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  • Dr Ashleigh Bhanjan

Unraveling the Mysteries of Peripheral Neuropathy : Symptoms, Treatments, and Promising Advances

Updated: Aug 25, 2023


Introduction


Peripheral neuropathy is a debilitating condition that affects millions of people worldwide. It occurs when the peripheral nerves, which transmit signals between the brain, spinal cord, and the rest of the body, become damaged.


In this comprehensive blog, we will dive deep into understanding peripheral neuropathy, its symptoms, current treatment options, and explore a promising therapy: photobiomodulation therapy. We will also discuss the latest clinical human trials in the field.

 

What is Peripheral Neuropathy?


Peripheral neuropathy refers to a range of conditions that lead to dysfunction or damage of the peripheral nerves. It can occur due to various causes, including diabetes, autoimmune diseases, infections, genetic disorders, medication side effects, and more. The damage can disrupt the normal functioning of the nerves, leading to a wide array of symptoms.


 

Symptoms of Peripheral Neuropathy


The symptoms of peripheral neuropathy can vary depending on the affected nerves, but commonly include:


- Tingling or numbness in the hands, feet, or other extremities

- Burning or shooting pain

- Muscle weakness or paralysis

- Loss of coordination and balance

- Sensitivity to touch or temperature

- Changes in skin, hair, or nail health

- Digestive issues

- Sexual dysfunction





 

What are the different types of neuropathy and their underlying mechanisms ?

Neuropathy is a disorder of the peripheral nervous system that can cause a variety of symptoms. There are different types of neuropathy, and their underlying mechanisms can vary depending on the cause.


Here are some of the different types of neuropathy and their underlying mechanisms:


1. Peripheral neuropathy : This type of neuropathy is caused by damage to the peripheral nerves, which are responsible for transmitting sensations, controlling muscles, and regulating automatic functions of the body. Peripheral neuropathy can be caused by a wide range of factors, including diabetes, physical injury to the nerves, viral infections, and inflammatory conditions. The exact pathophysiology of peripheral neuropathy is contingent on the underlying disease, but it can involve segmental demyelination, Wallerian and axonal degeneration, and molecular changes in nociceptive neurons.


2. Diabetic neuropathy: This is a complication of diabetes that can lead to problems throughout the body. High blood sugar causes chemical changes in nerves and impairs the nerves’ ability to transmit signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves. Other factors that may contribute to diabetic neuropathy include high triglyceride and cholesterol levels, being overweight or obese, and genetic traits that make some people more susceptible to nerve disease than others. The symptoms of diabetic neuropathy depend on the type of neuropathy and on which and how many nerves are affected


3. Neuropathic pain syndromes: This type of neuropathy is characterized by chronic pain disorders caused by a lesion or disease of the parts of the nervous system that normally signal pain. The pain is underpinned by various distinct pathophysiological mechanisms in the peripheral and central nervous systems. In some patients, the nerve lesion triggers molecular changes in nociceptive neurons, which become abnormally sensitive and develop pathological spontaneous activity. The treatment of neuropathic pain is still unsatisfactory, and a new hypothetical concept has been proposed, in which pain is analyzed on the basis of underlying mechanisms


In conclusion, neuropathy is a complex disorder that can have different types and underlying mechanisms depending on the cause. Understanding the underlying mechanisms of neuropathy is important for developing effective treatments for this disorder.


 

Nerve conduction studies

Nerve conduction studies (NCS) are a type of electrodiagnostic testing that can help diagnose issues with peripheral nerves, such as peripheral neuropathy and nerve compression syndromes. Here are some key points about nerve conduction studies:

  • Nerve conduction studies involve placing small metal wires called electrodes on the skin that release tiny electric shocks to stimulate the nerves. The speed and strength of the nerve signal is measured.

  • Nerve conduction studies may be diagnostically helpful in patients suspected of having almost any peripheral nervous system (PNS) disorder, including disorders of nerve roots, peripheral nerves, muscle, and neuromuscular junction. Cranial nerves and spinal cord function may also be assessed.

  • The diagnosis of peripheral neuropathy can be supported by electrodiagnostic testing, which includes nerve conduction studies and needle electromyography.

  • Peripheral neuropathy can be divided into those that primarily affect axons and those that primarily affect the myelin sheath. Axon loss is seen in axonal neuropathies, while demyelination is seen in demyelinating neuropathies. Nerve conduction studies can help differentiate between the two types of neuropathies.

  • Whether a neuropathy is axonal or demyelinating has implications for medical work-up and treatment options. Nerve conduction studies are required to make this distinction.

  • A nerve conduction study works by testing the transmission of electrical signals in nerves, especially the speed at which they travel and their strength. In healthy nerves, electrical signals can travel up to 120 miles per hour. If a nerve is damaged, the current will be slower and weaker.

In conclusion, nerve conduction studies are an important diagnostic tool for evaluating peripheral neuropathy and other PNS disorders. They can help differentiate between axonal and demyelinating neuropathies, which has implications for medical work-up and treatment options.

 

What should I expect during a nerve conduction study ?

A nerve conduction study (NCS) is a diagnostic test that evaluates the function of peripheral nerves. Here is what you can expect during a nerve conduction study:




  • You will be asked to remove any clothing, jewelry, hairpins, eyeglasses, and hearing aids that may interfere with the test.

  • You will be asked to sit or lie down on a table or bed.

  • A healthcare provider will attach one or more electrodes to a certain nerve or nerves using tape or a paste. The electrodes, called stimulating electrodes, deliver a mild electrical pulse.

