Neuropathies

 

[accordions]

  • Autoimmune Neuropathy
  • Autonomic Neuropathy
  • Burning Mouth Syndrome
  • Carpal Tunnel Syndrome
  • Causalgia
  • Charcot-Marie-Tooth Disease
  • Complex Regional Pain Syndrome / CRPS/RSD
  • Diabetic Neuropathy
  • Fabry’s Disease
  • Fibromyalgia
  • Guillain Barre Syndrome
  • HIV/AIDS
  • Leprosy
  • Lupus
  • Lyme Disease
  • MonoNeuropathy
  • Multiple Sclerosis
  • Neuralgia
  • Neuro Inflammatory Disease
  • Peripheral Neuropathy
  • Polyneuropathy
  • Post-Chemo Neuropathy
  • Post-Surgical Pain
  • Post-Herpetic
  • Neuralgia Post-Infectious
  • Reflex Sympathetic Dystrophy/ RSD/CRPS
  • Shoulder Hand Syndrome
  • Sympathetically Independent Pain Sympathetically
  • Mediated Pain
  • Toxic Neuropathy
  • Vasculitic Neuropathy



Neuropathy and Neuropathic pain are Symptoms of a hundred different diseases that have injurious effects on normal neurological functioning. These conditions are typically treated by many types of medical professionals; neurologist, pain management, anesthesiologist, Rheumatologist, physical therapist and more. Each professional focuses on one or a few aspects of the contributory development like cancer or diabetes or peripheral Neuropathy. Pain specialists must eventually deal with the common presentations of permanent neurological damage. Once the cellular damage occurs, reversing the disease state becomes almost impossible.

At the stage of Neuropathic pain diagnosis, analgesic treatment is often the only option. As the bio-mechanical make up of these conditions are found and documented new treatment modalities will improve the chances of eliminating of the pain and possibly the condition causing the pain. At this time effective treatment modalities are rare, but some patients are finding successes such as lower pain levels or even remission. The goal of treatments should be to understand the physiological system of the condition and then working to prevent permanent painful Neurological transformations.

7 Major Categories of Neuropathy Pain include:

Toxic

Toxic Neuropathy is typically the result of Chemo-radiation in the treatment of cancer. Other causes are found in tuberculosis patients who receive Isoniazid, a colorless crystalline compound, and thallium, a soft highly toxic white metallic element. Toxic exposure is generally a results in an abnormal and often inherited improper protein processing when a person is exposed to harmful chemicals. Whether it be from a purposeful exposure like Chemo or environmental exposures such as arsenic or lead.

Metabolic

Metabolic Dysfunction Neuropathy pain is typically seen in Diabetes patients. Other causes are Nutritional deficiencies. This can be low Vitamin B1 typically seen with alcohol induced Neuropathy in the case of diabetes and inhibiting of axonal, sodium, potassium and atpase (an enzyme that aids in the breakdown of ATP into ADP with a release of energy) axonal transport producing nerve cell degeneration.

Trauma

Trauma can result in phantom limb syndromes and/or Reflex Sympathetic Dystrophy Syndrome (RSD/CRPS). Amputee pain is thought to be a result of abrupt loss of sensory input from the limb to the brain. The pain is felt at discharges stemming from the nerve endings at the sight of the amputation that continue to send pain signals to the brain, making the brain think the limb is still there. Trauma or insults to the body, be it big or small, that do not heal correctly have been suggested as the cause of RSD , including dysfunctional processing throughout the entire nervous system involving peripheral, central and autonomic nerve systems.

Compressive/Entrapment

Carpal tunnel syndrome and compartment syndromes are common entrapment injuries. The excessive external pressure on nerve axon (transmits impulses outward from the cell body) can cause an inadequate supply of blood to the part of the body or stretching changes. Prolonged injury results not only in pain but we see a resultant muscle atrophy in patients with this type of injury.

Autoimmune

Autoimmune Neuropathic pain conditions include Polyneuropathy (the loss of the fatty covering myelin of the nerve fibers) and Vasculitic Neuropathy (relating to blood vessels). A patient may have an autoimmune antibodies involved in the disturbance of function that a disease causes in an organ, as distinct from any changes in structure that might be caused. These are usually modifiable with immune therapy (IVIG).

Infectious

Viral conditions are known to result in long-standing Neuropathic pain. Conditions in this category are Post-Herpetic Neuralgia, Lyme Disease, Leprosy, HIV and Post-infectious patients.

