Peripheral neuropathy: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(29 intermediate revisions by 8 users not shown)
Line 1: Line 1:
{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 9850 |
  ICD10          = {{ICD10|G|64||g|60}}, {{ICD10|G|90|0|g|90}} |
  ICD9          = {{ICD9|356}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D010523 |
}}
{{Search infobox}}
{{CMG}}
__NOTOC__
__NOTOC__
{{Editor Help}}
{{Peripheral neuropathy}}


==Overview==                             


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.
{{CMG}} {{AE}} {{MMJ}}
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. People may become unable to digest food easily, maintain safe levels of blood pressure, sweat normally, or experience normal sexual function. In the most extreme cases, breathing may become difficult or organ failure may occur.
==[[Peripheral neuropathy overview|Overview]]==


Some forms of neuropathy involve damage to only one nerve and are called mononeuropathies. More often though, multiple nerves affecting all limbs are affected-called polyneuropathy. Occasionally, two or more isolated nerves in separate areas of the body are affected-called mononeuritis multiplex.
==[[Peripheral neuropathy classification|Classification]]==


In acute neuropathies, such as Guillain-Barré syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. Some people may have periods of relief followed by relapse. Others may reach a plateau stage where symptoms stay the same for many months or years. Some chronic neuropathies worsen over time, but very few forms prove fatal unless complicated by other diseases. Occasionally the neuropathy is a symptom of another disorder.
==[[Peripheral neuropathy pathophysiology|Pathophysiology]]==


In the most common forms of polyneuropathy, the nerve fibers (individual cells that make up the nerve) most distant from the brain and the spinal cord malfunction first. Pain and other symptoms often appear symmetrically, for example, in both feet followed by a gradual progression up both legs. Next, the fingers, hands, and arms may become affected, and symptoms can progress into the central part of the body. Many people with diabetic neuropathy experience this pattern of ascending nerve damage.
==[[Peripheral neuropathy causes|Causes]]==


==Types==
==[[Peripheral neuropathy differential diagnosis|Differentiating Peripheral Neuropathy from other Diseases]]==


More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves-motor, sensory, or autonomic-that are damaged. Motor nerves control movements of all muscles under conscious control, such as those used for walking, grasping things, or talking. Sensory nerves transmit information about sensory experiences, such as the feeling of a light touch or the pain resulting from a cut. Autonomic nerves regulate biological activities that people do not control consciously, such as breathing, digesting food, and heart and gland functions. Although some neuropathies may affect all three types of nerves, others primarily affect one or two types. Therefore, physicians may use terms such as predominantly motor neuropathy, predominantly sensory neuropathy, sensory-motor neuropathy, or autonomic neuropathy to describe a patient's condition.
==[[Peripheral neuropathy epidemiology and demographics|Epidemiology and Demographics]]==


Often the form of neuropathy is further broken down as to cause (see below), or other type, such as [[small fiber peripheral neuropathy]], which is [[idiopathic]].
==[[Peripheral neuropathy risk factors|Risk Factors]]==


There are other less common forms of neuropathy, for example [[Enteric Neuropathy]]
==[[Peripheral neuropathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


Peripheral neuropathy is not a disease in itself, but a symptom or a complication of other underlying conditions. Peripheral nerves, either singly or in groups, are damaged through lack of circulation, chemical imbalance, trauma, or other factors.<ref>Ruth Werner, LMP, NCTMB A Massage Therapist's Guide to Pathology; Third Edition Copyright 2005</ref>
==Diagnosis==
[[Peripheral neuropathy history and symptoms|History and Symptoms]] | [[Peripheral neuropathy physical examination|Physical Examination]]| [[Peripheral neuropathy laboratory findings|Laboratory Findings]] | [[Peripheral neuropathy CT|CT]] | [[Peripheral neuropathy MRI|MRI]] | [[Peripheral neuropathy other imaging findings|Other Imaging Findings]] | [[Peripheral neuropathy other diagnostic studies|Other Diagnostic Studies]]


Peripheral neuropathies may either be ''symmetrical'' and ''generalized'' or ''focal'' and ''multifocal'', which is usually a good indicator of the cause of the peripheral nerve disease.
==Treatment==
[[Peripheral neuropathy medical therapy|Medical Therapy]] | [[Peripheral neuropathy surgery|Surgery]] | [[Peripheral neuropathy primary prevention|Primary Prevention]] | [[Peripheral neuropathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Peripheral neuropathy future or investigational therapies|Future or Investigational Therapies]]


