Scrambler, Greenville SC

Coping with Chronic Pain

A little pain usually is a good thing. It’s our alarm system. It’s our body’s way of saying, “Hey, that’s hot … get away before it hurts you!” But when the pain lingers on and on, it’s no longer helpful. Chronic pain can disrupt your normal lifestyle.

If you suffer from chronic pain, you should know that there are ways to cope. Chronic pain does not need to run, or ruin, your life.

The first step is to learn all you can about your condition. Talk to your doctor and read up on it. Understanding your pain is the first step to reducing it.

Next, take an active role in your recovery. Talk with your doctor about medical treatments that might reduce your pain. But if these treatments can’t completely heal you, don’t give up hope. You can use basic lifestyle choices to control your pain and regain a normal life.

Manage Stress and Your Emotions

Our bodies and minds are connected. Stress, tension and stirred emotions can aggravate pain. Find ways to reduce the stress in your life; deal with your troubling emotions and your pain likely will decrease. Deep breathing, visualization and other relaxation techniques can help you calm your mind and reduce your pain.

Exercise

Exercise leads to a healthier body, and a healthier body feels less pain. Strong, toned muscles feel less pain than unused muscles. Also, exercise will give you more of the energy you need to overcome the pain. Less tangible is the fact that when you’re more fit, you’ll feel better about yourself — more in control — and that can mean a lot. Be sure to talk to your doctor about exercise that is safe for you.

Control Your Physical Activity

Specific activities or body movements may aggravate your pain more than others. Excluding those movements from your day can reduce your pain a great deal. If the painful movements involve important household, personal or work activities, consider using adaptive equipment that will let you perform the same activity without using the same painful motion.

Find Support

Chronic pain can make you feel isolated and afraid. You may feel like you’re all alone. That couldn’t be further from the truth. But it’s estimated that one in three people suffer from chronic pain. Contact others who also suffer chronic pain to share what you know, and to learn from them. You’ll learn ways to cope. You’ll learn that the pain you feel, and the emotions that come with it, are not unusual. Chronic pain support groups can be a great way to get this important human contact.

Finally, look beyond the pain. Don’t let your pain consume your life. There are more important things in your life to focus on, such as friends, family, work, and hobbies. Talk to your doctor about the ideas mentioned above, and start taking back control of your life. As you begin to refocus, the pain will decrease, and you will begin to believe more strongly that you can lead a normal life despite the pain.

Article Provided By: Psych Central

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Nerve Pain Treatment, Pain Relief, Chronic Pain, Chronic Pain Therapy, Pain Therpy, Neuropathic Pain Therapy, Greenville SC

Managing Peripheral Neuropathy

There is no sure way to prevent chemo-induced peripheral neuropathy (CIPN), but there are things you can do to manage your symptoms. During treatment, your cancer care team will ask you about your symptoms and watch you to see if the CIPN is getting worse. Your team may need to delay your treatment, use smaller doses of the chemo drugs, or stop treatment with the drug that is causing the CIPN until your symptoms get better. These actions must be started right away to prevent long-term damage that won’t get better.

Can CIPN be treated?

Treatment can often help ease some of the symptoms of CIPN. Sometimes these symptoms go away a short time after treatment is done. But sometimes they last much longer and need long-term treatment. Severe CIPN may never go away.

Treatment is mostly given to relieve the pain that can come with CIPN. Some of the drugs used include:

  • Steroids for a short time until a long-term treatment plan is in place
  • Patches or creams of numbing medicine that can be put right on the painful area (for example, lidocaine patches or capsaicin cream)
  • Antidepressant medicines, often in smaller doses than are used to treat depression
  • Anti-seizure medicines, which are used to help many types of nerve pain
  • Opioids or narcotics, for when pain is severe

Researchers are looking at which drugs work best to relieve this kind of pain. It may take more than one try to find out what works best for you.

Other treatments that can be tried to ease nerve pain and its effects on your life include:

  • Electrical nerve stimulation
  • Occupational therapy
  • Physical therapy
  • Relaxation therapy
  • Guided imagery
  • Distraction
  • Acupuncture
  • Biofeedback

What can I do to deal with CIPN?

There are some things you can do to better manage the symptoms of CIPN, such as:

  • Talk to your doctor or nurse about the problems you are having in daily life. They might be able to suggest ways to make you feel better or function better.
  • If you are taking pain medicines, use them as your doctor prescribes them. Most pain medicines work best if they are taken before the pain gets bad. See Cancer Pain to learn more about pain, how to talk about it, and how to manage it.
  • Avoid things that seem to make your CIPN worse, such as hot or cold temperatures, or snug clothes or shoes.
  • Give yourself extra time to do things. Ask friends for help with tasks you find hard to do.
  • Don’t drink alcohol. It can cause nerve damage on its own, and might make CIPN worse.
  • If you have diabetes, control your blood sugar. High blood sugar levels can damage nerves.
  • If constipation is a problem, follow your doctor’s recommendations about laxatives and exercise. Drink plenty of water and eat fruits, vegetables, and whole grains to get enough fiber.
  • If the neuropathy is in your feet, sit down as much as possible, even while brushing your teeth or cooking.
  • If your neuropathy is permanent, your doctor may refer you to an occupational therapist (OT). They are experts who help people lead more normal lives despite physical limits.

What should I do to avoid injury?

When your sense of feeling is affected by CIPN, you might be more likely to injure yourself by accident. Here are some things you can do to stay safe:

  • If you have neuropathy in your hands, be very careful when using knives, scissors, box cutters, and other sharp objects. Use them only when you can give your full attention to your task.
  • Protect your hands by wearing gloves when you clean, work outdoors, or do repairs.
  • Take care of your feet. Look at them once a day to see if you have any injuries or open sores.
  • Always wear shoes that cover your whole foot when walking, even at home. Talk to your doctor about shoes or special inserts that can help protect your feet.
  • Be sure that you have ways to support yourself if you have problems with stumbling while walking. Hand rails in hallways and bathrooms may help you keep your balance. A walker or cane can give you extra support.
  • Use night lights or flashlights when getting up in the dark.
  • Protect yourself from heat injuries. Set hot water heaters between 105° to 120°F to reduce scalding risk while washing your hands. Use oven gloves and hot pads when handling hot dishes, racks, or pans. Check bath water with a thermometer.
  • Keep your hands and feet warm and well covered in cold weather. For example, consider keeping a pair of gloves in your car. Avoid extreme temperatures.

What questions should I ask about CIPN?

Here are some questions you might want to ask your health care team:

  • Is the chemo I’m getting likely to cause CIPN?
  • Am I at high risk for CIPN?
  • What symptoms do I need to watch for and report to you?
  • Have you treated CIPN in other patients? How? Did it work?
  • If my CIPN gets bad and is very painful, will it change my treatment plan?
  • Is it likely that my CIPN will get better or go away after treatment is over?

Talk to your health care team

It’s important to work closely with your doctor or nurse to manage peripheral neuropathy caused by chemotherapy. Talk to your doctor about any changes in how you feel, and any trouble you have walking or holding things. Tell the doctor how your symptoms affect the things you do every day.

