Neuropathy

Neuropathy is the medical term for “nerve damage” that usually causes pain or numbness in either the feet or hands or both. Sometimes the main symptom is tingling or pins and needles and pain. There are lots of different types of neuropathy- It can involve just one nerve (mononeuropathy) or several nerves (polyneuropathy), it may involve the longest nerves in the body such as those in the feet (length dependent neuropathy) or there may be nerves involved from both arms and legs or just arms (non-length dependent neuropathy). When you have nerves that are trapped in the back or neck that causes nerve pain in one leg or arm this is called a radiculopathy. Sometimes it feels as if there is a nerve problem- with symptoms such as numbness and tingling but it’s a problem with the muscles such as muscle spasm- whichever one you are suffering from should become apparent once your neurologist takes the history and examines you.

There are large and small fibres that control our ability to have sensation. The small fibres are the ones that are responsible for pain (often sharp or burning), tingling or numbness sensations that you may be experiencing. When nerves are damaged they can either be too excitable where they will cause pain or not excitable enough where they will cause numbness or lack of sensation. The large fibres help control balance- as in your ability to feel where your feet are on the ground. When large fibres are damaged you may notice that your balance is poor especially in the dark or on an uneven surface.

Every nerve is composed of thousands of nerve fibres. Most of the nerves are insulated with a substance called myelin. When you experience nerve damage it can be due to loss of the nerve fibres (much more common) or loss of the insulation surrounding the nerve fibre (far less common). Once you explain your symptoms to your neurologist they should have an idea of which type of nerve damage you are suffering from.

• The important features of neuropathy are:
• Where the abnormal sensation is (like in your arms, hands, legs, feet) and is it just one arm, just one leg or is it more symmetrical?
• Is it there all the time or does it come and go- and if it comes and goes is there any particular trigger such as walking, standing etc.?
• Is it a painful/burning sensation or a numbness?
• How long it has been present?
• Is it getting worse over time or staying the same?
• Is there any weakness associated with the numbness and tingling- for example does your foot drop as you try to walk or do you feel like you are dragging your leg as you walk? Or do you have trouble opening jars?

When you present to your neurologist with symptoms of what could be a neuropathy a thorough history and examination should ensue. The answers to the above questions will be very useful. Once the type of neuropathy you are suffering from has been established a diagnostic and treatment plan will be put in place.