What is peripheral neuropathy?


Peripheral neuropathy is nerve dysfunction or nerve damage involving arms or legs. Symptoms of nerve damage include: burning, tingling, numbness, and loss of sensation. Over 50% of diabetics will develop neuropathy in their lifetime. Other common causes include: vitamin deficiencies, anemia, and heavy metal toxicity.







Can An Unconventional Piercing Rid You of Migraine Pain?


How is Neuropathy Diagnosed?


Peripheral neuropathy is nerve damage or dysfunction that is present in the hands or feet. Is is generally suspected by a medical provider when deficits in temperature, pain, and vibratory sensation exist. Nerve conduction studies and electromyography studies are used to diagnose neuropathy.

Nerve conduction studies measure the speed of conduction of an electrical impulse through a nerve. This procedure may be performed by a trained medical technician or medical provider. NCS involves the placement of electrodes on the extremity to be tested, then a small amount of electricity is applied to detect nerve conductivity. This is typically not painful.

Electromyography measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle. This procedure is usually performed by a medical provider. EMG involves the insertion of fine needles into at least one muscle in the extremity to be tested. This may cause mild pain during needle insertion, but is generally not a painful procedure.

Generally, both procedures are done in sequence for comprehensive nerve conduction testing.  If nerve conduction tests demonstrate slowed conduction or nerve dysfunction, then investigation is necessary to determine the underlying cause of damage.  Generally, it is necessary to perform blood tests, and a complete history and physical examination to ascertain the etiology.

Some information obtained from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/electromyography_emg_92,p07656/.

Do you suffer from painful or numb feet? Tingling hands?


If so, you have symptoms of peripheral neuropathy. What is peripheral neuropathy? Neuropathy is nerve damage, resulting from local insult to the nerves or systemic factors. Peripheral means that extremities are affected i.e., hands and feet.

Symptoms include:

  • Burning
  • Numbness or tingling
  • Pins and needles sensation
  • Stabbing, sharp pains
  • Decreased temperature perception
  • Aching feet or hands
  • Decreased sensitivity to painful stimulus

Causes of peripheral neuropathy include:

  • Undiagnosed or poorly controlled Diabetes Mellitus
  • Nerve damage or compression r/t surgical repair or injury
  • Thyroid or other autoimmune diseases
  • Vitamin deficiencies
  • Exposure to heavy metals and environmental toxins
  • Genetic factors

It is important to diagnose neuropathy early, investigate the cause, and initiate treatment to halt and in many cases reverse nerve damage. Long-term consequences of untreated peripheral neuropathy include:

  • Progressive disability from pain
  • Trouble walking and falls
  • Slow healing wounds progressing to infection
  • Amputations
  • Decreased mobility
  • Decreased quality of life
  • Premature death

Peripheral neuropathy can be diagnosed through a brief office consultation and nerve conduction testing (takes approx. 30 minutes).  KCA Neurology providers will educate you concerning your diagnosis and initiate a comprehensive treatment plan.  At KCA, our ultimate goal is to improve your quality of life by improving mobility and decreasing pain.


KCA Neurology
4323 Carothers Pkwy, Williamson Tower, Ste. 609
Franklin, TN 37067


What’s the link between depression and pain?

What’s the link between depression and pain?


Chronic painThe convergence of depression and pain is reflected in the circuitry of the nervous system. In the experience of pain, communication between body and brain goes both ways. Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shutoff mechanism is impaired, physical sensations, including pain, are more likely to become the center of attention. Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself.

The mysterious disorder known as fibromyalgia may illustrate these biological links between pain and depression. Its symptoms include widespread muscle pain and tenderness at certain pressure points, with no evidence of tissue damage. Brain scans of people with fibromyalgia show highly active pain centers, and the disorder is more closely associated with depression than most other medical conditions. Fibromyalgia could be caused by a brain malfunction that heightens sensitivity to both physical discomfort and mood changes.

Taken from http://www.health.harvard.edu/newsweek/Depression_and_pain.htm.

Chronic pain

Chronic painNociceptive pain is caused by damage to somatic (bone or muscle) or visceral (lung or bladder) tissue. It is typically well localized, constant, aching or throbbing, and resolves as tissue damage heals. A notable exception is arthritis. Nociceptive pain generally responds to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids.

Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. Nerves are irritated by compression, scar tissue, or inflammation. Faulty signals are sent to the brain and experienced as pain and may be described as burning, lancing, or “electric shock-like.” Examples include sciatica from herniated discs. Neuropathic pain is often chronic, tends to be less responsive to opioids but may respond to anti-epileptic and antidepressant medications. In some conditions, pain can be mixed. An initial nervous system dysfunction or injury may trigger the neural release of inflammatory mediators and subsequent neurogenic inflammation. An example is migraine headaches. Treatment aims at both causes.

Alternatives tools to treat chronic pain include nonpharmacologic modes (lifestyle changes), nonopioid adjuvant analgesics (NSAIDs), opioids, psychological therapies (counseling or cognitive behavior therapy), physical rehabilitation, surgical intervention, and complementary medicine. Treatments may be combined and should be tailored to patient circumstances and integrated as part of a multimodal plan.

Pain medications are now the most commonly prescribed class of medications. All chronic pain should not be treated with opioids. Tramadol, an analgesic that activates mu receptor activity and leads to norepinephrine and serotonin reuptake inhibition, is useful in neuropathic pain and fibromyalgia treatment. Duloxetine is effective in treating chronic musculoskeletal pain, diabetic neuropathy, or fibromyalgia. Topical medications are often underused. Lidocaine 5% patch is approved by the Food and Drug Administration for postherpetic neuralgia. Topical NSAIDs provide significant analgesia, minimal adverse events, and are useful for muscle and joint pain.

Several alternative therapies have demonstrated excellent results in chronic pain treatment of. Practicing meditation over an 8-week period reduces the severity of irritable bowel symptoms in women. Researchers found that participants in the meditation group had greater reductions in symptom severity immediately after the training and at 3-month follow-up. (Gaylord, S.A., Palsson, O.S., Garland, E.L. et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011; 106: 1678–1688)

According to 2007 guidelines, acupuncture is 1 of several therapies to consider when patients with chronic low-back pain do not respond to conventional treatment. (Chou, R., Qaseem, A., Snow, V. et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147: 478–491). A large, rigorously designed clinical trial reported in May 2009 found that actual and simulated acupuncture were equally effective—and both were more effective than conventional treatment—for relieving chronic low-back pain. (Madsen, M.V., Gøtzsche, P.C., and Hróbjartsson, A. Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Br Med J. 2009; 338: a3115).

Tai chi is a complex integration of mental, spiritual, philosophical, and physical practices. In 1 study, (Wang, C., Schmid, C.H., Rones, R. et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010; 363: 743). Six fibromyalgia patients who practiced tai chi twice weekly reported less pain, better sleep, more energy, and improved overall health than a comparison group treated with wellness education and stretching exercises.

Chronic pain treatment is optimized by using multiple modes. Careful history, assessment, and diagnoses of type of pain are essential. Complementary therapies are effective and can give patients control in managing chronic pain.

Taken from “Managing Chronic pain:Useful tools and approaches” at http://dx.doi.org/10.1016/j.nurpra.2012.12.015.