If you get medicines to help CIPN, be sure to keep your doctor posted on whether the drugs are helping and if new problems start up. You might also want to talk with your doctor about whether you can get into a clinical trial to help deal with your CIPN.

If you are concerned about how future treatment might affect your quality of life, talk with your doctor about what’s most important to you. Remember that only you can decide whether you want to get, or keep getting, a certain treatment.

Article Provided By: American Cancer Society

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Chemotherapy, Chronic Pain, Pain Therapy, Chronic Pain Therapy, Neuropathic Pain Therapy, Greenville SC

Symptoms of DPN

What is diabetic peripheral neuropathy?

Diabetic peripheral neuropathy is a condition caused by long-term high blood sugar levels, which causes nerve damage. Some people will not have any symptoms. But for others symptoms may be debilitating.

Between 60 and 70 percent of people with diabetes have some form of neuropathy, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Peripheral neuropathy, the most common form of diabetic neuropathy, affects the legs, feet, toes, hands, and arms.

Many people do not know that they have diabetes. People unaware of their diabetes may not know what’s causing some of the unusual sensations they’re experiencing.

What causes nerve damage?

Nerve damage is the result of high levels of blood glucose over long periods of time. It isn’t entirely clear why high glucose levels damage nerves.

A number of factors may play a role in nerve fiber damage. One possible component is the intricate interplay between the blood vessels and nerves, according to the Mayo Clinic.

Other factors include high blood pressure and cholesterol levels and nerve inflammation.

Diabetic peripheral neuropathy usually first appears in the feet and legs, and may occur in the hands and arms later.

Feeling numbness

A common symptom of diabetic peripheral neuropathy is numbness. Sometimes you may be unable to feel your feet while walking.

Other times, your hands or feet will tingle or burn. Or it may feel like you’re wearing a sock or glove when you’re not.

Shooting pain

Sometimes you may experience sudden, sharp pains that feel like an electrical current. Other times, you may feel cramping, like when you’re grasping something like a piece of silverware.

You also may sometimes unintentionally drop items you’re holding as a result of diabetic peripheral neuropathy.

Loss of balance

Walking with a wobbly motion or even losing your balance can result from diabetic peripheral neuropathy. Wearing orthopedic shoes often helps with this.

Loss of coordination is a common sign of diabetic peripheral neuropathy. Often, muscle weakness affects the ankle, which can affect your gait. Numbness in the feet can also contribute to loss of balance.

CRPS, Complex Regional Pain Syndrome, Pain Relief, Chronic Pain, Pain Therapy, Pain Management, Carolina Pain Scrambler Center, Greenville South Carolina

Telltale Signs of CRPS/RSD

You are likely researching CRPS/RSD because you or a loved one are experiencing unexplained moderate-to-severe pain and are trying to find the cause. Perhaps a Google search of the symptoms got you to this page. You may have already visited one or more physicians.

A physician may have suggested that your symptoms could possibly be CRPSComplex Regional Pain Syndrome – or, RSD – Reflex Sympathetic Dystrophy, but that they do not specialize in this condition. You are on a journey for a concrete diagnosis.

First of all, you may or may not have CRPS/RSD. There are a number of conditions that have serious, chronic pain as a symptom, along with others that are also present in CRPS/RSD. Here you can learn more about this condition and its symptoms to help you and your doctor rule it in — or rule it out.

What is CRPS/RSD?

CRPS/RSD is a chronic neuro-inflammatory disorder. It is classified as a rare disorder by the United States Food and Drug Administration. However, up to 200,000 individuals experience this condition in the United States, alone, in any given year.

CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain. The level of pain is measured as one of the most severe on the McGill University Pain Scale.

CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization.

The persistent pain and disability associated with CRPS/RSD require coordinated, interdisciplinary, patient-centered care to achieve pain reduction/cessation and better function.

It has been shown that early diagnosis is generally the key to better outcomes. However diagnosing CRPS/RSD is not a simple matter and many patients search for months or years for a definitive diagnosis.

It is important to know that research has proven that CRPS/RSD is a physical disorder. Unfortunately, it has not been unusual for medical professionals to suggest that people with CRPS/RSD exaggerate their pain for psychological reasons. Trust your body and continue to seek a diagnosis. If it’s CRPS/RSD, the pain is not in your mind!

Making the Diagnosis

There is no single diagnostic tool for CRPS/RSD. Physicians diagnose it based on patient history, clinical examination, and laboratory results. Physicians must rule out any other condition that would otherwise account for the degree of pain and dysfunction before considering CRPS/RSD.

Early diagnosis and appropriate treatment offer the highest probability of effective treatment and possible remission of CRPS/RSD.

CRPS/RSD Signs and Symptoms Checklist

There is no gold standard for diagnosing CRPS/RSD. If the pain is getting worse, not better, and if the pain is more severe than one would expect from the original injury, it might be CRPS/RSD.

Look for these telltale signs and symptoms:

  • Pain that is described as deep, aching, cold, burning, and/or increased skin sensitivity
  • An initiating injury or traumatic event, such as a sprain, fracture, minor surgery, etc., that should not cause as severe pain as being experienced or where the pain does not subside with healing
  • Pain (moderate-to-severe) associated with allodynia, that is, pain from something that should not cause pain, such as the touch of clothing or a shower
  • Continuing pain (moderate-to-severe) associated with hyperalgesia, that is, heightened sensitivity to painful stimulation)
  • Abnormal swelling in the affected area
  • Abnormal hair or nail growth
  • Abnormal skin color changes
  • Abnormal skin temperature, that is, one side of the body is warmer or colder than the other by more than 1°C
  • Abnormal sweating of the affected area
  • Limited range of motion, weakness, or other motor disorders such as paralysis or dystonia
  • Symptoms and signs can wax and wane
  • Can affect anyone, but is more common in women, with a recent increase in the number of children and adolescents who are diagnosed

Please keep in mind that this information is not intended as medical advice, nor is it a substitute for a diagnosis by a qualified, medical professional. Please feel free to share the information with your doctor or doctors.

Article Provided By: RSDSA

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Chronic Pain, Pain Therapy, Pain Treatment, Pain Management, Pain Relief, Carolina Pain Scrambler, Greenville South Carolina

People with Chronic Pain Need to Know

People with chronic pain find that pain is a unique experience. One person may have a different experience dealing with pain than another person, in a similar situation. Pain is more than an unpleasant feeling. It also involves your emotions to events that trigger the pain, such as a car accident or a surgery.

It is hard for a patient, alone, to deal with chronic pain and its related problems such as insomnia and depression. A pain management doctor can help you through this difficult experience. As a patient, you need to take control over your pain, by getting the help that is needed and working with your treatment team to get better.

Understanding chronic pain

Chronic pain outlasts what is considered a normal healing time of three to six months, and can become a disease in itself. It starts in the setting of injury or even without a known trigger. You can understand chronic pain better, by comparing it to acute pain.