  • Another electrode, called a recording electrode, will be placed on your skin over the nerve being tested.

  • The healthcare provider will then place a stimulating electrode away from the recording electrode, at a known distance.

  • A mild and brief electrical shock, given through the stimulating electrode, will stimulate your nerve.

  • The other electrode records the resulting electrical activity, which is displayed as wavy and spiky lines on a video screen.

  • The activity may also be recorded and sent to an audio speaker. You may hear popping sounds when you contract your muscle.

  • This process is repeated for each nerve being tested.

  • The speed is then calculated by measuring the distance between electrodes and the time it takes for electrical impulses to travel between electrodes.

  • A related test that may be done is an electromyography (EMG), which measures the electrical activity in your muscles. It is often done at the same time as an NCS.

The entire procedure usually takes about 20-30 minutes to complete. In some cases, nerves may be tested in multiple locations, which can make the procedure take longer.


Overall, having a nerve conduction study is an effective way to allow your healthcare provider to diagnose issues with your peripheral nerves and determine the presence, location, and extent of diseases that damage the nerves and muscles.


 

Current Treatment Options and Medications


Treatment options for peripheral neuropathy aim to address the underlying cause, alleviate symptoms, and prevent further nerve damage.


These may include:


Medications : Doctors may prescribe pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants, or opioids to manage the neuropathic pain.


Physical therapy : Exercises, stretching, and strength training can improve muscle weakness and flexibility while enhancing balance.


Transcutaneous electrical nerve stimulation (TENS) : This therapy uses low-level electrical currents to block pain signals and provide temporary relief.


Lifestyle modifications : Managing blood sugar levels, maintaining a healthy diet rich in vitamins B12 and D, quitting smoking, and limiting alcohol consumption can all play a crucial role in managing peripheral neuropathy.


There is ongoing research into treatments for peripheral neuropathy, ranging from evaluating the effectiveness of photon stimulation to the use of photobiomodulation therapy

 

Introduction to Photobiomodulation Therapy


Also known as low-level laser therapy (LLLT), photobiomodulation therapy is an emerging treatment for peripheral neuropathy.





It involves exposing affected areas to low-intensity light, typically through laser or LED devices. These light waves penetrate the skin and stimulate cellular function, promoting nerve regeneration, reducing inflammation, and relieving pain.


 

Promising Advances in Photobiomodulation Therapy


The use of photobiomodulation therapy has shown promising results in the treatment of peripheral neuropathy.



Recent clinical human trials have shed light on the efficacy of this therapy, with encouraging outcomes such as:


  1. Reduced pain levels : Photobiomodulation therapy has significantly decreased pain intensity in patients, both during treatment sessions and in the long term.

  2. Improved nerve function : Studies have reported enhanced nerve conduction and regeneration, leading to restored sensory perception and improved coordination.

  3. Reduced inflammation : Low-level light wavelengths have shown beneficial anti-inflammatory effects, aiding in the reduction of peripheral nerve inflammation.

  4. Non-invasiveness and safety : Photobiomodulation therapy is a non-invasive treatment option with minimal side effects, making it an attractive alternative to traditional medications.


 

Latest Clinical Human Trials, using PBMT

  1. A randomized clinical trial showed that four treatments with photon stimulation resulted in significant improvements in some pain qualities, sensation, and quality of life outcomes in patients with diabetic peripheral neuropathy.

  2. A systematic review and meta-analysis of the effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes showed promising results.

  3. A randomized phase II trial suggested that laser PBM may provide meaningful symptom benefit in patients with established chemotherapy-induced peripheral neuropathy.

  4. A randomized, placebo-controlled pilot trial showed that PBM therapy may be effective in preventing chemotherapy-induced peripheral neuropathy.

  5. A machine learning-based severity prediction tool for diabetic sensorimotor polyneuropathy using Michigan neuropathy screening instrumentations was developed.

  6. A systematic review was conducted on pharmacological and non-pharmacological interventions for the prevention of diabetic peripheral neuropathy complications and treatment of diabetic peripheral neuropathy symptoms.

  7. The use of photobiomodulation therapy for the prevention of chemotherapy-induced peripheral neuropathy was studied in a randomized, placebo-controlled pilot trial.

In conclusion, peripheral neuropathy is a disorder of nerve(s) apart from the brain and spinal cord that can cause a variety of symptoms. The treatment for peripheral neuropathy depends on its cause, and there are several options available, including the use of photobiomodulation therapy.


Ongoing research is being conducted to evaluate the effectiveness of PBM therapy in treating peripheral neuropathy.


 

Conclusion


Peripheral neuropathy is a complex condition that greatly impacts the quality of life for those affected. While current treatments focus on symptom management and addressing underlying causes, photobiomodulation therapy presents a promising avenue for comprehensive and effective treatment.


With ongoing research and the latest clinical human trials, this innovative therapy offers hope for a brighter future for individuals battling peripheral neuropathy.


Disclaimer: The content in this blog is intended for informational purposes only and should not replace professional medical advice.
Always consult with a healthcare provider before starting any new treatment or making changes to existing treatments.

 

References


1. National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy Fact Sheet. Accessed from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet



3. American Association of Neuromuscular & Electrodiagnostic Medicine. Phototherapy for Pain Relief: A Systematic Review. Accessed from: https://www.aanem.org/Patients/About-Neuromuscular-Electrodiagnostic-Medicine/Conditions-Treated/Phototherapy-for-Pain-Relief


4. National Center for Biotechnology Information. Photobiomodulation Therapy for the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review. Accessed from: https://pubmed.ncbi.nlm.nih.gov/33065688/







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