Nerve Pain and Peripheral Neuropathy

One of the most difficult aspects of peripheral neuropathy is understanding and explaining the condition to a patient who is experiencing its debilitating effects for the first time. As patients learn of the condition and as they experience its numbing, tingling, and burning effects in their feet and hands, they are more likely to seek effective treatment. Unfortunately, many patients are told that their peripheral neuropathy is a result of their diabetes or severe injury, and they can either choose between various medications, painkillers, invasive procedures and implants, or surgery. Some of those “solutions” treat the pain momentarily while the others can have drastic effects that last for a lifetime. 

In the end, patients want one thing: a treatment that is safe, effective, lasting, affordable, and accessible. They want to find a treatment center that tackles the issue at its source. But without a firm understanding of the condition, patients may turn to alternative methods of treatment that have little to no effect on pain. Worse, some patients will turn to methods that worsen the pain of peripheral neuropathy. The first step to treating peripheral neuropathy should be to understand the condition and how it works.

Understanding Peripheral Neuropathy In Terms Of Pain

Peripheral neuropathy is most commonly identified as pain, burning, and tingling sensations, or loss of feeling in the extremities. Since our nervous system stems from our brains and out to the tips of our fingers and toes, the most common signs of peripheral neuropathy occur at the ends or periphery of our bodies. Patients who suffer from peripheral neuropathy often have trouble with other qualities of life like movement, balance, and sleeping and experience frustration and confusion with the loss of sensation or pain that they experience. 

Since most patients experience peripheral neuropathy in their toes and feet, loss of balance is a common symptom that can be especially dangerous for the elderly. Many patients also experience difficulty standing from a low-seated position or getting out of bed in the morning or rising from the toilet and any number of situations that create a diminished quality of life. 

While some patients experience less severe, but equally frustrating symptoms such as a lack in coordination or weakness, others will experience debilitating cramps and spasms.

Nerves Affected By Peripheral Neuropathy

Simply looking at the symptoms caused by peripheral neuropathy isn’t enough to understand this condition. This is because each patient’s life will be affected in a unique way depending on which nerves are damaged and what part of the body is experiencing the symptoms. 

To understand this, let’s take a step back. 

Stemming from the Greek terms for “nerve” (neuro) and “condition” (pathos), neuropathy is simply a word used to describe “nerve damage” – a disorder that is estimated to affect 2.4-8% of the population. This condition commonly affects the nerves located outside of the spine and the brain, or the Peripheral Nervous System (PNS). 

In particular, there are three different types of nerves in the PNS – sensory, motor, and autonomic nerves – each with essential signaling roles. Let’s look at them below and clarify what happens when neuropathy affects the different nerve types. 

Sensory Nerves

Sensory nerves are the conduits between the spine and the limbs, muscles, and organs like the skin. They carry signals related to sensations such as pain, temperature, and touch. These signals are then processed by the brain, which uses them to get a sense of the surrounding world. 

When sensory nerves are damaged, their ability to transmit signals to the brain is inhibited. In turn, you might begin to experience unfamiliar or abnormal sensations, such as tingling, burning, stabbing, and numbness. 

Sensory nerves in the hands and feet are among the first ones to be affected by neuropathy. This is because neuropathy follows a principle called axonal degeneration (or the dying-back phenomenon). This process begins by affecting the longer nerves and the extremities that are the furthest from the spine (i.e.: the ones in the hands and feet), in order to protect more important nerves, such as the ones close to vital organs.

Motor Nerves

The second nerve type in the PNS is motor nerves. Motor nerves have the role of carrying motor signals to the brain. They are in charge of enabling voluntary muscle movements and they allow you to coordinate the motion of arms, legs, feet, hands, etc. 

When these nerves are affected by neuropathy, you are likely to experience spasms, muscle cramps, and other involuntary muscle movements such as fasciculations. Damaged motor nerves can also lead to impaired coordination and loss of balance. 