Congenital/Hereditary

Inherited genetic diseases such as Fabry’s Disease and Charcot-Marie-Tooth Disease are good examples of peripheral Neuropathic pain associated with congenital abnormalities.

Autonomic Neuropathy

[image lightbox="true" box="full-one-half" align="right"]http://nervepainfoundation.org/wp-content/uploads/2012/07/autonomic.gif[/image]

The Autonomic Nervous System

The autonomic nervous system consists of sensory neurons and motor neurons that run between the central nervous system (especially the hypothalamus and medulla oblongata) and various internal organs. Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.

Autonomic nerve damage may produce the following symptoms:

  • inability to sense chest pain, such as angina or heart attack
  • too much sweating (known as hyperhidrosis) or too little sweating (known as anhidrosis)
  • lightheadedness
  • dry eyes and mouth
  • constipation
  • bladder dysfunction
  • sexual dysfunction

 

Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.

Motor nerves may produce the following symptoms:

  • weakness
  • muscle atrophy
  • twitching, also known as fasciculation
  • paralysis

 

Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Sensory nerve damage may produce the following symptoms:

  • pain
  • sensitivity
  • numbness
  • tingling or prickling
  • burning
  • problems with positional awareness

Nerve pain and nerve damage can be mild. Nerve pain and damage can seriously affect your quality of life because nerves are essential to all you do. With nerve damage there can be many symptoms. Your symptomes will depend on the location and type of nerves that are affected. Damage can occur to nerves in your brain and spinal cord. It can also occur in the peripheral nerves, which are located throughout the rest of your body. In some instances, people with nerve damage will have symptoms that indicate damage to two, or even three, different types of nerves. For instance, you might experience weakness and burning of your legs at the same time.


Peripheral Neuropathy

The name of the condition tells you a bit about what it is:

  • Peripheral: Beyond (in this case, beyond the brain and the spinal cord.)
  • Neuro-: Related to the nerves
  • -pathy: Disease

Put these concepts together and this is what peripheral Neuropathy means: It refers to the conditions that result when nerves that connect to the brain and spinal cord from the rest of the body are damaged or diseased.

The peripheral nerves make up an intricate network that connects the brain & spinal cord to the muscles, skin, and internal organs. Peripheral nerves come out of the spinal cord and are arranged along lines in the body called Dermatomes. Typically, damage to a nerve will affect one or more Dermatomes, which can be tracked to specific areas of the body. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain.

Peripheral Neuropathy describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral Neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body. Because every peripheral nerve has a highly specialized function in a specific part of the body, a wide array of symptoms can occur when nerves are damaged. Some people may experience temporary numbness, tingling, and pricking sensations (Paresthesia), sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction.

RSD/ Reflex Sympathetic Dystrophy Syndrome aka CRPS/ Complex Regional Pain Syndrome

This syndrome has changed names over 20 times through out history and is projected to again change names as more bio-mechanical information is discovered. Other names include: Post Sympathectomy Pain, Hyperpathic Pain, and Mimocausalgia, among many others.

This condition is a progressive neurological condition that can affect one extremity or all 4, and can go full body. It also can affect the immune system, skin, muscles, joints, and bones. The pain can start in one area but spread to other areas of the body. The syndrome usually develops after a minor insult to the body, such as whiplash, sprain, broken bone, or following surgery and in a few cases, no precipitating insult can be identified. RSD/CRPS is characterized by constant burning pain at various levels but always present. Patients may also see excessive sweating, swelling, and sensitivity to touch. RSD can go into remission for a period of time and then reappear with a new injury. This most commonly occurs when it is treated within the first 9 months with appropriate care.

Things to remember:

  • Minor injuries, such as a sprain or a fall are frequent causes of CRPS. One characteristic of CRPS is that the pain is more severe than expected for the type of injury that occurred.
  • Early and accurate diagnosis and appropriate treatment are key to recovery, yet many health care professionals and consumers are unaware of its signs and symptoms. Typically, people with CRPS report seeing an average of five physicians before being accurately diagnosed.
  • Symptoms include persistent moderate-to-severe pain, swelling, abnormal skin color changes, skin temperature, sweating, limited range of movement, movement disorders.
  • CRPS is two to three times more frequent in females than males.
  • The main age at diagnosis is 42 years. However, we are seeing more injuries among young girls, and children as young as 3 years old can get CRPS.
  • This is not a psychological syndrome, but people may develop psychological problems when physicians, family, friends, and co-workers do not believe their complaints of pain.