Chronic pain vs. acute pain

Acute pain is the short-term pain you feel when you burn your hand, sprain your wrist, or pull a muscle. Your body is warning you to stop a harmful behavior, modify activity to reduce strain on the injured area and seek treatment. 

With chronic pain, the nervous system begins to adjust to ongoing pain signals, and the nerves become overactive. This becomes a persistent issue, that can lead to other problems like sleeplessness, depression, or anxiety. 

While acute pain acts like a fire alarm that tells you to find and remove the danger, chronic pain acts like a fire alarm that can’t shut off and keeps ringing long after the fire goes out.

Chronic pain and your central nervous system

Early Greeks and Romans believed that the brain plays a role in feeling pain. Although modern science supports this view, we now understand that our pain-sensing system is far more complex than the simple view of the old. The central nervous system (the brain and the spinal cord) is your body’s control center when it comes to pain. 

Pain can be either magnified or reduced in the brain and spinal cord, based on a series of relay stations that occur throughout the nervous system’s pain signaling pathway. This process starts when the pain signals in the body get turned on more easily. As a result, a person can become more sensitive and feel moderate to severe pain even with normal stimuli or mild pressure, like a light brush against the skin.

Recognizing chronic pain

Although pain starts at a small level in the brain and spinal cord, it can have a big effect on your life.

Signs of chronic pain:

  • Pain lasts over six months
  • The amount of pain you feel seems greater than what you would expect
  • Sometimes, there is pain without a known cause
  • Sleeplessness, anxiety, depression develop

Causes of chronic pain

Chronic pain can start after direct tissue damage, as a result of an illness, or after nerve damage. 

Conditions that result in chronic pain:

  • Arthritis
  • Cancer
  • Neck/back radiculopathy  (herniated disc presses on a spinal nerve)
  • Diabetic neuropathy (hand and foot numbness)
  • Myofascial pain syndrome (muscle pain)
  • Post-surgical pain syndrome (long-term pain after surgery)
  • Phantom limb pain (pain and sensation that a leg or arm is still there after amputation)

Finding the source of pain

Your doctor diagnoses your pain, after a thorough medical history and exam. A description of your pain’s location, duration, and pattern, leads a doctor to the correct diagnosis. Tests such as X-rays, MRIs, CAT scans, may reveal why you are having pain. 

Braking the pain cycle

Several everyday habits can help you gain control over your chronic pain:

  1. Stay ahead of the pain – take your medications on a schedule
  2. Find what increases your pain and try to work around it – for some that means rest, and for others it means greater activity
  3. Remain active – people with chronic pain exercise less and have increased risk for cardiovascular problems
  4. Avoid stress – the sympathetic (flight or fight) response triggered by stress, can increase pain
  5. Get enough sleep – the brain “turns-off” during sleep and gives you a break from pain
  6. Stop smoking – smoking slows down blood flow to the tissues, slowing down the removal of toxins from the painful area
  7. Maintain a healthy diet – an anti-inflammatory, low sugar, diet may decrease inflammation pain

Outcomes

Under the care of your pain management doctor, chronic pain often improves, or may even disappear. Although chronic pain may return after an injury, such as a fall, it may also return in cycles that are not related to anything you do. Therefore, it is important to seek help early, from your pain doctor, in order to better control your pain and to regain the active lifestyle you deserve.

 Article Provided By: Advanced Medical Group

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Carpal Tunnel, Chronic Pain, Pain Therapy, Pain Management, Pain Relief, Carolina Pain Scrambler Center, Greenville South Carolina

Relief from Carpal Tunnel Syndrome

Does wrist or hand pain wake you up at night? Do you shake your wrist to stop the pain? Are you someone who types or holds the phone a lot? You may suffer from Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome affects about 3 to 6 percent of American adults. It is often seen in people whose work or hobbies require repetitive motions of the wrist and hand. These include musicians, hair stylists, assembly line workers (especially those who operate vibrating tools), IT professionals and those who use keyboards.

The result can be burning, numbness or pain in the wrist and hand. This can ultimately lead to decreased gripping strength and coordination.

How does Carpal Tunnel Syndrome develop?

The median nerve runs the length of the arm and provides feeling to the palm side of the thumb and fingers (except for the pinky) This nerve and a series of tendons run through a narrow channel between the wrist bones called the carpal tunnel. If the tendons become irritated and swollen, the tunnel becomes smaller and the media nerve can get squeezed or pinched.

Those with smaller bone structures may be more susceptible to Carpal Tunnel Syndrome. This is why the condition is seen more frequently in women than in men. Obesity is also a significant risk factor for developing Carpal Tunnel Syndrome.

Who is at risk of developing Carpal Tunnel Syndrome?

In addition to those whose work or hobbies require repetitive motions of the wrist and hand, some patients develop Carpal Tunnel Syndrome because of:

  • Heredity: Some people have smaller carpal tunnels or may have other anatomic structures that reduce the space for the median nerve. This is why women are more prone than men to develop the condition.
  • Pregnancy: Sometimes the hormonal changes that occur during pregnancy can cause water retention. This may lead to swelling in the hand and wrist that can result in a flare-up of Carpal Tunnel Syndrome.
  • Chronic Disease or Illness: A number of chronic conditions, including diabetes, rheumatoid arthritis and thyroid disease, can increase the risk of developing Carpal Tunnel Syndrome. This is due to impacts to the nerve and the formation of bone spurs in and around the carpal tunnel bones.

Carpal Tunnel Syndrome Symptoms

  • Numbness, weakness or pain in the hand, including decreased grip strength.
  • A loss of strength and coordination, especially the ability to use your thumb to pinch.
  • Burning, tingling or itching of the index and middle fingers.
  • A sense of the hand “falling asleep” at night and awakening to a pins-and-needles sensation.
  • A worsening of symptoms as the day progresses, perhaps while engaged in activities like driving, holding a phone or reading a paper.

How Carpal Tunnel Syndrome is Diagnosed

First, your doctor will take your full medical history. Then he or she will examine your hands, arms, shoulders and neck, looking for signs of tenderness, swelling, warmth. He or she will then examine the median nerve and the carpal tunnel area and perform a series of specific clinical test maneuvers. These tests will determine pain patterns and check for strength, sensation and proper nerve function. Your doctor may:

  • Bend and hold your wrists in a flexed position to see if it results in numbness or tingling in your hands.
  • Tap over the median nerve in the carpal tunnel to recreate paresthesia.
  • Touch your fingertips and hands with a special instrument to see how much feeling you have in those extremities. Your eyes will be closed during this exercise.
  • Check for weakness in the muscles around the base of your thumb.

Imaging Tests to Diagnose Carpal Tunnel Syndrome

Imaging tests may be ordered to look for things like a fracture, arthritis, a cyst or tumor.