=== Generalized peripheral neuropathy ===
== Case Studies ==
Generalized peripheral neuropathies are symmetrical, and usually due to various systematic illnesses and disease processes that affect the [[peripheral nervous system]] in its entirety.
[[Peripheral neuropathy case study one|Case #1]]
They are further subdivided into several categories:


* '''[[Distal axonopathy|Distal axonopathies]]''' are the result of some metabolic or toxic derangement of [[neuron]]s. They may be caused by metabolic diseases such as [[diabetes]], [[renal failure]], deficiency syndromes such as [[malnutrition]] and [[alcoholism]], or the effects of [[toxin]]s or [[medication|drugs]].
==Neuropathy Related Organizations==
 
* '''[[Myelinopathy|Myelinopathies]]''' are due to a primary attack on [[myelin]] causing an acute failure of impulse conduction. The most common cause is [[acute inflammatory demyelinating polyneuropathy]] (AIDP; ''aka'' [[Guillain-Barré syndrome]]), though other causes include [[chronic inflammatory demyelinating polyneuropathy]] (CIDP), [[genetics|genetic]] metabolic disorders (''e.g.'', [[leukodystrophy]]), or toxins.
 
* '''[[Neuronopathy|Neuronopathies]]''' are the result of destruction of [[peripheral nervous system]] (PNS) [[neuron]]s. They may be caused by [[motor neurone disease]]s, sensory neuronopathies (''e.g.'', [[Herpes zoster]]), toxins or [[autonomic nervous system|autonomic]] dysfunction. [[Neurotoxicity|Neurotoxins]] may cause neuronopathies, such as the [[chemotherapy]] agent [[vincristine]].
 
==Causes==
Aside from diabetes (see [[Diabetic neuropathy]]), the common causes of neuropathy are [[herpes zoster]] infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and [[autoimmune]] conditions such as [[celiac disease]], which can account for approximately 16% of small fiber neuropathy cases.<ref>
{{cite web
  | last =
  | first =
  | authorlink =
  | coauthors =
  | title = Up to 16% of Patients with Small Fiber Neuropathy May Have Celiac Disease
  | work =
  | publisher = Celiac.com
  | date =
  | url = http://www.celiac.com/st_prod.html?p_prodid=842
  | format =
  | doi =
  | accessdate = 2007-26-06 }}
</ref> Neuropathic pain is common in [[cancer]] as a direct result of the cancer on peripheral nerves (e.g., compression by a tumor), as a side effect of many [[chemotherapy]] drugs, and as a result of [[electrical injury]]. In many cases the neuropathy is "idiopathic," meaning no cause is found.  A form of spinal nerve entrapment called [[Posterior Rami Syndrome]] can led to neuropathic pain.
 
*Genetic diseases:
:*[[Friedreich's ataxia]],
:*[[Charcot-Marie-Tooth syndrome]]
*Metabolic / Endocrine:
:*[[diabetes mellitus]],
:*[[Chronic renal failure]],
:*[[porphyria]],
:*[[amyloidosis]],
:*[[liver failure]],
:*[[hypothyroidism]]
*Toxic causes:
:*[[alcoholism]],
:*[[drug]]s
:*:*[[vincristine]],
:*:*[[phenytoin]],
:*:*[[isoniazid]],
:*organic metals,
:*:*[[heavy metals]]
*Inflammatory diseases:
:*[[Guillain-Barré syndrome]],
:*[[systemic lupus erythematosus]],
:*[[leprosy]],
:*[[Sjögren's syndrome]]
*Vitamin deficiency states:
:*[[vitamin B12|vitamin B<sub>12</sub>]],
:*[[vitamin A]],
:*[[vitamin E]],
:*[[thiamin]]
*Others:
*malignant disease,
*[[radiation]]
 
