Polyneuropathy, which is also generally called peripheral neuropathy, is when many peripheral nerves are affected.
The nerves outside of the brain and spinal cord are peripheral nerves. They relay information from the other areas of the body and the central nervous system ( CNS). The CNS is composed of the brain and the spinal cord.
Polyneuropathy affects many nerves at the same time in various areas of the body. Only one nerve is impaired in cases of mononeuropathy.
Nerves responsible for feeling (sensory neuropathy), movement (motor neuropathy), or both (sensorimotor neuropathy) may be impaired by polyneuropathy.
The autonomic nerves responsible for the regulation of functions such as digestion, bladder, blood pressure , and heart rate can also be impaired.
The National Institute of Neurological Disorders and Stroke (NINDS) reports that about 20 million people in the United States have a form of peripheral neuropathy, but the precise number of people with polyneuropathy is not known, although most of them have polyneuropathy.
Types
Peripheral neuropathy has more than 100 forms, and most of them are polyneuropathies.
Each type is defined according to the type of damage to the nerve, the underlying cause, and the effects it causes.
In individuals with diabetes, for example, diabetic neuropathy occurs, while idiopathic neuropathy tends to have no known cause.
Polyneuropathy has three main patterns:
- Chronic symmetrical peripheral neuropathy: Most polyneuropathies are chronic and develop over many months.
- Multiple mononeuropathy: There is damage to at least two separate nerve areas.
- Acute symmetrical peripheral neuropathy: This is rare. The most common cause is Guillain-Barré syndrome, a condition that can be fatal.
Some neuropathies can take years to evolve, but within hours to days of onset, others become serious.
Causes and risk factors
Polyneuropathy can be caused by a number of medical conditions and other causes, including:
- Diabetes: This can be a significant risk factor, especially if blood glucose levels are poorly controlled. One study of more than 1,400 people with type 2 diabetes found that every fifth person had diabetic neuropathy.
- Alcohol abuse: Alcohol can damage nerve tissue, and alcohol abuse is often associated with nutritional deficiencies that contribute to neuropathy.
- Autoimmune conditions: The immune system attacks the body, causing damage to nerves and other areas. Conditions include Sjogren’s syndrome, celiac disease, Guillain-Barré syndrome, rheumatoid arthritis, and lupus.
- Bacterial or viral infections: Certain infections can lead to neuropathy, including Lyme disease, shingles, hepatitis B, hepatitis C, and HIV.
- Bone marrow disorders: Examples of these include abnormal proteins in the blood, some forms of bone cancer, and lymphoma.
- Exposure to toxins: Toxic neuropathy may be caused by exposure to industrial chemicals such as arsenic, lead, mercury, and thallium. Drug or chemical abuse is also a risk factor.
- Hereditary disorders: Certain conditions, such as Charcot-Marie-Tooth disease, are forms of hereditary neuropathy.
- Hypothyroidism: An underactive thyroid may lead to polyneuropathy, although this is uncommon.
- Kidney disease: Uremic neuropathy is a form of polyneuropathy that affects 20 percent to 50 percent of people with kidney disease, according to the Center for Peripheral Neuropathy.
- Liver disease: Research indicates that peripheral neuropathy is very common in those with cirrhosis of the liver.
- Medications: Chemotherapy, along with some drugs used to treat HIV/AIDS, can cause neuropathy.
- Poor nutrition: Deficiencies of vitamins B-1, B-6, B-12, and E may lead to polyneuropathy, as these are vital for nerve health.
- Physical trauma or injury: Repetitive motion such as typing, accidents, or other injuries can damage peripheral nerves.
There’s no established cause for certain forms of polyneuropathy. These are known as idiopathic neuropathy.
Symptoms
Depending on which nerves are affected, polyneuropathy may cause a number of symptoms.
Sensory or motor nerve damage-related signs may include:
- tingling
- numbness
- pins and needles
- difficulty using the arms, legs, hands, or feet
- increased pain (such as burning, stabbing, freezing, or shooting pains)
- sleep problems due to night-time pain
- inability to feel pain
- extreme sensitivity to touch
- inability to sense temperature changes
- lack of coordination
- increased episodes of falling
- changes to the skin, hair, or nails
- foot and leg ulcers
- skin and nail infections
- muscle weakness
- muscle twitching
Symptoms associated with autonomic nerve damage include:
- heat intolerance
- unusual sweating
- bladder problems or incontinence
- digestive problems
- dizziness
- blood pressure or pulse abnormalities
- difficulty eating or swallowing
- difficulty breathing
- inability to sense temperature changes
- lack of coordination
Other conditions with similar symptoms
Different signs can be seen in fibromyalgia and polyneuropathy, although the cause of fibromyalgia remains unclear.
Similarities in multiple sclerosis and peripheral neuropathy often occur.
Conditions associated with polyneuropathy
There are several polyneuropathy-associated disorders, including:
- amyloidosis
- celiac disease
- Charcot-Marie-Tooth Disease
- diabetes
- diphtheria
- Guillain-Barré Syndrome
- hepatitis B
- hepatitis C
- HIV/AIDS
- kidney disease
- hypothyroidism
- leprosy
- liver disease
- Lyme disease
- lymphoma
- osteosclerotic myeloma
- pernicious anemia (vitamin B-12 deficiency)
- radiculopathy
- rheumatoid arthritis
- shingles
- Sjogren’s syndrome
Complications
Common complications associated with polyneuropathy include:
- Falls and injury: A lack of balance and coordination, along with muscle weakness, can lead to an increase in falls and injuries sustained from falls.
