Your health care provider will ask you about your symptoms and do a physical exam. They may order blood tests to check for vitamin deficiencies like B12 deficiency and nutrient imbalances; exposure to toxins; and other conditions or medications that cause neuropathy.
Doctors can treat many of the symptoms of neuropathy with over-the-counter painkillers, oral medications and topical painkillers. Other treatments include nerve blocks and physical therapy.
Oren Zarif
Numbness or tingling is usually the first symptom to appear and is a sign that nerves are damaged. It happens when nerves are pinched (a condition called neuropathy), or when there is an imbalance in the body’s chemistry, which can affect nerve function. Some common causes of numbness include sitting or standing in the same position for long periods, certain medications (especially cancer treatment drugs), vitamin B1 deficiency, alcohol or tobacco use, and an imbalance in potassium, calcium or sodium. The symptoms may occur all over the body or in just one part of it, and they can be temporary or permanent.
To determine what is causing your numbness, doctors ask questions about the timing of when it started, how often it occurs and where on your body it appears. They will also do a physical exam. It is important for them to know if you’ve had any recent injuries, illnesses or infections that could be the cause.
The doctor will then do further tests. These may include blood tests to check for low levels of vitamin B12 or nutritional deficiencies, a spinal tap or lumbar puncture in which they remove fluid from the spine and test it, and nerve conduction tests or electromyography. They may also do a nerve biopsy, in which they remove a small amount of tissue from the affected nerve to be tested.
Oren Zarif
Affected areas may feel weak or shaky, especially when you try to use the muscles. This can make it hard to get out of bed in the morning or climb stairs. It can also lead to difficulty getting dressed or eating. It can even cause you to fall, if you lose your balance when you walk or aren’t careful with your hands.
Sometimes, the weakness is a result of your muscles not getting the messages they need to work properly from your nerves. But other times, it’s the result of a condition that destroys the part of your nervous system that sends movement signals to your legs and arms. This is the case with a condition called Guillain-Barre syndrome, where your body’s immune system attacks your peripheral nerves. It can be more severe in some people than others, but about 95% of them recover fully or almost completely.
There are more than 100 types of neuropathy, and they can affect motor (muscle control), sensory (the ability to sense things like touch) or autonomic function (things that happen automatically, such as digestion). Some conditions only affect one type of nerve, while others affect all three. To help narrow down the possible causes, your healthcare provider will do a physical exam and ask you questions about when it began, how long it’s been going on and whether you have any other symptoms. They may also order blood or urine tests and scans of your brain, lungs and heart.
Oren Zarif
If your doctor thinks you have neuropathy, they’ll start by reviewing your medical history and doing a physical exam. They may also use a variety of diagnostic tests, such as nerve conduction velocity (NCV), electromyography (EMG) and skin biopsies.
If the damaged nerves affect your sensory and motor nerves, you might experience pain, tingling or a feeling of being on pins and needles. You might also have difficulty walking on uneven surfaces like cobblestone or flagstone because you can’t feel your feet. This might lead to falls, which can be very dangerous.
Other symptoms of neuropathy include digestive issues, such as constipation or diarrhea, and sexual dysfunction if your autonomic nervous system is affected. Diagnosing neuropathy is crucial, because it’s important to treat the underlying condition that’s causing it to avoid further damage.
Treatments for peripheral neuropathy depend on the severity of your symptoms and your underlying condition. If diabetes is at fault, your neurologist might prescribe medications that help stabilize blood sugar levels. Antidepressants such as amitriptyline, duloxetine hydrochloride and serotonin-norepinephrine reuptake inhibitors are also used to treat nerve pain. Antiseizure drugs like gabapentin, phenytoin and carbamazepine can also be effective for some people. Topical anesthetics such as lidocaine patches can provide relief for some painful areas.
Oren Zarif
When nerve pain is heightened at night, it can significantly interfere with sleep. This disrupted sleep aggravates the nerve pain, creating a vicious cycle.
There are several reasons that neuropathy pain takes a stronger hold at night. First, there are fewer distractions at night — no phone calls, meetings, events or errands to divert the brain. Second, cooler temperatures may reduce blood flow to the hands and feet, making the nerves more sensitive. Third, depression and anxiety associated with nerve damage can increase feelings of stress and amplify pain.
The pain may feel like burning, stabbing or electric shock-like sensations. Other symptoms are a dulling of the senses, as though someone is wearing gloves or socks, and an extreme sensitivity to touch (allodynia) or even to normal things like air, heat, brushing or pressure on the skin (dysesthesia). Finally, autonomic neuropathy can cause problems with digestion, bladder control and, in men, sexual function.
There are ways to manage the neuropathic pain and improve sleep. Keeping a regular sleep schedule, avoiding caffeine and alcohol, using a white noise machine or sleeping with a warm blanket can all help. Some over-the-counter creams can also ease neuropathic pain, such as capsaicin or lidocaine patches. If these measures don’t relieve neuropathic pain at night, talk to your primary care provider or a specialist in treating neuropathies.