  • Ultrasounds provide a look at the bones and tissues in your arm and wrist to detect signs of median nerve compression.
  • X-rays help your physician eliminate other potential causes of your pain, such as arthritis, ligament injury or a fracture.
  • Magnetic resonance imaging (MRI) scans of the soft tissues in your arm and hand can assess whether abnormal tissue or damage to the median nerve itself (perhaps from injury or tumor) might be the cause of your pain.
  • Electrophysiological tests measure how well your median nerve is working and can determine if there is too much pressure on the nerve. These include nerve conduction studies that measure the signals that travel along the nerves of your hand and arm. The results provide a “road map” to determine the severity of your nerve impingement.
  • Electromyograms (EMG) measure the electrical activity in muscles to determine if you have suffered nerve or muscle damage.

Your doctor may also order lab tests to rule out underlying conditions, such as diabetes, hypothyroidism and rheumatoid arthritis.

Non-Surgical Treatments for Carpal Tunnel Syndrome

Like most conditions, Carpal Tunnel Syndrome is best treated early for greater success. Your physician will most likely begin treatment with conservative measures such as:

  • Splinting to stabilize movement in the wrist.
  • Lifestyle changes, including efforts to reduce or eliminate repetitive movements, or at least incorporating designated rest periods into the day. Improved posture and form can help, too.
  • Ice to reduce swelling.
  • Exercises to strengthen and stretch the tendons that may be causing the nerve irritation.
  • Reducing pain and discomfort with over-the-counter anti-inflammatory medications.

If these efforts do not result in relief, your doctor may suggest prescription corticosteroid or lidocaine injections into the wrist to relieve pressure on the median nerve.

If these minimally invasive measures are unsuccessful, some patients may be candidates for regenerative injections to restore the normal chemical environment within the carpal tunnel and aid in nerve recovery.

Early treatment is key. Patients who ignore the symptoms of Carpal Tunnel Syndrome risk severe muscle atrophy that may make a complete recovery impossible.

Article Provided By: Advanced Medical Group

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If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Chronic Pain, Pain Relief, Pain Therapy, Pain Management, Nerve Pain Treatment, Carolina Pain Scrambler, Greenville South Carolina, Psychological

Psychological Impacts of Chronic Pain

When it comes to the topic of living with chronic pain, the focus is generally on its impact on the body—the back, the knees or the shoulders. But chronic pain has a significant impact on your mental health as well.

More and more research indicates that pain, especially when dealt with for long periods of time, can lead to a host of psychological effects. This means it can be classified as a neurological condition. Research indicates that nearly half of those dealing with chronic pain face depression at some point. Left untreated, depression related to chronic pain can become more complex and more difficult to overcome.

What are the psychological impacts of chronic pain?

Living with pain can lead to a host of additional mental health problems, including:

  • Depression: One of the most common thoughts expressed by those in chronic pain is, “Will I ever feel better?” Dealing with pain day after day can lead to a sense of hopelessness. If ignored, these feelings can magnify and make physical and emotional recovery more difficult. For many, chronic pain leads to a great loss of enjoyment and functional abilities in everyday life.
  • Anxiety and stress: People living with chronic pain think about the pain often throughout the day. Patients can begin to focus too much energy on their painful symptoms. Concerns over health and well-being begin to overwhelm their coping strategies. They begin to obsess about their reduced function levels, health care burdens, and ultimately on their ability to keep their jobs, pay their bills and support their families.
  • Moodiness and irritability: The challenges of coping with physical pain and anxiety can lead to more erratic or unstable behavior.  A common symptom reported is increased impatience and anger. People around them notice that they have a “short fuse.” These emotions are natural. Living with chronic pain is difficult and makes people feel more on edge, which can have negative impacts on both personal and professional relationships.
  • Decreased cognitive function: Have you ever tried to concentrate when you have a headache? Imagine living with that kind of pain every day. It takes a toll on your ability to focus and remember things.
  • Insomnia and fatigue: Chronic pain can make it difficult to fall asleep and stay asleep. This creates a vicious cycle. Lack of restful sleep impedes your body’s ability to heal and think clearly. The lack of sleep, combined with reduced activity and increased anxiety, often leads to more restless sleep—and increased fatigue.
  • Sexual dysfunction: Chronic pain can make sexual activity difficult in several ways.  Pain increases stress, anxiety, insomnia and depression, all of which reduce sexual drive and cause some people to lose interest in sex all together. Also, for many the physical act of sex can increase pain, so they avoid it. The reduction in libido and reduced sexual activity can have a significant impact, both physical and emotional, on relationships and intimacy.

All of these factors contribute to a decline in quality of life. This can exacerbate the emotional aspects of living with daily pain. For example, when we a miss a family event because of pain, we become depressed, angry and irritable. So it is critical to address the psychological effects of pain in coordination with treating the physical aspects of it.

Addressing the Psychological Effects of Chronic Pain

Chronic pain is exhausting, both physically and mentally. The body expends a great deal of energy trying to heal, while the brain works overtime trying to process the pain signals. Your interventional pain specialist can address the physical injuries that are causing chronic pain. But if you are suffering from depression, anxiety, insomnia, reduced libido, or other concerns in your emotional life, you should communicate them to your doctor. He or she will likely recommend a number of mental health interventions, including:

  • Biofeedback: This technique helps you learn how to control your body’s reactions to pain and stress. By learning how to relax tight muscles and breathe deeply you can refocus your brain and gain greater control over your body’s reaction to pain.
  • Cognitive therapy: Working with a mental health professional, you will have the opportunity to talk about your feelings and fears. The goal is to raise your awareness of inaccurate or negative thinking so you can reframe those ideas and emotions to deal with them in a more positive and healthy way.
  • Exercise: Although it is often difficult to think of exercising while in pain, gentle body movement can be helpful and lead to the release of endorphins, the body’s “feel good” hormones. Non-impact exercise, such as swimming, yoga, Pilates and stretching can be beneficial to the body and mind.
  • Massage therapy: A soothing massage offers both physical and psychological benefits. It relieves muscle tension and stiffness and increases blood flow to encourage healing of injured tissues. It also stimulates the release of endorphins to reduce stress and anxiety.
  • Medications: In some cases, prescription antidepressants, sleep medications or anxiety medications may be appropriate. This is something you should discuss with your pain specialist, who may work with an outside specialist or your primary care doctor to address your symptoms with medications.

Early Diagnosis is Key

As is the case with all medical conditions, it is important to recognize and diagnose the psychological effects of chronic pain early. This begins when both patient and physician agree that there is an issue with mood that needs to be addressed—in addition to pain. A plan can be established to treat you as a whole person, treating both the physical and the mental aspects of chronic pain.

 

Remember, if you are suffering from chronic pain, there is hope! It is possible to overcome the psychological impacts of this pain. Be honest with your pain management specialist. They are very familiar with all of the consequences of dealing with pain and will develop a plan to support your entire well-being, from head to toe.

Article Provided By: Advanced Medical Group

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Neuropathy Treatment, Pain Relief, Treatments, South Carolina

Peripheral Neuropathy Fact Sheet

What is peripheral neuropathy?