RSD has been categorized with two types, although both share the same signs and symptoms.

Type 1 – without nerve injury

Type 2 (formerly called Causalgia) – with nerve injury

Millions of people in the United States suffer from RSD. It affects woman 3 to 1 over men and it can occur at any age. According to Dr. Schwartzman, a leading doctor in the field of RSD treatment, RSD appears to involve a complex interaction among the sensory, motor, and autonomic nervous systems, and the immune system. The brain and spinal cord (central nervous system) which as control over these various processes is somehow changed as a result of an injury.

Early treatment is the key, Leading experts now believe that any invasive procedure or injury can cause the RSD to worsen or spread. Treatments such as spinal cord stimulators, pain pumps and sympathectomies are now considered contraindicated. As well application of ice to the affected areas is also not recommended.

Ketamine Infusions are believed to be the future standard treatment for RSD by top doctors in the field and have been very successful to date. There are not many doctors performing this procedure and wait lists are extremely long for the doctors who are successful with it. The protocol makes a difference, be sure to check with your doctor(s) prior to any treatments or medical intervention. Other treatment modalities include nerve blocks, massage, traction for upper extremity, proper posture, medications At this time, there is no cure, but the bio-mechanical mechanisms are now known and progress for a cure is underway. At this time the closest thing to a cure is Ketamine Infusions and hope.

Causalgia is intense burning pain and sensitivity to the slightest vibration or touch, usually in the hand or foot, at a site some distance removed from a wound that has healed. This phenomenon was first described in 1872 by the American neurologist Silas Weir Mitchell. Now this is typically know as Reflex Sympathetic Dystrophy Syndrome or Complex Regional Pain Syndrome.

Chronic pain is defined as pain that lasts longer than 3 months. That’s the main symptom of Fibromyalgia: widespread muscle pain that lasts longer than 3 months. Widespread pain is defined as pain both above and below the waist and on both the right and left sides of the body.

At its best, Fibromyalgia may be described as “mild.” At its worst, intense pain can get in the way of doing normal day-to-day activities.

Some Fibromyalgia sufferers describe their pain as “all over” or “everywhere.” For some people, the pain and stiffness are worst when they wake up. Then it improves during the day. Symptoms may increase again at night. But other people have all-day, nonstop pain. This could include combinations of neck pain, arm pain, shoulder pain, back pain, hip pain, knee pain, feet pain, and pain in just about every other body part.

Some Lifestyle Changes May Help You Find Fibromyalgia Pain Relief Exercise A healthy and active lifestyle may help you decrease your Fibromyalgia symptoms. Studies show that second to medication, the actions most likely to help are light aerobic exercises (such as walking or water exercise to get your heart rate up) and strength training. But always check with your doctor before you start any exercise program.

These tips from the National Fibromyalgia Association may help you get started.

  • Start slow. If you’re moving more today than yesterday, that’s progress
  • Listen closely to your body. It’s important not to overdo it. Don’t increase your activity too quickly
  • Start with just a few minutes of gentle exercise a day. Then work your way up
  • Walking is a great form of exercise
  • Track your progress. Note the exercise you’re doing and how you feel both during and afterward
  • Stretch your muscles before and after exercise
  • Post-exercise soreness will decrease over time. But respond to your body’s signals and pace yourself

Sleep

If you find that you are sleeping poorly, you’re not alone. With Fibro, pain and poor sleep happen in a circle. Each worsens the other. Fortunately, there is a lot you can do to help yourself sleep better. The National Fibromyalgia Association, the National Pain Foundation, the National Sleep Foundation, and other expert organizations recommend the following steps to help people sleep:

  • Stick to a sleep schedule. If you go to bed at the same time every night, your body will get used to falling asleep at that time. So choose a time and stay with it, even on weekends
  • Keep it cool. When a room is too warm, people wake up more often and sleep less deeply. According to the National Sleep Foundation, studies show that you’re likely to sleep better in a room that’s on the cool side. So try turning down the thermostat and/or keeping a fan on hand
  • As evening approaches, cut out the caffeine. Caffeine has a wake-up effect that lasts. It’s best to avoid it well before bedtime. That includes not just coffee, but also tea, colas, and/or chocolate
  • Avoid alcohol before bed. That “nightcap” may make you sleepy at first. But as your blood alcohol levels drop, it has the opposite effect. You may find yourself wide awake
  • Exercise in the afternoon. Afternoon exercise may help you sleep more deeply. But exercising before bedtime can make it harder to fall asleep
  • Nap if you need to, but be brief. If you’re so tired that you must take a nap, set the alarm for 20 minutes. Snooze any longer and you may have trouble falling asleep at night · Make your room a relaxing refuge. Treat yourself to comfortable bedclothes and snugly pajamas. A white-noise machine or fan may help you fall asleep to a soothing background sound
  • Develop a relaxing bedtime routine. Reading helps some people fall asleep. So does listening to soft music. Do whatever works for you. But try to follow the same routine every night to signal your body that it’s time for sleep

