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Understanding Neuropathy

  • Common Causes of Tingling, Numbness and Burning

  • Neuropathy is the medical term to describe problems with the nerves – which can give rise to symptoms like tingling, numbness, burning and pain – most commonly in the hands and feet.

    MyLifeStages asked some of our experts to help us understand the troubling symptoms of neuropathy, what they may mean, and what treatments are available.

  • What is Neuropathy?

  • First things first: We have nerves all over the body – branching off of the spinal cord and extending out to all areas, with the longest nerves extending to our fingers and down to our toes. Nerves send signals from the brain to the body, and to transmit information from exterior back in to the spinal cord and brain.

    If you experience pain, it is a nerve that transmitted that “pain” to your senses. As Neurologist Smriti Wagle, D.O., of Sutter Pacific Medical FoundationOpens new window, explains: “If you get kicked in the shin and it hurts, your nerves are involved. But it’s not your nerve that is damaged – it’s likely the soft tissues in your shin. The nerves are reporting the shin damage to your brain. That’s not neuropathy.”

    Neuropathy is a term that means pathology or abnormality with the nerves. The symptoms of neuropathy – which can include tingling, numbness, burning, weakness and sensations of pain – indicate that the nerve itself is impacted or damaged.

  • Causes and Symptoms of Neuropathy

  • We have probably all experienced nerve pain when we “sleep wrong” or sit too long in one position. Our hand or foot goes numb and tingles as the normal function returns.

    Longer-lasting nerve pain can have a host of causes, says Neurologist Nicole Lopez-Seminario, M.D., of Sutter Medical Group in RosevilleOpens new window. Among the possible causes are:

    • Impingement of nerves on bones
    • Repetitive motion injuries, like carpal tunnel syndrome
    • Diabetes
    • Vitamin deficiencies
    • Alcoholism
    • Thyroid problems
    • Infections
    • Herpes
    • Autoimmune diseases
    • Hereditary diseases
    • Chemotherapy treatments

  • Diagnosing Neuropathy

  • With a list of causes that long, it’s clear that a proper evaluation of symptoms is needed, notes Dr. Toni Brayer, M.D., an internist with California Pacific Medical CenterOpens new window in San Francisco. “When a patient comes to me with symptoms of neuropathy, we start with a good history and physical. Often, this alone can lead me to a diagnosis.” For example, neuropathy in the hands is often associated with carpal tunnel syndrome in a patient who uses his or her hands all day. Other symptoms may indicate a pinched nerve exiting the spine and causing symptoms in the buttocks or legs, usually on a single side.

    Blood tests can also reveal other possible causes, such as thyroid disorders or vitamin deficiencies. After these first steps, other diagnostic tests may be used, including imaging or nerve conduction studies.

    Drs. Brayer and Lopez both note that diabetes can often cause nerve damage and symptoms of neuropathy, but nerve pain itself is usually not the first indication of diabetes.

    If you are seeing a physician for neuropathy, be ready to discuss your specific symptoms: When does it occur? How often? What exactly is the sensation? How long does it last? (You can use our personal health record tool to keep track of this info for your visits.)

  • Treatment for Neuropathy

  • For many of the conditions causing neuropathy, proper management of the underlying disease can resolve the associated nerve pain. If a nerve is being pinched, such as in sciatica or carpal tunnel, treatment may focus on the skeletal structures involved. People with lower back pain often face a complex mix of nerve and orthopedic issues.

    For thyroid conditions, vitamin deficiencies, and earlier stages of diabetes, treatment focuses on restoring balance in the body. Ideally, nerve functioning will also be restored, if slowly. “Nerves do regenerate and heal, but not terribly quickly,” notes Dr. Wagle. “It is estimated that a nerve will heal about 1 mm per month.”

    For nerve damage that is painful, there are medications that can help. “There are a wide variety of medications – some well known and many less well known - for neuropathy,” says Dr. Wagle. “However, what is right for one patient and one condition will not likely be right for another. Your treatment won’t be the same as your neighbor’s.”

    Both neurologists note that some patients find relief from chronic nerve pain via alternative treatments such as acupuncture, although there is not a strong body of scientific evidence to support these methods. “Many of my patients do report relief with acupuncture, and I am comfortable with them trying that path,” says Dr. Wagle.

  • When Should I Seek Help?

  • With a topic as complex as this, you might ask: When should I worry about my symptoms of neuropathy? And how much should I worry?

    Our experts suggest these basic guidelines:

    • Occasional nerve pain – waking up with a numb hand, for example – probably doesn’t need medical treatment.
    • However, a recurring problem – numbness every morning for weeks – or symptoms that last a full day and don’t resolve, should probably be a cause for concern.

    Neuropathy is a common complaint, and the good news is that proper identification of the cause can lead to a resolution. And even when true nerve damage has occurred, there are medications that can provide relief.

    Dr. Wagle also notes that some symptoms, such as facial or arm numbness, can be an indicator of other serious conditions such as a stroke or heart attack.

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