== Complete Differential Diagnosis for Peripheral Neuropathy ==
*[[Acromegaly]]
*[[Alcoholic polyneuropathy]]
*[[Atherosclerosis]]
*[[Amyloidosis]]
*[[Botulism]]
*[[Brucellosis]]
*[[Carpal Tunnel Syndrome]]
*[[Charcot-Marie-Tooth Disease]]
*Compression
*[[Diabetic polyneuropathy]]
*[[Diabetes Mellitus]]
*[[Diptheria]]
*[[Drugs]]
*[[Dysentery]]
*[[Dysproteinemia]]
*[[Fabry's Disease]]
*[[German Measles]]
*Hereditary [[Ataxia]]
*[[Herpes Zoster]]
*[[HIV]]
*[[Hypothyroidism]]
*[[Infectious Mononeucliosis]]
*[[Leukemia]]
*[[Lyme Disease]]
*[[Lymphoma]]
*[[Malaria]]
*[[Metachromatic leukodystrophy]]
*[[Multiple Myeloma]]
*[[Mycosis]]
*[[Paraneoplasia]]
*[[Paraproteinemia]]
*[[Paratyphus]]
*[[Pernicious anemia]]
*[[Polyarteritis Nodosa]]
*[[Polyrediculitis]]
*[[Porphyria]]
*Post-[[tetanus]] shot
*[[Primary biliary cirrhosis]]
*[[Refsum's Disease]]
*[[Rheumatoid Arthritis]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*[[Sjogren's Syndrome]]
*Spinal process
*[[Spotted Fever]]
*[[Sprue]]
*[[Syphillis]]
*[[Systemic Lupus Erythematosus]]
*[[Thiamine deficiency]]
*[[Trauma]]
*[[Tuberculosis]]
*[[Typhoid Fever]]
*Uremic/[[Chronic Renal Failure]]
*Viral [[Hepatitis]]
*[[Vitamin B1]] deficiency
*[[Vitamin B6]] deficiency
*[[Vitamin B12 deficiency]]
 
== Signs and symptoms ==
 
Neuropathy often results in numbness, abnormal sensations called [[dysesthesia]]s and [[allodynia]]s that occur either spontaneously or in reaction to external stimuli, and a characteristic form of pain, called neuropathic pain or neuralgia, that is qualitatively different from the ordinary [[Pain and nociception|nociceptive]] pain one might experience from stubbing a toe or hitting a finger with a hammer.
 
Neuropathic pain is usually perceived as a steady burning and/or "pins and needles" and/or "electric shock" sensations and/or tickling. The difference is due to the fact that "ordinary" pain stimulates only pain nerves, while a neuropathy often results in the firing of both pain and non-pain (touch, warm, cool) sensory nerves in the same area, producing signals that the spinal cord and brain do not normally expect to receive.
 
Those with diseases or dysfunctions of their [[peripheral nerve]]s can present with problems in any of the normal peripheral nerve functions.
 
In terms of sensory function, there are commonly ''loss of function'' (''negative'') symptoms, which include [[numbness]], [[tremor]], and [[encopresis|gait imbalance]].
 
''Gain of function'' (''positive'') symptoms include [[tingling]], [[Pain and nociception|pain]], [[itch]]ing, [[crawling]], and [[paresthesia|pins and needles]]. Pain can become intense enough to require use of opiate drugs (i.e., morphine, oxycontin).
 
Skin can become so hypersensitive that patients are prohibited from having anything touch certain parts of their body, especially the feet. People with this degree of sensitivity cannot have a bed sheet touch their feet or wear socks or shoes, and eventually become housebound.
 
Motor symptoms include ''loss of function'' (''negative'') symptoms of weakness, [[fatigue (physical)|tiredness]], heaviness, and [[gait abnormality|gait abnormalities]]; and ''gain of function'' (''positive'') symptoms of [[cramps]], tremor, and [[fasciculation]]s.
 
There is also [[Pain and nociception|pain]] in the muscles (''[[myalgia]]''), cramps, ''etc''., and there may also be [[autonomic nervous system|autonomic]] dysfunction.
 
During [[physical examination]], those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, though those with a [[pathology]] (problem) of the peripheral nerves may be perfectly normal; may show proximal weakness, as in some [[inflammatory]] [[neuropathy|neuropathies]] like [[Guillain-Barré syndrome]]); or may show focal sensory disturbance or weakness, such as in [[mononeuropathy|mononeuropathies]], [[radiculopathy|radiculopathies]] and plexopathies.
 