Peripheral neuropathy refers to the many conditions that involve damage to the peripheral nervous system, the vast communication network that sends signals between the central nervous system (the brain and spinal cord) and all other parts of the body. Peripheral nerves send many types of sensory information to the central nervous system (CNS), such as a message that the feet are cold. They also carry signals from the CNS to the rest of the body. Best known are the signals to the muscles that tell them to contract, which is how we move, but there are different types of signals that help control everything from our heart and blood vessels, digestion, urination, sexual function, to our bones and immune system. The peripheral nerves are like the cables that connect the different parts of a computer or connect the Internet. When they malfunction, complex functions can grind to a halt.

Nerve signaling in neuropathy is disrupted in three ways:

  • loss of signals normally sent (like a broken wire)
  • inappropriate signaling when there shouldn’t be any (like static on a telephone line)
  • errors that distort the messages being sent (like a wavy television picture)

Symptoms can range from mild to disabling and are rarely life-threatening. The symptoms depend on the type of nerve fibers affected and the type and severity of damage. Symptoms may develop over days, weeks, or years. In some cases, the symptoms improve on their own and may not require advanced care. Unlike nerve cells in the central nervous system, peripheral nerve cells continue to grow throughout life.

Some forms of neuropathy involve damage to only one nerve (called mononeuropathy). Neuropathy affecting two or more nerves in different areas is called multiple mononeuropathy or mononeuropathy multiplex. More often, many or most of the nerves are affected (called polyneuropathy).

More than 20 million people in the United States have been estimated to have some form of peripheral neuropathy, but this figure may be significantly higher—not all people with symptoms of neuropathy are tested for the disease and tests currently don’t look for all forms of neuropathy. Neuropathy is often misdiagnosed due to its complex array of symptoms.

How are the peripheral neuropathies classified?

More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis. Symptoms vary depending on the type of nerves—motor, sensory, or autonomic—that are damaged.

  • Motor nerves control the movement of all muscles under conscious control, such as those used for walking, grasping things, or talking.
  • Sensory nerves transmit information such as the feeling of a light touch, temperature, or the pain from a cut.
  • Autonomic nerves control organs to regulate activities that people do not control consciously, such as breathing, digesting food, and heart and gland functions.

Most neuropathies affect all three types of nerve fibers to varying degrees; others primarily affect one or two types. Doctors use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe different conditions.

About three-fourths of polyneuropathies are “length-dependent,” meaning the farthest nerve endings in the feet are where symptoms develop first or are worse.  In severe cases, such neuropathies can spread upwards toward the central parts of the body. In non-length dependent polyneuropathies, the symptoms can start more toward the torso, or are patchy.

What are the symptoms of peripheral nerve damage?

Symptoms are related to the type of nerves affected.

Motor nerve damage is most commonly associated with muscle weakness. Other symptoms include painful cramps, fasciculations (uncontrolled muscle twitching visible under the skin) and muscle shrinking.

Sensory nerve damage causes various symptoms because sensory nerves have a broad range of functions.

  • Damage to large sensory fibers harms the ability to feel vibrations and touch, especially in the hands and feet. You may feel as if you are wearing gloves and stockings even when you are not. This damage may contribute to the loss of reflexes (as can motor nerve damage). Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons or maintaining their balance when their eyes are shut.
  • The “small fibers” without myelin sheaths (protective coating, like insulation that normally surrounds a wire) include fiber extensions called axons that transmit pain and temperature sensations. Small-fiber polyneuropathy can interfere with the ability to feel pain or changes in temperature.  It is often difficult for medical caregivers to control, which can seriously affect a patient’s emotional well-being and overall quality of life. Neuropathic pain is sometimes worse at night, disrupting sleep. It can be caused by pain receptors firing spontaneously without any known trigger, or by difficulties with signal processing in the spinal cord that may cause you to feel severe pain (allodynia) from a light touch that is normally painless. For example, you might experience pain from the touch of your bedsheets, even when draped lightly over the body.

Autonomic nerve damage affects the axons in small-fiber neuropathies. Common symptoms include excess sweating, heat intolerance, inability to expand and contract the small blood vessels that regulate blood pressure, and gastrointestinal symptoms. Although rare, some people develop problems eating or swallowing if the nerves that control the esophagus are affected.

There are several types of peripheral neuropathies, the most common of which is linked to diabetes. Another serious polyneuropathy is Guillain-Barre syndrome, which occurs when the body’s immune system mistakenly attacks the nerves in the body.  Common types of focal (located to just one part of the body) mononeuropathy include carpal tunnel syndrome, which affects the hand and the wrist, and meralgia paresthetica, which causes numbness and tingling on one thigh.  Complex regional pain syndrome is a class of lingering neuropathies where small-fibers are mostly damaged.

What are the causes of peripheral neuropathy?

Most instances of neuropathy are either acquired, meaning the neuropathy or the inevitability of getting it isn’t present from the beginning of life, or genetic.  Acquired neuropathies are either symptomatic (the result of another disorder or condition; see below) or idiopathic (meaning it has no known cause).

Causes of symptomatic acquired peripheral neuropathy include:

  • Physical injury (trauma) is the most common cause of acquired single-nerve injury. Injury from automobile accidents, falls, sports, and medical procedures can stretch, crush, or compress nerves, or detach them from the spinal cord. Less severe traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves and slipped disks between vertebrae can compress nerve fibers where they emerge from the spinal cord. Arthritis, prolonged pressure on a nerve (such as by a cast) or repetitive, forceful activities can cause ligaments or tendons to swell, which narrows slender nerve pathways. Ulnar neuropathy and carpal tunnel syndrome are common types of neuropathy from trapped or compressed nerves at the elbow or wrist. In some cases, there are underlying medical causes (such as diabetes) that prevent the nerves from tolerating the stresses of everyday living.
  • Diabetes is the leading cause of polyneuropathy in the United States. About 60 – 70 percent of people with diabetes have mild to severe forms of damage to sensory, motor, and autonomic nerves that cause such symptoms as numb, tingling, or burning feet, one-sided bands or pain, and numbness and weakness on the trunk or pelvis.
  • Vascular and blood problems that decrease oxygen supply to the peripheral nerves can lead to nerve tissue damage. Diabetes, smoking, and narrowing of the arteries from high blood pressure or atherosclerosis (fatty deposits on the inside of blood vessel walls) can lead to neuropathy. Blood vessel wall thickening and scarring from vasculitis can impede blood flow and cause patchy nerve damage in which isolated nerves in different areas are damaged—called mononeuropathy multiplex or multifocal mononeuropathy.
  • Systemic (body-wide) autoimmune diseases, in which the immune system mistakenly attacks a number of the body’s own tissues, can directly target nerves or cause problems when surrounding tissues compress or entrap nerves.  Sjögren’s syndrome, lupus, and rheumatoid arthritis are some systemic autoimmune diseases that cause neuropathic pain.
  • Autoimmune diseases that attack nerves only are often triggered by recent infections. They can develop quickly or slowly, while others become chronic and fluctuate in severity. Damage to the motor fibers that go to the muscle includes visible weakness and muscle shrinking seen in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively. In other autoimmune neuropathies the small fibers are attacked, leaving people with unexplained chronic pain and autonomic symptoms.
  • Hormonal imbalances can disturb normal metabolic processes, leading to swollen tissues that can press on peripheral nerves.
  • Kidney and liver disorders can lead to abnormally high amounts of toxic substances in the blood that can damage nerve tissue. Most individuals on dialysis because of kidney failure develop varying levels of polyneuropathy.
  • Nutritional or vitamin imbalances, alcoholism, and exposure to toxins can damage nerves and cause neuropathy. Vitamin B12 deficiency and excess vitamin B6 are the best known vitamin-related causes. Several medications have been shown to occasionally cause neuropathy.    
  • Certain cancers and benign tumors cause neuropathy in various ways. Tumors sometimes infiltrate or press on nerve fibers. Paraneoplastic syndromes, a group of rare degenerative disorders that are triggered by a person’s immune system response to a cancer, can indirectly cause widespread nerve damage.
  • Chemotherapy drugs used to treat cancer cause polyneuropathy in an estimated 30 to 40 percent of users. Only certain chemotherapy drugs cause neuropathy and not all people get it. Chemotherapy-induced peripheral neuropathy may continue long after stopping chemotherapy. Radiation therapy also can cause nerve damage, sometimes starting months or years later.
  • Infections can attack nerve tissues and cause neuropathy. Viruses such as varicella-zoster virus (which causes chicken pox and shingles), West Nile virus, cytomegalovirus, and herpes simplex target sensory fibers, causing attacks of sharp, lightning-like pain. Lyme disease, carried by tick bites, can cause a range of neuropathic symptoms, often within a few weeks of being infected. The human immunodeficiency virus (HIV), which causes AIDS, can extensively damage the central and peripheral nervous systems.  An estimated 30 percent of people who are HIV-positive develop peripheral neuropathy; 20 percent develop distal (away from the center of the body) neuropathic pain.

