to Peripheral Neuropathy
Millions in this country and elsewhere have peripheral neuropathy in different forms
and to various degrees. The number usually cited in the U.S. is two million. Yet a study
of its incidence just among specific population groups, for example among people with
diabetes or with HIV infections, would suggest a much larger number.
It can strike any age group in any social or cultural
strata. Many, perhaps most, victims do not realize what ails their aching soles and numb
toes, as well as their tingling fingers, throbbing hands or weakening muscles. The shame
of this is that without early action based on knowledge of their afflictions, the pain and
other symptoms experienced by these sufferers almost invariably gets worse. Moreover their
neuropathies often tend to advance in their bodies, causing more and more areas to be
affected. Another problem is that if attention is delayed certain neuropathies can become
more difficult to treat.
Symptoms and Effects
Symptoms of sensory neuropathies, which may gradually
occur over many months, often include numbness of the affected members, burning, tingling
sensations, "electric" shocks, aching pain and extreme sensitivity to touch.
Motor neuropathies frequently result in weakness in
the feet, ankles, hands and wrists. Diarrhea, light-headedness or sexual dysfunction are
some of the possible consequences of autonomic neuropathies. In severe cases
involving these neuropathies, activities such as walking normally and sleeping may be
In rare situations even respiratory failure or paralysis may
occur with certain neuropathies such as Guillain-Barre syndrome.
There are said to be more than 100 causes of peripheral
neuropathy. Diabetes is considered the most common, at least in the
United States. It is variously estimated that 30 to 65% of people with diabetes have PN to
some degree. In this group it is especially prevalent among those having particular
difficulty in controlling their blood glucose levels and/or those having high lipid levels
(cholesterol and triglycerides), those over 40 and among smokers.
PN also is said to cause pain for up to one third of people
with AIDS or HIV. In fact it is thought to be the most frequent neurologic
disorder associated with HIV infection, typically occurring in the later stages of the
Various toxins and metallic poisons (such as
arsenic, lead and mercury), certain chemicals (especially solvents and some
insecticides), excessive alcohol intake, vitamin deficiencies (particularly
B12) or vitamin excesses (B6), nutritional imbalances, and a number of drugs
used to treat HIV infections and AIDS can all cause
peripheral neuropathy. It can also result from kidney failure, liver disease,
rheumatoid arthritis, abnormal blood proteins, cancer (and even cancer
chemotherapy), leukemia and shingles.
Certain repetitive activities such as typing can also
be the cause of some neuropathies. Carpal tunnel syndrome is one example. This is a
so-called entrapment neuropathy a condition resulting from a nerve
lesion at a point where the nerve is confined to a narrow passageway. Another instance of
entrapment neuropathy is where restrictive clothing compresses a nerve called the lateral
femoral cutaneous nerve which runs from the groin to the upper thigh.
A tendency toward peripheral neuropathy can also be inherited.
A family history of the disorder increases the likelihood. In a different twist on
inherited susceptibility, a study done in France in 1995, reported in the November 1995
issue of Alcohol and Alcoholism, suggested a relationship between a history of
alcoholism in a father and peripheral neuropathy in his alcoholic offspring. Ninety
alcoholics, some with neuropathies and some without, were included in the study. The
investigators found neuropathies occurred in alcoholics five times as often when the
father was an alcoholic himself than when he was not. (Unfortunately, the study did not
consider the incidence of PN in the alcoholic fathers, raising the obvious question
whether perhaps it was the PN itself which was inherited rather than a greater disposition
to neuropathy simply because of The publication Bio Medical Frontiers reports that
the cause of one third of all neuropathies is unknown mine included. These
cryptogenic disorders are called "idiopathic." Some clinicians believe
many of these unexplained cases are really genetic in origin.
Incidentally, I discovered that not only does my neuropathy
have a name idiopathic it has a number. Under the International Classification
of Diseases- a world-wide system which groups related diseases and procedures for
reporting statistical information idiopathic neuropathy is code 356.8. A word of
advice: if you happen to be idiopathic and are ever doing a slow shuffle down the street,
having a particularly bad day with your PN, and somebody annoyingly asks what's wrong with
you, you can be sure they won't stay around too long if you say "I've got the 356.8
Coping with Peripheral Neuropathy
It may not be possible for us to feel like we once did before we got stuck with this
atrocious ailment at least not yet, not until some true cure comes along but
there is much we can do now to improve the quality of our lives.