Common disorders of the peripheral nerves include ''focal entrapment neuropathies'' (''e.g.'', [[carpal tunnel syndrome]]), ''generalized peripheral neuropathies'' (''e.g.'', [[diabetic neuropathy]]), ''plexopathies'' (''e.g.'', [[brachial]] [[neuritis]]) and ''radiculopathies'' (''e.g.'', of [[cranial nerve]] VII; [[Facial nerve]]).
 
==Treatment of neuropathic pain==
 
Neuropathic pain can be very difficult to treat. Sometimes strong [[opioid]] analgesics  may provide only partial relief. Opioid analgesics are to be considered only as a [[tertiary]] treatment.  Several classes of medications not normally thought of as analgesics are often effective, alone or in combination with opioids and other treatments. These include [[tricyclic antidepressant]]s such as [[amitriptyline]] (Elavil®), [[anticonvulsant]]s such as [[gabapentin]] (Neurontin®) and [[pregabalin]] (Lyrica®).
 
In animal models of neuropathic pain it has been found that compounds which only block serotonin reuptake do not improve neuropathic pain.<!--
  --><ref>{{cite journal |author=Bennett G, Xie Y |title=A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man |journal=Pain |volume=33 |issue=1 |pages=87-107 |year=1988 |pmid=2837713}}</ref><!--
  --><ref>{{cite journal |author=Seltzer Z, Dubner R, Shir Y |title=A novel behavioral model of neuropathic pain disorders produced in rats by partial sciatic nerve injury |journal=Pain |volume=43 |issue=2 |pages=205-18 |year=1990 |pmid=1982347}}</ref><!--
  --><ref>{{cite journal |author=Kim S, Chung J |title=An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat |journal=Pain |volume=50 |issue=3 |pages=355-63 |year=1992 |pmid=1333581}}</ref><!--
  --><ref>{{cite journal |author=Malmberg A, Basbaum A |title=Partial sciatic nerve injury in the mouse as a model of neuropathic pain: behavioral and neuroanatomical correlates |journal=Pain |volume=76 |issue=1-2 |pages=215-22 |year=1998 |pmid=9696476}}</ref><!--
  --><ref>{{cite journal |author=Sung B, Na H, Kim Y, Yoon Y, Han H, Nahm S, Hong S |title=Supraspinal involvement in the production of mechanical allodynia by spinal nerve injury in rats |journal=Neurosci. Lett. |volume=246 |issue=2 |pages=117-9 |year=1998 |pmid=9627194}}</ref><!--
  --><ref>{{cite journal |author=Lee B, Won R, Baik E, Lee S, Moon C |title=An animal model of neuropathic pain employing injury to the sciatic nerve branches |journal=Neuroreport |volume=11 |issue=4 |pages=657-61 |year=2000 |pmid=10757496}}</ref><!--
  --><ref>{{cite journal |author=Decosterd I, Woolf C |title=Spared nerve injury: an animal model of persistent peripheral neuropathic pain |journal=Pain |volume=87 |issue=2 |pages=149-58 |year=2000 |pmid=10924808}}</ref><!--
  --><ref>{{cite journal |author=Vadakkan K, Jia Y, Zhuo M |title=A behavioral model of neuropathic pain induced by ligation of the common peroneal nerve in mice |journal=The journal of pain : official journal of the American Pain Society |volume=6 |issue=11 |pages=747-56 |year=2005 |pmid=16275599}}</ref>
Similarly, compounds that only block [[norepinephrine]] reuptake also do not improve neuropathic pain.  Compounds such as [[duloxetine]], [[venlafaxine]], and [[milnacipran]] that block both [[serotonin]] reuptake and norepinephrine reuptake do improve neuropathic pain.
Antidepressants usually reduce neuropathic pain more quickly and with smaller doses than they relieve depression.  Antidepressants therefore seem to work differently
on neuropathic pain than on depression, perhaps by activating descending norepinephrinergic and serotonergic pathways in the spinal cord that block pain signals from ascending to the brain.
 
Many of the pharmacologic treatments for chronic neuropathic pain decrease the sensitivity of [[nociceptive]] receptors, or desensitize [[C fibers]] such that they transmit fewer signals. The newer anticonvulsants gabapentin and pregabalin appear to work by blocking calcium channels in damaged peripheral neurons.  Tricyclic antidepressants may also work on sodium channels in peripheral nerves.  The anticonvulsants [[carbamazepine]] (Tegretol®) and [[oxcarbazepine]] (Trileptal®), especially effective
on [[trigeminal neuralgia]], are thought to work principally on [[sodium channels]].
 