- Burns and skin damage: Numbness and an inability to feel pain or temperature changes can lead to accidental burns, cuts, and other damage to the skin.
- Infections: Injuries, burns, and cuts, particularly on the legs and feet, can go unnoticed, leading to an increased risk of infection.
Diagnosis
Diagnosis is based on family records, neurological assessment, and a physical examination. Tests can be prescribed, based on the symptoms of the person.
A thorough analysis of all conditions, lifestyle variables, and family history will be done by the doctor.
They will check the height , weight, pulse, blood pressure , and temperature of the patient as well. In order to rule out possible physiological factors, the heart, lungs, and abdomen can also be tested.
To check for diabetes, thyroid activity, immune function, nutrient deficiencies, and other conditions that may trigger polyneuropathy, blood tests might be required.
Few basic tests can be done to evaluate reflexes, muscle strength, temperature sensitivity and other stimuli, balance, and posture.
Other tests
Some examinations that can be used for polyneuropathy diagnosis include:
- MRI or CT scan: These imaging techniques look for tumors, herniated disks, or other abnormalities that may be affecting nerve function.
- Electro-diagnostic tests: These non-invasive tests measure the electrical activity in the muscles and nerves, helping to detect nerve damage. Examples are electromyography and nerve conduction velocity.s
- Biopsies: The doctor may remove a small portion of a nerve, or sample of the skin, to test for abnormalities in nerve function or nerve endings.
Treatment
The American Academy of Family Physicians suggests treating the underlying disease cause, correcting dietary deficiency, and striving to offer relief from symptoms of peripheral neuropathy therapy.
Medication, conventional therapies and techniques, and complementary approaches are eligible for patients.
Medications
To treat neuropathy and its effects, several different medications are available. They include:
- Medicinal drugs for associated conditions: Conditions that can induce polyneuropathy should be treated by different medications, including, as prescribed by a doctor, medicinal products. Insulin for diabetes and thyroid hormones for hypothyroidism are examples.
- Pain medication: For people with mild to severe pain, over-the-counter pain relief may be helpful. It is not appropriate to take these drugs on a long-term basis.
- Prescription drugs: Certain antidepressants can be included, such as a category of drugs named TCAs (including amitriptilyne or nortriptilyne), and another group called SNRIs can also be beneficial, such as duloxetine. Injections of corticosteroids can be used for mononeuropathy, and certain drugs for seizures, such as gabapentin or pregabalin, can benefit.
Medical therapies
A variety of medical procedures are available. They include:
- Transcutaneous electrical nerve stimulation: Electrodes send a gentle current of electricity through the skin. This can help with pain and sensitivity.
- Plasma exchange: People with inflammatory or autoimmune conditions may benefit from this therapy. The practitioner removes blood from the body, then separates antibodies and other proteins from the blood, before returning the blood to the body.
- Immune globulin therapy: Those with inflammatory and autoimmune conditions are given high levels of proteins to act as antibodies, which helps with immune function.
- Physical therapy: People with muscle weakness or coordination issues may find physical therapy helpful.
- Orthotic and other devices: Braces, canes, casts, splints, walkers, and wheelchairs may provide support and pain relief to those with neuropathy of the hands, feet, legs, and arms.
Surgery can be recommended if neuropathy is triggered by strain on a nerve.
Alternative therapies
Any patients with polyneuropathy can be given relief through alternative and supportive therapies. Examples are:
- acupuncture
- chiropractic care
- massage
- meditation
These solutions have not been commonly studied, however.
Prevention and outlook
Polyneuropathy treatment requires limiting the risk factors and controlling the underlying circumstances. An individual with polyneuropathy may not be able to eliminate all risk factors, but the risk can be minimized by certain lifestyle choices. These are:
- avoiding alcohol
- avoiding exposure to toxins, including cigarette smoke
- limiting factors that contribute to physical trauma or injury, such as repetitive actions and restrictive positions
- getting enough sleep and physical activity to support immune function
- eating a balanced diet rich in vitamins and minerals
- considering vitamin B-12 supplements if a vegan or vegetarian
Managing underlying conditions
Managing the underlying situations can help reduce the onset of the disease. Those with diabetes and other polyneuropathy-related diseases should carefully follow the care plan formulated by their physicians, as well as ensure that all check-ups are performed.
Outlook
The outlook for polyneuropathy differs and can depend on the underlying cause, the damage to the nerves and the magnitude of the damage.
Treating the root cause will result in improvements for certain persons. The damage is irreversible among others. In some cases, over time, the symptoms may get worse.
When to see a doctor
It is necessary to see a doctor if you notice some of the signs of polyneuropathy, such as fatigue, discomfort, or tingling in your hands or feet.
It is necessary to initiate a recovery plan as quickly as possible to relieve the symptoms and avoid further damage to the nerve.
