The Causes of Painful Polyneuropathy
Symptoms and Diagnosis
Polyneuropathy -- Diabetic Neuropathy, AIDS Neuropathy, and Related Websites
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A neuropathy is a condition in which the peripheral
nerves (the nerves in your body, aside from your spinal cord and brain)
are damaged or not working correctly. There are hundreds of different
types of neuropathies and many different ways to categorize them, including
by the type of nerve damaged, the causes of the nerve damage, or the pattern
of nerve damage.
A polyneuropathy is a neuropathy pattern, whereby
the nerve damage initially starts in both feet and may progress to involve
the feet, calves, and fingers/hands. Another word for this pattern is
a Stocking and Glove Neuropathy. Many patients
with polyneuropathy may not even have any symptoms; in this case the diagnosis
is made by a physical examination or a laboratory test (electromyography
(EMG) and nerve conduction velocity test (NCV)). Some patients with polyneuropathy
have only numbness, "tingling," and/or "pins and needles."
Less often, some unlucky patients with polyneuropathy experience pain.
There are many causes of painful polyneuropathy. The most common cause
is diabetes, both Type 1 and Type 2. Other causes include old age, certain
drugs (such as some chemotherapy drugs), alcohol abuse, AIDS, environmental
toxins, and inherited neurological neuropathies. However, in up to one-third
of patients with painful polyneuropathy, no underlying cause can be found.
Importantly, the chance of obtaining pain relief with proper treatment
is the same for patients with or without a known etiology.
The actual injury to the nerves may result from several different problems.
Possible injuries include:
||not enough blood supply to the nerves, resulting in
loss of oxygen and other needed nutrients to the nerve and thus
damage to the nerve, and
||abnormal function of the nerve itself, such that the
nutrients within the nerve are not properly metabolized. In any
individual patient, it is not possible to find out which type of
problem exists. However, it does not matter which problem is present
with regard to pain treatment.
The symptoms of painful polyneuropathy start in the toes and feet (right
and left). In some patients the symptoms gradually rise up the calves
and into the knees. This is called a stocking pattern.
Then, in some the symptoms may also begin in the fingers and hands --
causing a stocking and glove pattern. It cannot
be predicted how any one patient's symptoms will spread. In some patients,
the pain does not spread beyond the toes or feet; in others, the progression
to calves and hands occurs in months; and yet in others the spread is
very gradual, over many years.
Patients who develop pain with polyneuropathy describe the pain using
a variety of words, including "burning," "raw skin,"
"skin sensitivity," "sharp," "electric-like,"
"deep ache," "freezing cold," "like walking
on ground glass," "itchy," and others. Some patients
say they don't have pain but have unpleasant and irritating sensations,
which may include "buzzing," "like bugs crawling,"
and "aching." Some patients have constant pains, day and night,
whereas others only have noticeable pain at bedtime. Often, patients
may complain that the pain interferes with their sleep.
Some patients with polyneuropathy may have difficulty feeling things
with their feet or hands. Therefore, it is very important that these
patients examine their affected skin areas regularly to make sure they
haven't injured themselves (cuts, burns, infections, etc.). Also, some
patients with neuropathy have trouble with their balance when walking;
these patients should keep a nightlight on in their bedrooms and bathrooms,
so they do not fall when they get up at night.
As with all chronic pain, patients with painful polyneuropathy may develop
depression and sleep problems.
Most often, a doctor should be able to diagnose painful polyneuropathy
solely on a patient's description of his/her symptoms and a simple neurological
examination. Sometimes, however, a doctor may order special nerve tests,
electromyography (EMG) and nerve conduction testing (NCV); please note
that EMG/NCV are painful tests: a doctor sticks a needle in the muscle
and send electric shocks along the nerves to measure how well nerves
are working. Another type of nerve test, quantitative sensory testing
(QST), is less painful and measures how well the patient feels vibration
and temperature changes. Importantly, in some painful polyneuropathy
patients, the EMG/NCV tests may be completely normal.
TheBody.com: AIDS Neuropathy
National Diabetes Information Clearinghouse (NDIC)
Complementary and Alternative Treatments (pdf) [members report]: Northern
Cal. Chapter of the Neuropathy Assoc.
eMedicine: Diabetic Neuropathy
Washington University, St. Louis: Neuromuscular Disease Center
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