In general, the antidepressants seem to be most effective on continuous burning pain, while the anticonvulsants seem to
work best on sudden, lancinating, "shock-like" pains that appear to involve large numbers of peripheral nerves improperly firing together.
 
In some forms of neuropathy, especially post-herpes neuralgia, the topical application of local anesthetics such as [[lidocaine]] can provide relief. A transdermal patch containing 5% [[lidocaine]] is available.  [[Ketamine]] in a transdermal gel is also frequently effective when the neuropathy is localized. Neurontin 100mg/g PLO gel is also effective for treating peripheral neuropathy, including [[Carpal Tunnel Syndrome]].  [[Capsaicin]] cream can be beneficial in several neurogenic pain disorders, which causes release of the pain neurotransmitter [[Substance P]], and eventually reduces the availability of Substance P.
 
[[Transcutaneous electrical nerve stimulation]] (TENS) is worth a trial in chronic neurogenic pain. Some pain management specialists will try acupuncture, with variable results. TENS, with certain electrical waveforms, appears to have an acupuncture-like function.
 
In some neuropathic pain syndromes, "crosstalk" occurs between descending sympathetic nerves and ascending sensory nerves. Increases in sympathetic nervous system activity result in an increase of pain; this is known as sympathetically-mediated pain. Reducing the sympathetic nerve activity in the painful region with local nerve blocks or systemic medications such as the [[alpha-blocker]] [[clonidine]] may provide relief. Other drugs, known for their ability to desensitize cardiac tissue, include [[beta-blockers]] such as [[propanolol]] and [[calcium channel blockers]] such as [[verapamil]].
 
The [[NMDA receptor]] seems to play a major role in neuropathic pain and in the development of opioid tolerance, and many experiments in both animals and humans have established that NMDA [[Receptor antagonist|antagonists]] such as [[ketamine]] and [[dextromethorphan]] can alleviate neuropathic pain and reverse opioid tolerance. Unfortunately, only a few NMDA antagonists are clinically available and their use is usually associated with unacceptable side effects.
 
Several opioids, particularly [[methadone]], have NMDA antagonist activity in addition to their μ-opioid agonist properties that seems to make them effective against neuropathic pain, although this is still the subject of intensive research and clinical study. Methadone has this property because it is a [[racemic]] mixture; one stereo-isomer is a μ-opioid agonist; the other is a NMDA antagonist.
 
A recent study showed smoking [[marijuana]] is beneficial in treating HIV-associated periphial <!--sp?
  -->neuropathy.<ref>{{cite journal |author=Abrams D, Jay C, Shade S, Vizoso H, Reda H, Press S, Kelly M, Rowbotham M, Petersen K |title=Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial |journal=Neurology |volume=68 |issue=7 |pages=515-21 |year=2007 |pmid=17296917}}</ref>
 
In addition to pharmacological treatment there are several other modalities that help some cases. While lacking double blind trials, these have shown to reduce pain and improve patient quality of life particularly for chronic neuropathic pain: Interferential Stimulation; [[Acupuncture]]; [[Meditation]]; [[Cognitive Therapy]]; and prescribed exercise.
 
In more recent years, infrared photo therapy has been used to treat neuropathic symptoms.  Photo therapy devices emit near [[infrared light]] typically at a wavelength of 890nm. This wavelength is believed to stimulate the release of [[nitric oxide]], an [[endothelium-derived relaxing factor]] into the bloodstream, thus vasodilating the capilaries and venuoles in the microcirculatory system. This increase in circulation has been shown effective in various clinical studies, to decrease pain and improve sensation in [[diabetes|diabetic]] and non-diabetic patients.{{Fact|date=June 2007}}  Note that the U.S. [[FDA]] has not approved any infrared photo therapy devices to treat neuropathy.<ref>http://www.healthlight.stirsite.com/page/page/2909659.htm</ref>
 
==Alternative medicine treatments==
 
There are 2 dietary supplements that have clinical evidence showing them to be effective treatments of diabetic neuropathy; alpha lipoic acid and benfotiamine. In several studies using a variety of dosages and routes of administration, [[alpha lipoic acid]] was found to reduce the various symptoms of peripheral diabetic neuropathy. A recent review of the published data determined “ALA should be considered as a treatment option for patients with peripheral diabetic neuropathy.” Also a recent study using orally administered alpha lipoic acid found that 600 mg once a day caused a marked reduction in the symptoms of diabetic neuropathy including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet.
[[Benfotiamine]] is a lipid soluble form of thiamine that has several placebo controlled double blind trials proving efficacy in treating neuropathy and various other diabetic comorbidities. 400 mg a day was the most commonly studied dose.
 
