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Painful Peripheral Neuropathy
More than 2 million people in the United Stated suffer from painful peripheral neuropathy. This refers to pain arising from the damage to the nerves of the limbs. This condition usually affects both lower extremities simultaneously. Occasionally, it affects the upper extremities.
The nerves are composed of
(1) motor fibers, which tell muscles to move,
(2) sensory fibers, responsible for touch, temperature, pain and other sensations and (3) autonomic fibers, which regulate automotive functions in the body
The most frequent causes of damage to the peripheral nerves are diabetes and chronic, heavy alcohol use. Less common causes of damage include vitamin deficiency, low thyroid levels, autoimmune disease, certain medications and intoxication from chemicals and heavy metals.
The longest nerves, such as the ones linking the spinal cord to the feet, are more susceptible to damages; thus, the first noticeable problems occur in the feet. Common symptoms include numbness and tingling, as well as feelings of swelling and tightness. Complaints of “bugs crawling” or “running water” sensations are common.
Weakness in the legs is a common associated problem, as is a loss of sensation in the legs and feet leading to poor balance when standing or walking.
A condition sometimes associated with painful neuropathy is Restless Leg Syndrome (RLS), a peculiar type of pain and discomfort that causes people to move and shift their legs continuously.
A characteristic of painful neuropaths is burning, especially at night. In fact, the skins may be so sensitive that the weight of the bed sheets can’t be tolerated. Electrical or lightning sensations are also common. Loss of sleep due to the pain compounds the problem and facilitates the onset of depression.
Although there is no reliable cure for neuropathic pain, many drugs used to treat depression, seizures and other central nervous system disorders can help. Elavil, Tegratol, Neurontin and Klonopin are just a few of the drugs used. Small doses of narcotics are sometimes effective, but large doses may compound the problem.
Nerve blocks or injections of certain medications around the painful nerves often help in selected cases. Nerve blocks may last for a long time (up to several months) but are seldom permanent.
Physical therapy modalities, as well as water therapy and electrical stimulation, may provide relief, and exercises are also important to maintain function. The vast majority of patients can improve substantially after the proper combination of treatments is found.
Procedures to destroy painful nerves such as cutting or burning nerves, rarely help and often create additional pain.
Pain may arise from damage to almost any single nerve in the body. Nerves may be damaged in a variety of ways, including trauma from injuries or surgical procedures, viral infections, such as shingles, or a compression of a nerve, such as a ruptured disk, or carpal tunnel syndrome.
The pain is often similar to the one that occurs in peripheral neuropathies, and treatment options are the same, although the damage to a single nerve may respond much better to nerve blocks.
Restless Leg Syndrome
Restless Leg Syndrome (RLS) is a fairly common condition that afflicts people primarily at night. The symptoms usually start shortly after retiring to bed and are described in many ways. Some describe is as a “creepy-crawly” sensation, others as severe tingling or painful numbness. These uncomfortable sensations are promptly alleviated by moving the legs but often reappear after a short while. When the pain is severe, sleep is impossible and patients often have to pace the floor continuously to obtain relief. RLS has no known cause, but it is often associated with diabetes and is frequently found in other members of the family.
As if this were not enough, patients suffering from RLS often have a condition named PLMS*. This causes the legs to “jump” at night starting while trying to fall asleep but continuing throughout the night. Often the spouse complains about being “kicked" by the sleeping partner. This may, without the person’s awareness, disrupt his or her sleep at night, leading to excessive daytime sleepiness and fatigue.
There is no known cure for RLS or PLMS, but they are treatable with medication. Restless Leg Syndrome responds well to some drugs used to treat Parkinson’s disease, such as Sinemet. Other drugs, such as Klonopin and Neurontin, are effective in treating both conditions.
*Periodic Leg Motion of Sleep