 

Fibromyalgia Diet

So what about your diet? There’s a lot of information on the Internet about “Fibromyalgia diets.” But many researchers say there is no perfect eating plan for Fibromyalgia relief. Talk to your doctor about what is right for your needs and your lifestyle. Let your doctor know if you have eliminated any foods from your diet. Also, be sure to tell your doctor if you are taking any nutritional supplements. They can possibly interact with any medications you may be taking.



Diabetic Neuropathy is a disorder associated with diabetes mellitus. These conditions are thought to result from diabetic micro vascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic Neuropathy include third nerve palsy; Mononeuropathy; Mononeuropathy multiplex; Diabetic Amyotrophy; a painful Polyneuropathy; Autonomic Neuropathy; and Thoracoabdominal Neuropathy. Diabetes is the leading known, cause of Neuropathy in developed countries, and Neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes patients. It is estimated that the prevalence of Neuropathy in diabetes patients is approximately 20%. Diabetic Neuropathy is implicated in 50-75% of non-traumatic amputations.

Diabetic nerve pain, or painful diabetic peripheral neuropathy, is a separate condition from diabetes. It is the result of damaged nerves caused by uncontrolled blood sugar over time or fluctuations in blood sugar. This nerve damage is what causes the pain in your feet and hands. You can’t undo the damage that has already occurred. But there are 2 things you can do.

1.

Take control of your blood sugar

If you have diabetes, it is important to control your blood sugar. Your doctor has probably tested your A1C level before. This measures your average blood sugar level over the past 3 months. The American Diabetes Association recommends a goal of 7% or lower.

2.

Do something to relieve diabetic nerve pain

Controlling your blood sugar can prevent further nerve damage. However, that won’t reverse the damage or relieve your diabetic nerve pain. And since nerve pain isn’t like other kinds of pain, it may require a diabetic nerve pain treatment.

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and germs (“foreign invaders,” like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues (“auto” means “self”) and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

  • Lupus is not contagious, not even through sexual contact. You cannot “catch” lupus from someone or “give” lupus to someone.
  • Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.
  • Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.
  • Our research estimates that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.
  • It is believed that 5 million people throughout the world have a form of lupus.
  • Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.
  • Women of color are 2-3 times more likely to develop lupus.
  • People of all races and ethnic groups can develop lupus.
  • More than 16,000 new cases of lupus are reported annually across the country.

What are the Symptoms of Lupus

Because lupus can affect so many different organs, a wide range of symptoms can occur. These symptoms may come and go, and different symptoms may appear at different times during the course of the disease.

The most common symptoms of lupus, which are the same for females and males, are:

  • headaches
  • extreme fatigue (tiredness)
  • painful or swollen joints
  • fever
  • anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
  • swelling (edema) in feet, legs, hands, and/or around eyes
  • pain in chest on deep breathing (pleurisy)
  • butterfly-shaped rash across cheeks and nose
  • sun- or light-sensitivity (photosensitivity)
  • hair loss
  • abnormal blood clotting
  • fingers turning white and/or blue when cold (Raynaud’s phenomenon)
  • mouth or nose ulcers

Many of these symptoms occur in other illnesses besides lupus. In fact, lupus is sometimes called “the great imitator” because its symptoms are often like the symptoms of rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and a number of heart, lung, muscle, and bone diseases.

 


Mononeuropathy is damage to a single nerve or nerve group, which results in loss of movement or sensation.

Mononeuropathy is most often caused by injury, although systemic (body wide) disorders may cause isolated nerve damage. For example, Mononeutitis multiplex. Prolonged pressure on the nerve due to swelling or injury can result in Mononeuropathy. The covering of the nerve ( Myelin Sheath) or part of the nerve cell (the axon) is destroyed. This damage slows or prevents signaling through the nerves.



Multiple Sclerosis, also commonly called MS, is a disease that affects a person’s brain and spinal cord. Like in an autoimmune disease, the body affects itself by attacking the proteins in the protective coating around the nerves in the brain and spinal cord. The scarring caused by these attacks is called sclerosis. Eventually, this will impede the nerve impulses sent from the brain to the body and signals muscles to move and feel. MS is a chronic disease that’s typically progressive and sometimes debilitating.