==See also==
*[[Nerve]]
*[[Peripheral nervous system]]
*[[Neuritis]]
*[[Neuralgia]]
*[[Small fiber peripheral neuropathy]]
*[[Phantom limb]]
*[[Phantom pain]]
*[[Posterior Rami Syndrome]]
*[[Neuropathy]]
*[[Myopathy]]
*[[Myelinopathy]]
*[[Guillain-Barré syndrome]]
 
==References==
{{Reflist|2}}
 
==Additional Resources==
 
* [http://www.dellon.com/content/view/32/5/ Dr. Lee Dellon: Pioneering Pain Relief] '''''Dr. Lee Dellon's''''' research in the pain caused by Peripheral Neuropathy and other nerve disorders is highlighted in this recent article.
 
==Neuropathy related organizations==
* [http://www.neupsig.org/ Special Interest Group on Neuropathic Pain]of the [http://www.iasp-pain.org International Association for the Study of Pain (IASP)]
* [http://www.neupsig.org/ Special Interest Group on Neuropathic Pain]of the [http://www.iasp-pain.org International Association for the Study of Pain (IASP)]
*[http://www.neuropathy.org/site/PageServer The Neuropathy Association]
*[http://www.neuropathy.org/site/PageServer The Neuropathy Association]


==External links==
==External Links==
* [http://www.nepknowmore.ca/ Nep Know More Provides Additional Help and Information on Neuropathic Pain]
*[http://www.loftusmd.com/Articles/Pain/overview.html A neuropathic series of articles from a neurologist who researches neuropathic pain]
*[http://www.loftusmd.com/Articles/Pain/overview.html A neuropathic series of articles from a neurologist who researches neuropathic pain]
* [http://www.celiac.com/st_prod.html?p_prodid=842 Up to 16% of Patients with Small Fiber Neuropathy May Have Celiac Disease]
* [http://diabetes.niddk.nih.gov/ National Diabetes Information Clearinghouse]
* [http://www.mapinc.org/drugnews/v07/n260/a03.html Information about Neurology Article on marijuana's effect on neuropathic pain]
* [http://www.mapinc.org/drugnews/v07/n260/a03.html Information about Neurology Article on marijuana's effect on neuropathic pain]
* [http://www.diabetesincontrol.com/annodyne/burkeseries.php Nitric Oxide and its Role in Diabetes, Wound Healing and Peripheral Neuropathy]
* [http://diabetes.niddk.nih.gov/ National Diabetes Information Clearinghouse]
== Acknowledgements ==
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
{{PNS diseases of the nervous system}}
{{PNS diseases of the nervous system}}
{{SIB}}
[[Category:Neurological disorders]]
[[Category:DiseaseState]]
[[Category:Neurology]]
[[de:Neuropathie]]
[[de:Neuropathie]]
[[es:Neuropatía]]
[[es:Neuropatía]]
Line 279: Line 46:
[[es:Neuropatía periférica]]
[[es:Neuropatía periférica]]
[[it:Neuropatia periferica]]
[[it:Neuropatia periferica]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Neurological disorders]]
[[Category:Disease]]
[[Category:Neurology]]

Latest revision as of 23:39, 29 July 2020

Peripheral neuropathy Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating peripheral neuropathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Peripheral neuropathy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Peripheral neuropathy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Peripheral neuropathy

CDC on Peripheral neuropathy

Peripheral neuropathy in the news

Blogs on Peripheral neuropathy

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Peripheral neuropathy


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Classification

Pathophysiology

Causes

Differentiating Peripheral Neuropathy from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination| Laboratory Findings | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Neuropathy Related Organizations

External Links

Template:PNS diseases of the nervous system de:Neuropathie it:Neuropatia nl:Neuropathie it:Neuropatia periferica

Template:WikiDoc Sources