Condition
Peripheral Neuropathy
Peripheral neuropathy is damage to the peripheral nerves that causes numbness, tingling, pain, or weakness, usually in the hands and feet.
Overview
Aetiology
Alcoholism
Chronic excessive alcohol use damages peripheral nerves both directly and through the associated nutritional deficiencies, particularly of B vitamins.
Autoimmune Conditions
- Sjogren’s syndrome
- Lupus
- Rheumatoid arthritis
- Guillain-Barre Syndrome
- Chronic inflammatory demyelinating polyneuropathy
- Necrotizing vasculitis
Diabetes
Diabetes is the most common cause of peripheral neuropathy; more than half of people with diabetes will develop nerve damage at some point, typically affecting the feet first.
Heavy Metal or other Toxic Exposure
A number of substances, including heavy metals, industrial chemicals, and certain medications, can damage peripheral nerves and result in neuropathy.
Infection
- Lyme Disease
- Shingles
- HIV
- Epstein-Barr
- Herpes virus
- Hepatitis C
- Leprosy
- Diptheria
Traumatic Injury
Physical injury to nerves, common in sporting and motor vehicle accidents, can cause localized neuropathy through compression, stretching, or severance of the nerve.
Vitamin Deficiencies
Deficiency of B vitamins, especially B1, B6, and B12, impairs nerve function and is a recognized cause of peripheral neuropathy.
Presentation
Symptoms
Symptoms typically begin in the feet and hands and may include numbness, tingling or “pins and needles”, burning or sharp pain, and increased sensitivity to touch. Motor involvement causes muscle weakness, cramping, and loss of coordination, while autonomic involvement can affect blood pressure, digestion, and bladder function.
Assessment
Diagnostic Considerations
- Electrodiagnostic testing to assess electrical activity in the nerves.
Blood Tests
- Vitamin B12 and folate levels
- Thyroid Function Testing
- Liver function testing
- Kidney function testing
- Blood glucose testing
- Antibodies to nerve components
- Antibodies related to celiac disease
- Lyme disease
- HIV/AIDS
- Hepatitis B and C
Assessment
Differential Diagnosis
- Diabetes mellitus
Comorbidities/Risk Factors
- Burns and skin trauma
- Infection
- Falls/bone fractures
- Diabetes mellitus
The Herbs
Materia Medica (4)
Herbs traditionally or clinically used for peripheral neuropathy.
Supplementation
Supplementation (5)
Supplements, nutrients and compounds used for peripheral neuropathy.
Acetyl-L-Carnitine (ALCAR)
Amino acid derivative
The acetylated form of L-carnitine, taken for mood, brain energy in aging, and nerve and sperm support — best evidenced where carnitine status or nerve function is already low.
Agmatine (sulfate)
Amino acid metabolite
Agmatine is a decarboxylated-arginine metabolite studied mainly for neuropathic pain, with proposed roles in mood and neuroprotection.
ARA-290 (Cibinetide)
Non-erythropoietic EPO-derived peptide (innate repair receptor agonist)
An 11-amino-acid erythropoietin-derived peptide that activates the innate repair receptor without raising red-cell count; tested in small trials, never approved.
Vitamin B1 (Thiamine)
Vitamin (water-soluble)
Vitamin B1 (thiamine) is an essential water-soluble B vitamin required for carbohydrate energy metabolism and normal nerve function.
Vitamin B12
Vitamin
Cobalamin — the cobalt-containing B vitamin needed for red-blood-cell formation, DNA synthesis and the upkeep of the nervous system; found almost only in animal foods.