Types

  • Relapsing-remitting MS (RRMS) is found in 85% of MS cases, where the person has a partial or total recovery after each attack.
  • Secondary-progressive MS (SPMS) starts out as RRMS and progresses.
  • Primary-progressive MS (PPMS) starts out as a progressive disease with little relief.

Symptoms

As the nerves that get affected vary, the symptoms also vary accordingly.

  • Some are vision problems like double vision or blurred vision, loss of vision
  • numbness or weakness in limbs
  • tingling
  • pain
  • fatigue
  • dizziness
  • tremor
  • a shaky gait
  • lack of coordination
  • shock-like pain when moving the head
  • Muscles stiffness
  • paralysis
  • bladder and bowel control
  • impaired sexual function
  • slurred speech



Neuralgia is pain that follows the path of a specific nerve.

The causes of neuralgia vary. Chemical irritation, inflammation, trauma (including surgery), compression of nerves by nearby structures (for instance, tumors), and infections may all lead to neuralgia. In many cases, however, the cause is unknown.

Neuralgia is most common in elderly persons, but it may occur at any age. Diabetes is another common cause of neuralgia. Diabetes damages the tiny arteries that supply circulation to the nerves, resulting in nerve fiber malfunction and sometimes nerve loss.

Diabetes can produce almost any neuralgia nearly anywhere in the body, including Trigeminal Neuralgia.



Polyneuropathy accounts for the greatest number of Peripheral Neuropathy cases. It occurs when many peripheral nerves throughout the body malfunction at the same time. Polyneuropathy can have a wide variety of causes, including exposure to certain toxins, poor nutrition (particularly vitamin B deficiency), and complications from diseases such as cancer or kidney failure.

One of the most common forms of chronic Polyneuropathy is diabetic Neuropathy, a condition that occurs in people with diabetes. It is the result of poorly controlled blood sugar levels. Though less common, diabetes can also cause Mononeuropathy, often characterized by weakness of the eye or of the thigh muscles.



Post Surgical Pain is a complex response to tissue trauma during surgery that stimulates hypersensitivity of the central nervous system. The result is pain in areas not directly affected by the surgical procedure. Postoperative pain may be experienced by an inpatient or outpatient. It can be felt after any surgical procedure, whether it is minor dental surgery or a triple-bypass heart operation.


Shoulder Hand Syndrome is a syndrome characterized by severe constant intractable pain in the shoulder and arm, limited joint motion, diffuse swelling of the distal part of the upper extremity, fibrosis and atrophy of muscles, and decalcification of underlying bones; the cause is not well understood; it is similar to, or may be a form of, Causalgia. Also known as hand-shoulder syndrome.


SIP/ Sympathetically Independent Pain Some patients will present with the classic symptoms of RSD; however, sympathetic blockade does not take away their pain. This may be due in part to a disease process that we don’t understand, or it may be that these patients have progressed so far along in their disease that the disease has become centrally maintained only (there are now changes in the nerve cells in the spinal cord), and sympathetic blocks have little or no effect on it whatsoever. Often SIP is seen later in the development or progression of RSD patients.


SMP/ Sympathetically Maintained Pain One of the factors common to RSD and Causalgia is that almost all patients will respond to sympathetic blockade (blockage of the sympathetic nerves supplying the area with local anesthetics), which will take away their pain for a variable length of time. However, many patients do not present with the full-blown syndrome that includes all the signs listed above, but do respond to a sympathetic blockade. For example, a patient may come to a doctor with pain only. There may not be Allodynia, there may not be swelling, there may not be muscle spasms or any of the other factors relevant to the diagnosis of RSD. However, a sympathetic blockade takes away their pain. In fact, patients can present with any of the symptoms of RSD on their own. They can present with just swelling, just Allodynia, just burning pain, muscle spasm, etc., and if these people respond to sympathetic blocks, they are then defined as having sympathetically maintained pain or sympathetically maintained pain syndrome sympathetically maintained pain.

Patient Power® is devoted to bringing significant news from medical conferences to patients living with the conditions covered. Our programs are posted on our Patient Power website, on medical center and advocacy group sites, and picked up by multiple sites including the Power of Pain Foundation for professionals and consumer facing the daily challenges of chronic care conditions involving Neuropathy pain.


[/accordions]