Autonomic Nerves

The autonomic nerves in the peripheral nervous systems are responsible for carrying information to the spine and brain that relate to the functioning of autonomic processes. Autonomic functions are the ones we don’t have direct control over, such as breathing, digesting, and sweating. 

When autonomic nerves are damaged, you might experience abnormal bodily activities such as digestion issues, erratic heartbeat, and excessive sweating. In severe cases, patients whose autonomic nerves are affected by neuropathy might require medical interventions and devices such as pacemakers to re-establish the normal functioning of organs such as the heart.

Nerve Pain Symptoms Related To Peripheral Neuropathy

A lot of the symptoms a patient with neuropathy will experience depend on the type of nerves affected and the area of the body where the peripheral nervous system has been damaged. However, most cases of neuropathy share similar symptoms, which include the ones below:

Unexpected Pain

Unexpected pain and burning or stabbing sensations are common indicators that sensory nerves have been damaged. Neuralgia – or nerve pain – derives from the fact that damaged nerves become more active and begin to transmit improper signals to the brain.

This results in pain that starts suddenly and in response to stimuli that should normally be painless, such as holding a cup. Neuralgia tends to become more evident at night, when there are fewer distractions, thus leading to sleep disturbances and deprivation. This complication is estimated to affect nearly 70% of people with neuropathy. In turn, a lack of sleep can lead to fatigue, inhibited productivity, and impaired daytime functions. 

Numbness And Tingling

Numbness and tingling stem from a similar cause to unexpected pain: when sensory nerves are damaged, they are unable to transmit signals relating to pain, touch, and temperature to the brain. 

Although numbness and tingling might be mild sensations at first, they can lead to a cascade of complications. For example, in diabetic patients with neuropathy, numbness in their feet can prevent them from feeling pain, such as the one from a wound that is becoming infected. 

The degeneration of tissue can, in turn, lead to ulcers and, in severe cases, limb amputation. Currently, ulcers caused by diabetic neuropathy account for 50-75% of nontraumatic limb amputations. 

Sensitivity To Touch

Excessive sensitivity to touch, known as allodynia, is a common type of neuropathic pain. This symptom causes people with nerve damage to experience severe pain from stimuli that shouldn’t provoke pain normally, such as brushing their hair or wearing a soft t-shirt. 

Allodynia affects between 15-50% of people with neuropathy, and this excessive sensitivity to touch can impact all aspects of an individual’s personal and professional life. In severe cases, allodynia can trigger anxiety, depression, and other mental health conditions. 

Muscle Weakness

When motor nerves are affected by neuropathy, you might be unable to properly move your limbs or extremities. For example, your hands and feet might be affected by involuntary muscle movements, but won’t respond to voluntary ones. 

If left unaddressed, this condition can cause the muscles to become underused which, in turn, can lead to atrophy (the shrinking of muscle mass) and paralysis. These complications can impact other aspects of a patient’s life and cause reduced mobility, impaired coordination, and a greater risk of falls and injuries. 

Fuzzy Sensations

Paresthesia, which is often described as a skin-crawling, itching, or fuzzy sensation, is a symptom of neuropathy that arises when the sensory nerves in the skin and extremities are impaired. 

Although these sensations aren’t usually painful, they can interfere with a person’s normal functioning and manifest themselves suddenly and without warning. 

Heat Intolerance

Depending on whether the autonomic or sensory nerves are affected, you might become unable to experience temperature changes or regulate your body’s response to heat and cold. This can translate into excessive sweating or poor body temperature control. 

Additionally, if sensory nerves are unable to carry temperature signals to the brain, you might inadvertently expose your skin and extremities to extreme heat or cold and report severe injuries.

Why Proper Diagnosis Is Important

Neuropathy isn’t always permanent. For example, when triggered by medications or chemotherapy, nerve pain might disappear at the end of treatment, and nerves are given the chance to regenerate. 

