The vertebral column, also known as the spinal column or simply the spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum’s five bones and the coccyx’s four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper and mid back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).
The spinal cord is an extension of the central nervous system, which consists of the brain and the spinal cord. The peripheral nervous system is the part of the nervous system that consists of the nerves and ganglia (nerve cell cluster) outside of the brain and the spinal cord. The peripheral nervous system sends nerve impulses to and from the brain to a specific location of the body though the spinal cord.
Peripheral neuropathy occurs when there is damage to one (mononeuropathy) or more (multiple mononeuropathies) of the peripheral nerves which may impair movement, sensation, gland and organ function, etc. This condition can often cause numbness, tingling, and/or weakness in your hands and feet, but can affect other areas of the body as well. Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, or systemic diseases. It can also be genetic/inherited or idiopathic where the cause is unknown.
Each nerve in the peripheral system has a specific function, so the symptoms depend on the type of nerves affected. Common symptoms of peripheral neuropathy are:
- Gradual numbness and tingling in the hands or feet that may spread upwards in to the arms or legs
- Sensitivity to touch, unable to tolerate extreme temperatures
- Sharp, burning, or “jabbing” pain
- Weakness or paralysis in muscles and certain parts of the body
- Lack of coordination resulting in falling
- Changes in blood pressure that may cause dizziness
- Problems with bladder, bowel, or digestion
Early diagnosis and treatment is best to help manage symptoms, therefore it is highly recommended to seek medical advice if an individual experiences the aforementioned symptoms.
Since peripheral neuropathy can produce a number of symptoms that could have other causes as well, the diagnosis is a lot more involved than some other conditions. The goal of diagnosis is to identify the location as well as the source. Therefore, diagnosis will consist of a combination of a patient history, physical examination, and a series of tests. After discussing the medical history of the individual, the physician may conduct a neurological exam testing your sensation, tendon reflexes and the strength of your muscles. The physician may order additional imaging studies such as a CT or MRI scan to rule out other abnormalities, as well as conduct a nerve function test called Nerve Conduction Study (NCS) and Electromyography (EMG). He or she will be able to test the electrical activity in the muscles and nerves to determine the cause of symptoms.
Treatment of peripheral neuropathy will depend heavily on the location and source. The main goal of treatment is to manage the conditions causing peripheral neuropathy and relieve the symptoms. If after diagnostic testing, the physician is unable to find any underlying conditions, the treatment approach may just be to keep a close eye on the individual to see if the neuropathy improves on its own. The consumption of alcohol and other similar toxins has been linked to peripheral neuropathy; therefore the physician may recommend avoiding such substances. Diabetes is also a very common cause of peripheral neuropathy so controlling blood sugar will help.
Medication - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by the physician, he or she might prescribe stronger pain relief medication. Additionally, the physician may also prescribe anti-seizure or antidepressant medication to help relieve nerve pain by interfering with the chemical processes in the brain and spinal cord.
Therapy - There are a number of therapies that might help in relieving symptoms caused by peripheral neuropathy:
- Transcutaneous electrical nerve stimulation (TENS) - This method delivers a gentle electric current at various frequencies via an adhesive electrode placed on the skin.
- Physical Therapy - A physical therapist will instruct the individual on specific movements and exercises that can help build the strength in the muscles.
Recovery will depend on the treatment option chosen by the individual as well as the physician. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of damage, and desired level of activity they would like to return to. Based on the treatment approach, the physician will discuss the appropriate recovery timeline or continued need for future treatments.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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