Genetically-caused polyneuropathies are rare.  Genetic mutations can either be inherited or arise de novo, meaning they are completely new mutations to an individual and are not present in either parent. Some genetic mutations lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood. Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy, is one of the most common inherited neurological disorders.

The small-fiber neuropathies that present with pain, itch, and autonomic symptoms also can be genetic. As our understanding of genetic disorders increases, many new genes are being associated with peripheral neuropathy.

How is peripheral neuropathy diagnosed?

The bewildering array and variability of symptoms that neuropathies can cause often makes diagnosis difficult.  A diagnosis of neuropathy typically includes:

  • Medical history.  A doctor will ask questions about symptoms and any triggers or relieving factors throughout the day, work environment, social habits, exposure to toxins, alcohol use, risk of infectious diseases, and family history of neurological diseases.
  • Physical and neurological exams. A doctor will look for any evidence of body-wide diseases that can cause nerve damage, such as diabetes. A neurological exam includes tests that may identify the cause of the neuropathic disorder as well as the extent and type of nerve damage.
  • Body fluid tests. Various blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, infections and signs of abnormal immune system activity. Less often other body fluids are tested for abnormal proteins or the abnormal presence of immune cells or proteins associated with some immune-mediated neuropathies.
  • Genetic tests. Gene tests are available for some inherited neuropathies.

Additional tests may be ordered to help determine the nature and extent of the neuropathy.

Physiologic tests of nerve function

  • Nerve conduction velocity (NCV) tests measure signal strength and speed along specific large motor and sensory nerves. They can reveal nerves and nerve types affected and whether symptoms are caused by degeneration of the myelin sheath or the axon. During this test, a probe electrically stimulates a nerve fiber, which responds by generating its own electrical impulse. An electrode placed further along the nerve’s pathway measures the speed of signal transmission along the axon. Slow transmission rates tend to indicate damage to the myelin sheath, while a reduction in the strength of impulses at normal speeds is a sign of axonal degeneration. Inability to elicit signals can indicate severe problems with either.
  • Electromyography (EMG) involves inserting very fine needles into specific muscles to record their electrical activity at rest and during contraction. EMG tests irritability and responsiveness, detects abnormal muscular electrical activity in motor neuropathy, and can help differentiate between muscle and nerve disorders.

Neuropathology tests of nerve appearance

  • Nerve biopsy involves removing and examining a sample of nerve tissue, usually a sensory nerve from the lower leg (called a sural nerve biopsy). Although a nerve biopsy can provide the most detailed information about the exact types of nerve cells and cell parts affected, it can further damage the nerve and leave chronic neuropathic pain and sensory loss.
  • Neurodiagnostic skin biopsy allows specialists to examine nerve fiber endings following removal of only a tiny piece of skin (usually 3 mm diameter) under local anesthesia. Skin biopsies have become the gold standard for diagnosing small fiber neuropathies that don’t affect standard nerve conduction studies and electromyography.

Autonomic testing

  • Several different types of autonomic testing can evaluate peripheral neuropathies, one of which is a QSART test that measures the ability to sweat in several sites in the arm and leg. Abnormalities in QSART are associated with small fiber polyneuropathies

Radiology imaging tests

  • Magnetic resonance imaging (MRI) of the spine can reveal nerve root compression (“pinched nerve), tumors, or other internal problems. MRI of the nerve (neurography) can show nerve compression.
  • Computed tomography (CT) scans of the back can show herniated disks, spinal stenosis (narrowing of the spinal canal), tumors, bone and vascular irregularities that may affect nerves.

Muscle and nerve ultrasound is a noninvasive experimental technique for imaging nerves and muscles for injury such as a severed nerve or a compressed nerve. Ultrasound imaging of the muscles can detect abnormalities that may be related to a muscle or nerve disorder. Certain inherited muscle disorders have characteristic patterns on muscle ultrasound.

What treatments are available?

Treatments depend entirely on the type of nerve damage, symptoms, and location. Your doctor will explain how nerve damage is causing specific symptoms and how to minimize and manage them. With proper education, some people may be able to reduce their medication dose or manage their neuropathy without medications. Definitive treatment can permit functional recovery over time, as long as the nerve cell itself has not died.

Addressing neuropathy’s causes. Correcting underlying causes can result in the neuropathy resolving on its own as the nerves recover or regenerate. Nerve health and resistance can be improved by healthy lifestyle habits such as maintaining optimal weight, avoiding toxic exposures, eating a balanced diet, and correcting vitamin deficiencies. Smoking cessation is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms. Exercise can deliver more blood, oxygen, and nutrients to far-off nerve endings, improve muscle strength, and limit muscle atrophy. Self-care skills in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and often create conditions that encourage nerve regeneration. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage.

Inflammatory and autoimmune conditions leading to neuropathy can be controlled using immunosuppressive drugs such as prednisone, cyclosporine, or azathioprine. Plasmapheresis—a procedure in which blood is removed, cleansed of immune system cells and antibodies, and then returned to the body—can help reduce inflammation or suppress immune system activity. Agents such as rituximab that target specific inflammatory cells, large intravenously administered doses of immunoglobulins, and antibodies that alter the immune system, also can suppress abnormal immune system activity.