However, in most cases, neuropathy is a permanent and degenerative condition that can lead to irreversible malfunctioning of the PNS if left unaddressed. Because of this, it is crucial to accurately diagnose nerve disorders as the first symptoms begin to appear, and administer effective treatment. 

This is particularly important in high-risk people, such as individuals with diabetes. Indeed, the prevalence of diabetic neuropathy can be as high as 51% in diabetic patients. And, for these patients, the risk of developing severe complications (i.e.: foot ulcers and amputation) increases alongside how long their blood sugar levels are inadequately managed. 

Ultimately, tackling neuropathic pain in a timely manner is key to limiting nerve damage, preventing life-threatening or disabling complications, and easing the symptoms of nerve pain.

The Relationship Between Nerve Pain And Diabetes

The uncomfortable and elusive symptoms of peripheral neuropathy often cause hopelessness in patients who may not understand how or why it relates to their diabetes and insulin resistance. Knowing what is happening to your body and its primary causes is the first step in seeking and understanding effective treatment. 

So, why does it happen to patients who are also experiencing the insulin resistance associated with diabetes?

How Peripheral Neuropathy Affects Diabetics

To use a simple analogy, think of your body’s blood vessels as a river and picture the body’s insulin levels as a dam that has been built to keep out waves of sugar from damaging the body. If the body experiences a higher intake of sugar, insulin must be used to build the dam higher. Over time, the level of blood sugar may decrease, and the insulin may be lowered to match it. However, if the body is unable to handle a high level of sugar in the blood, the sugar will spill over the dam of insulin and flood the body’s normally functioning systems with damaging complications. Although this analogy doesn’t effectively explain the complex interaction of sugar to insulin, it helps to understand the basic idea of how we need insulin to keep our blood sugars under control and prevent excess sugar crystals in the blood from causing destructive damage in the small spaces and vessels in the peripheral areas of the body.

What The Research Says

Physicians Liumeng Jian and Guangda Yang confirmed in a recent study in 2020 that “Diabetes-related metabolic factors such as increased glucose, decreased insulin, and increased lipids produce changes underlying the development of diabetic neuropathy. Injury to neurons, microvascular endothelium, and Schwann cells in DM contributes to the pathogenesis of neuropathy” (2020). These changes associated with diabetes and insulin resistance are damaging to patients’ neurons (the cells responsible for communicating sensory experiences to the brain). The damage inflicted on neurons can account for patients losing feeling in their toes, feet, and sometimes fingers or hands. 

Some of the other changes mentioned by Jian and Yang include damage to microvascular endothelium (our small blood vessels that run along our bodies next to our peripheral nerve system) and damage to Schwann cells. Schwann cells function much like the body’s neurons, but they have the specific function of maintaining and regenerating peripheral nerves. Without our neurons that communicate sensations to our nervous system, microvascular endothelium that supply blood to our peripheral nerve system, and Schwann cells that maintain peripheral nerves, we will experience the contributing pain, numbness, and burning sensations associated with peripheral neuropathy.

Does Diabetes Cause Peripheral Neuropathy?

The pathogenesis (or development) of peripheral neuropathy is directly tied to our body’s ability to process and maintain blood sugar and its level of resistance to insulin. Although the most common cause of peripheral neuropathy is diabetes, patients without diabetes may experience symptoms of peripheral neuropathy primarily due to metabolic related nerve damage, nerve injuries, medication induced neuropathy, and other various causes.

Other Causes Of Nerve Pain

Currently, a diagnosis of diabetes represents the greatest risk factor for neuropathy. However, the peripheral nervous system is incredibly complex and co-dependent on other processes, such as circulatory functions. Because of this, there might be other, sometimes less obvious causes behind nerve pain. 

Let’s look at these in detail below. 

Injuries

Nerves in the PNS can become damaged or severed as a consequence of a traumatic injury. For example, if you have reported a bone fracture, torn ligament, or ruptured tendon, or have been involved in a collision, the nerves in the affected area might have become compressed, stretched, crushed, or detached from the spinal cord. 