Specific symptoms can usually be improved

  • For motor symptoms, mechanical aids such as hand or foot braces can help reduce physical disability and pain. Orthopedic shoes can improve gait disturbances and help prevent foot injuries. Splints for carpal tunnel problems can help position the wrist to reduce pressure of the compressed nerve and allow it to heal. Some people with severe weakness benefit from tendon transfers or bone fusions to hold their limbs in better position, or to release a nerve compression.
  • Autonomic symptoms require detailed management depending on what they are. For example, people with orthostatic hypotension (significant drop in blood pressure when standing quickly) can learn to prevent drops by standing up slowly and taking medications to improve blood pressure swings. Many people use complementary methods and techniques such as acupuncture, massage, herbal medications, and cognitive behavioral or other psychotherapy approaches to cope with neuropathic pain.
  • Sensory symptoms, such as neuropathic pain or itching caused by injury to a nerve or nerves, are more difficult to control without medication.  Some people use behavioral strategies to cope with chronic pain as well as depression and anxiety that many may feel following nerve injury.

Medications recommended for chronic neuropathic pain are also used for other medical conditions. Among the most effective are a class of drugs first marketed to treat depression.  Nortriptyline and newer serotonin-norepinephrine reuptake inhibitors such as duloxetine hydrochloride modulate pain by increasing the brain’s ability to inhibit incoming pain signals. Another class of medications that quiets nerve cell electrical signaling is also used for epilepsy. Common drugs include gabapentin, pregabalin, and less often topiramate and lamotrigine. Carbamazepine and oxcarbazepine are particularly effective for trigeminal neuralgia, a focal neuropathy of the face.

Local anesthetics and related drugs that block nerve conduction may help when other medications are ineffective or poorly tolerated.  Medications put on the skin (topically administered) are generally appealing because they stay near the skin and have fewer unwanted side effects.

Lidocaine patches or creams applied to the skin can be helpful for small painful areas, such as localized chronic pain from mononeuropathies such as shingles.  Another topical cream is capsaicin, a substance found in hot peppers that can desensitize peripheral pain nerve endings.  Doctor-applied patches that contain higher concentrations of capsaicin offer longer term relief from neuropathic pain and itching, but they worsen small-fiber nerve damage.  Weak over-the-counter formulations also are available. Lidocaine or longer acting bupivicaine are sometimes given using implanted pumps that deliver tiny quantities to the fluid that bathes the spinal cord, where they can quiet excess firing of pain cells without affecting the rest of the body. Other drugs treat chronic painful neuropathies by calming excess signaling.

Narcotics (opioids) can be used for pain that doesn’t respond to other pain-control medications and if disease-improving treatments aren’t fully effective. Because pain relievers that contain opioids can lead to dependence and addiction, their use must be closely monitored by a physician.  One of the newest drugs approved for treating diabetic neuropathy is tapentadol, which has both opioid activity and norepinephrine-reuptake inhibition activity of an antidepressant.

Surgery is the recommended treatment for some types of neuropathies. Protruding disks (“pinched nerve”) in the back or neck that compress nerve roots are commonly treated surgically to free the affected nerve root and allow it to heal. Trigeminal neuralgia on the face is also often treated with neurosurgical decompression. Injuries to a single nerve (mononeuropathy) caused by compression, entrapment, or rarely tumors or infections may require surgery to release the nerve compression. Polyneuropathies that involve more diffuse nerve damage, such as diabetic neuropathy, are not helped by surgical intervention. Surgeries or interventional procedures that attempt to reduce pain by cutting or injuring nerves are not often effective as they worsen nerve damage and the parts of the peripheral and central nervous system above the cut often continue to generate pain signals (“phantom pain”). More sophisticated and less damaging procedures such as electrically stimulating remaining peripheral nerve fibers or pain-processing areas of the spinal cord or brain have largely replaced these surgeries.

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive intervention used for pain relief in a range of conditions. TENS involves attaching electrodes to the skin at the site of pain or near associated nerves and then administering a gentle electrical current. Although data from controlled clinical trials are not available to broadly establish its efficacy for peripheral neuropathies, in some studies TENS has been shown to improve neuropathic symptoms associated with diabetes.

How can I prevent neuropathy?

The best treatment is prevention, and strategies for reducing injuries are highly effective and well tested. Since medical procedures ranging from casting fractures to injuries from needles and surgery are another cause, unnecessary procedures should be avoided. The new adjuvanted vaccine against shingles prevents more than 95 percent of cases and is widely recommended for people over 50, including those who have had previous shingles or vaccination with the older, less effective vaccine. Diabetes and some other diseases are common preventable causes of neuropathy. People with neuropathy should ask their doctors to minimize use of medications that are known to cause or worsen neuropathy where alternatives exist. Some families with very severe genetic neuropathies use in vitro fertilization to prevent transmission to future generations.

What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

NINDS-funded research ranges from clinical studies of the genetics and the natural history of hereditary neuropathies to discoveries of new cause and treatments for neuropathy, to basic science investigations of the biological mechanisms responsible for chronic neuropathic pain. Together, these diverse research areas will advance the development of new therapeutic and preventive strategies for peripheral neuropathies. Understanding the causes of neuropathy provides the foundation for finding effective prevention and treatment strategies.

Genetic mutations have been identified in more than 80 distinct hereditary neuropathies. NINDS supports studies to understand the disease mechanisms of these conditions and to identify other genetic defects that may play roles in causing or modifying the course of disease. The Inherited Neuropathies Consortium (INC)—a group of academic medical centers, patient support organizations, and clinical research resources dedicated to conducting clinical research in Charcot-Marie-Tooth disease and improving the care of people with the disease—seeks to better characterize the natural history of several different forms of neuropathy and to identify genes that modify clinical features in these disorders. Knowing which genes are mutated, and what their normal function is, permits precise diagnosis and leads to new therapies that prevent or reduce nerve damage. INC is also developing and testing biomarkers (signs that can indicate the diagnosis or progression of a disease) and clinical outcome measures that will be needed in future clinical trials to determine whether individuals respond to candidate treatments.

Rapid communication between the peripheral nervous system and the central nervous system often depends on myelination, a process through which special cells called Schwann cells create an insulating coating around axons. Several NINDS-funded studies focus on understanding how myelin protein and membrane production and maintenance in Schwann cells is regulated and how mutations in genes involved in these processes cause peripheral neuropathies. Schwann cells play a critical role in the regeneration of nerve cell axons in the peripheral nervous system. By better understanding myelination and Schwann cell function, researchers hope to find targets for new therapies to treat or prevent nerve damage associated with neuropathy.

Other efforts focus on immune system peripheral nerve damage. In inflammatory peripheral neuropathies such as Guillain-Barre Syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP), the body’s immune system mistakenly attacks peripheral nerves, damaging myelin and weakening signaling along affected nerves. NINDS-supported researchers hope to better understand how antibodies to cell membrane components cause peripheral nerve damage and how the effects of these antibodies can be blocked. Researchers are also studying how mutations in the Autoimmune Regulator (AIRE) gene in a mouse model of CIDP cause the immune system to attack peripheral nerves. NINDS research has helped discover that some types of small-fiber polyneuropathy appear to be immune-caused, particularly in women and children.

NINDS-supported researchers are also exploring the use of tissue engineered from the cells of humans with peripheral neuropathy as models to identify specific defects in the transport of cellular components along axons and the interactions of nerves with muscles. Such tissue engineering approaches may eventually lead to new therapeutics for peripheral neuropathies.

In addition to efforts to treat or prevent underlying nerve damage, other NINDS-supported studies are informing new strategies for relieving neuropathic pain, fatigue, and other neuropathy symptoms. Researchers are investigating the pathways that carry pain signals to the brain and are working to identify substances that will block this signaling.

Article Provided By: NIH

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Guide to Diabetic Peripheral Neuropathy

What Is It?

Diabetes can damage your peripheral nerves, the ones that help you feel pain, heat, and cold. Called DPN for short, this condition most often affects your feet and legs. It can affect your hands and arms, too. It causes odd feelings in your skin and muscles, as well as numbness that could lead to injuries you don’t realize you have.

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What Causes It?

Someone who has diabetes is more likely to have high levels of glucose and triglycerides (a kind of fat) in their blood. Over time, these damage the nerves that send pain signals to your brain, as well as the tiny blood vessels that supply the nerves with nutrients. The best way to prevent or delay diabetic peripheral neuropathy is to control your blood sugar and blood pressure.

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Who Gets It?

About half of people with diabetes have some kind of nerve damage. Two out of 10 people already have diabetic peripheral neuropathy when they’re diagnosed, although it’s more common the longer you’ve had the disease. Someone who is obese or has prediabetes or metabolic syndrome (an unhealthy combination of high blood pressure, high blood sugar, high cholesterol, and belly fat) has a greater chance of getting diabetic peripheral neuropathy, too.

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Symptoms

Your feet or fingers may start to tingle or burn, like “pins and needles.” The lightest touch, perhaps from sheets on your bed, might hurt. In time, your muscles can become weak, especially around your ankles. You could find it harder to balance or painful to walk.

But you may not have any symptoms, even though there’s nerve damage.

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Get Checked Regularly

When you have diabetes, it’s important to see your doctor to try to catch diabetic peripheral neuropathy early. How often? Every year if you have type 2. For type 1, you should get tested yearly, starting either after puberty or after 5 years if you were diagnosed when you were older.

Ask your doctor about getting checked for diabetic peripheral neuropathy if you don’t have diabetes yet but are at risk for it.

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Doctor’s Exam

Because DPN often starts in the feet and legs, your doctor will look there for cuts, sores, and circulation issues. They’ll check your balance and watch you walk. They’ll want to find out how well you sense changes in temperature and delicate touches like vibrations. They may place a thin piece of string or a tuning fork on your toes and feet to see if you feel it.

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Blood and Urine Tests

These help your doctor track your blood sugar and triglyceride levels. The tests might help rule out other causes of neuropathy like kidney disease, thyroid problems, low B12 levels, infections, cancer, HIV, and alcohol abuse, which may need to be treated differently.

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Treatment

Drugs for depression (citalopram, desipramine, nortriptyline, paroxetine) and seizures (gabapentin, pregabalin) could make your diabetic peripheral neuropathy hurt less, but over-the-counter painkillers may not. Products you put on your skin to numb it, like lidocaine, might also help. Nothing will reverse the nerve damage. Your doctor may suggest special exercises (physical therapy) to help you feel better and keep you moving.

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Infection

One side effect of diabetic peripheral neuropathy is that you may not notice minor cuts, blisters, burns, or other injuries because you simply don’t feel them. Since diabetes makes these wounds slower to heal, they might become very serious before you find them. They’re far more likely to get infected. Without the proper care, you could lose a toe, your foot, or even part of your leg.

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Charcot Foot

Severe neuropathy can weaken the bones in your foot. They could crack or break, making your foot red, sore, swollen, or warm to the touch. But because you can’t feel it, you may keep walking on your foot and deform it. For example, the arch could collapse and bulge toward the ground. Caught early, your doctor can treat Charcot foot with rest, braces, and special shoes. Serious cases might need surgery.

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Take Care of Your Feet

Every day, look for cuts, sores, or burns that you might not feel. A mirror can help with those hard-to-see places. Don’t forget to check between your toes. Wash your feet daily in warm water: 90-95 F is safe. (Use a thermometer to test the temperature.) When you rest, wiggle your toes and put your feet up to help keep your blood moving. Call your doctor about any problem that doesn’t clear up in a few days.

Wear Shoes

They protect your feet from the ground, whether it’s burning hot, icy cold, or covered in rough edges. Make sure your shoes breathe, are comfortable, and have plenty of room for your toes. Bring the ones you wear most to your doctor when you go for your checkup. You may need special shoes or inserts when you have foot problems.

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Other Types of Neuropathy

Diabetes can also cause nerve problems other places in your body.

Autonomic is damaged nerves that help control your bladder, stomach, eyes, blood vessels, and other body functions.

Proximal is in your hip, butt, or thigh (usually on just one side), which makes it hard to move.

Focal hurts single nerves, often in your leg, hand, head, or chest and belly.

Article Provided By: webMD

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Chemo Induced Peripheral Neuropathy

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN?

Certain chemotherapy drugs are more likely to cause neuropathy. These include: platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.

Other chemotherapy drugs can also cause neuropathy. The risk of developing CIPN is higher with higher doses, multiple courses, and combination chemotherapy. Patients are more likely to develop CIPN if they are older or have diabetes, vitamin deficiencies, or preexisting peripheral neuropathy.

How Can I Reduce My Risk of Developing CIPN?

No medication or supplement has been shown to definitively prevent CIPN. Regular exercise, reducing alcohol use, and treating preexisting medical conditions (vitamin B12 deficiency) may reduce the risk of CIPN.

What Are the Symptoms and Complications of CIPN?

Depending on the nerves affected, symptoms include:

  • Tingling (“pins and needles”)

  • Pain, which may be severe and constant, may come and go, or may feel like burning

  • Decreased sensation (“legs feel like jelly”)

  • Increased sensitivity to touch, temperature, pressure, pain

  • Muscle weakness

Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time. Commonly, symptoms occur weeks to months after chemotherapy. They can get worse with additional cycles of chemotherapy.

What Should I Do If I Develop Symptoms?

You should notify your care team. Symptoms are likely to worsen if not addressed. Your oncologist can diagnose CIPN based on symptoms and by examining you. Specialized testing is rarely needed.

I Have CIPN—What Now?

One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the kitchen to avoid burns. Your oncologist may choose to discontinue or reduce the dose of a chemotherapy drug. Your oncologist may recommend over-the-counter pain medications, lidocaine patches, menthol creams, or a medication called duloxetine. Physical therapy, occupational therapy, and rehabilitation may be helpful to regain function. Studies are researching how novel therapies (biofeedback or scrambler therapy) can help. Improvements in function may be gradual. In some cases, nerve damage may be permanent.

Article Provided By: JAMA Network

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