Infections

Some infections caused by bacteria and viruses can damage nerves, often due to the high levels of inflammation that arise in the body as an immune system response. 

Some of the most common infections that can lead to nerve damage include:

• HIV/AIDS
• Lyme disease
• Shingles
• Hepatitis B and C
• Leprosy
• Diphtheria 
• Epstein-Barr virus
• Charcot-Marie-Tooth disease (hereditary)

Statistics show that up to 60% of people diagnosed with HIV also suffer from neuropathy. 

Medications

Taking certain medications can have a toxic effect on the peripheral nervous system, which can lead to nerve damage. Some of the most common medications that include neuropathy as a side effect include:

• Medications to control blood pressure (i.e.: Amiodarone and Hydralazine)
• Medications used to fight infections (i.e.: Chloroquine, Dapsone, or Didanosine for HIV)
• Drugs used to fight autoimmune diseases (i.e.: Etanercept and Infliximab)
• Chemotherapy medications (i.e.: Cisplatin and Docetaxel)

Currently, 19-85% of chemotherapy patients experience nerve pain. 

Alcoholism

Taking excessive quantities of alcohol over a long period or suffering from an Alcohol Use Disorder can cause neuropathy. This is because the toxins contained in alcohol (and in nicotine) can lead to the degeneration of the protective sheath that coats the nerves (myelin). 

According to estimations, this kind of damage appears in 25-66% of people with an alcohol use disorder. 

Idiopathic Peripheral Neuropathy

Although, over the past years, research has been able to identify the major causes and risk factors of neuropathy, around 20% to 30% of cases of nerve pain remain idiopathic.

Idiopathic neuropathy has no obvious underlying condition and can develop spontaneously.

Why Most Treatments For Nerve Pain Don’t Always Work

As we have seen above, there are a myriad of symptoms and causes associated with neuropathy. Because of this nerve pain remains a clinically challenging condition to address and treat. 

Generally, healthcare professionals will recommend one of three treatment options: medications, physical therapy, or surgery. 

NSAIDs and opioids can certainly ease nerve pain in the short term, but they can have severe side effects in the long term, including dependency and addiction. On the other hand, physical therapy can help those whose nerve pain is stemming from traumatic injury and conditions such as arthritis. 

Lastly, surgery is sometimes recommended if nerve damage is caused by improper body mechanics, deformities, or pressure (such as in the case of carpal and cubital tunnel syndromes). 

These treatment options can have an analgesic effect in the short term, free affected nerves from excessive pressure and compression, and improve the body’s mechanics. However, no treatment will be truly efficient without addressing the underlying cause of neuropathy. 

Tackling conditions such as diabetes and alcoholism and reducing risk factors such as obesity and a sedentary lifestyle can help people prevent or keep at bay nerve damage. Additionally, new nonsurgical treatments can support the regeneration of damaged tissue and restore overall health – let’s look at these treatment options below.

A Viable Solution For Nerve Pain

Regardless of the causes of peripheral neuropathy, patients want a safe and effective treatment and Relatyv offers a next generation proprietary chronic pain management solution called Neuralgesia that can effectively treat a wide range of chronic pain conditions, notably peripheral neuropathy pain. Hundreds of patients have experienced relief from the pains and irritations of peripheral neuropathy through Neuralgesia treatment program. Patients suffering from chronic pain can relieve pain, restore health, and magnify quality of life without medications, surgery, or invasive procedures.

Many patients experience immediate relief and regain function in their extremities after only a few sessions. Neuralgesia is a combination of specialized hydration therapy and high pulse electrical stimulation that effectively relieves pain and magnifies quality of life. Neuralgesia is not only used to treat peripheral neuropathy pain but a wide range of other chronic pain conditions such as joint pain, back pain, plantar fasciitis, fibromyalgia and pain stemming from accidents or surgery. Neuralgesia is the next generation of chronic pain management as it addresses not only pain relief but health restoration and creates a magnified quality of life for patients in chronic pain.