Benefits of Exercise
Most clinicians think the benefits of exercise
stem largely from the improvement in blood circulation
it produces. This improvement permits oxygen to be
carried to various parts of the body (including nerve tissue) where it's needed most. Also
a good exercise program will almost inevitably lead to a loss of weight
a desirable goal in itself for most people and one which is believed especially important
for people with neuropathy. In any event, as one PNer said plaintively : "At least
one good thing about weight reduction is there is less of you to hurt."
Of course beyond any particular PN benefits, there are a
number of general health boons from exercise. These include the reduction of low
density lipids (LDLs) and triglycerides, the increase of favored high
density lipids (HDLs), and the lowering of blood pressure. David C.
Nieman, professor of health and exercise science at Appalachian State University in Boone,
North Carolina, also points out that moderate daily exercise can boost the body's immune
I found one formal study on the value of exercise to
PNers. As reported in the October 1997 issue of Physical Therapy, 28 subjects with
peripheral neuropathy between the ages of 23 to 84 were followed through a six week period
during which half completed a home exercise program. Dr. Richard K. Shields, a professor
in the Physical Therapy Graduate Program at the College of Medicine, University of Iowa,
was the principal investigator in the study.
Subjects were given stretching bands to exercise the upper
body, gradually increasing resistance, with a goal of 10 daily repetitions. They also were
instructed to exercise aerobically up to 20 minutes each day, either by walking or
bicycling, with enough intensity to achieve a heart rate of 60 to 70% of their estimated
maximum heart rate (220 minus their age).
Study conclusions were based on impairment measures which
included average muscle scores, handgrip force, walking time and "forced vital
capacity." A health survey was also used which dealt with quality of life
At the end of the six week period those in the exercise
group showed moderate improvements in their strength impairment measures, as could be
expected. What was noteworthy were the significant improvements reported in the quality
of life surveys. Exercise participants indicated on average a meaningful change in
"physical and mental role limitations" (self perceptions of physical and mental
disabilities) and "social function limitations" (self perceptions of
interference with normal social activities). The study did not, however, demonstrate any
overall pain reduction for those participants. From an analysis of the results Dr. Shields
concluded that a home exercise program should be an important component of treating people
with peripheral neuropathy.
I think the message from this study is that, apart from any
direct physical benefits (which can be significant), exercise makes us feel better about
ourselves, that perhaps we figure we are not quite as hobbled by our PN as we previously
thought, that we look better, have more energy, are generally healthier and happier, etc.
Types of Exercise
Of the various forms of exercise, most PNers seem to agree water
aerobics (such as running in deep water while wearing flotation devices) or simply
swimming laps, or a combination of the two, is best since it takes the weight off
of painful feet while you're exercising. Also it's easier to stretch and work
muscles in the water. If you prefer to exercise in the shallower end of a pool you
might consider buying a pair of water shoes to give your feet some protection and
traction. (Occasionally people simply use old tennis shoes for this purpose.) To get the
full benefit of any water workout it's suggested you spend at least 30 minutes in a pool,
daily if possible but at least several times a week.
If our feet can handle walking the faster the
better that also is an excellent form of exercise. Unfortunately running or jogging
must remain a memory for most of us who used to enjoy those pursuits. A treadmill
provides much the same walking experience but under controlled conditions. (I used to have
one but my feet couldn't take it anymore.)
The Stair Master is a step removed (no pun intended)
from walking. This machine eliminates the foot impact of walking though it can still
put stress on your feet as you push down. I personally prefer a machine called the Precor,
where you slide your legs back and forth in a gliding motion while your feet are planted
on "skis." With the Precor you can increase the resistance or raise or lower the
height of the ski tips on the control panel. Another so-called elliptical machine is the Body
Trek which involves the use of arms as well as legs.
Easier on the feet yet are exercise bikes. A type
many favor, me included, are recumbent models where you plop yourself in a
"chair" and pedal while sitting back with your legs pumping horizontally. You
can read, watch TV or just listen to music, all while getting a great workout.
Many PNers also use strength-building routines such
as weight lifting. Well equipped fitness centers offer all kinds of equipment for this
Physical therapy experts maintain that gradual stretching
and strengthening exercises help relieve the stress of chronic pain. An
organization called Stretching, Inc., has a web site (www.stretching.com) offering various
helpful books on stretching and body building techniques. Incidentally it is always a good
idea to have a trained physical therapist formulate your exercise program.
One other form of exercise some PNers use is the Chinese
martial arts routine called tai chi. This is a training exercise involving slow,
graceful movements such as seen performed in Chinese parks early in the morning. These
movements are derived from the movements of animals and follow a natural, relaxed pattern.
They increase the body's motion range and are said to exercise the internal organs. (Don't
ask me how.) According to practitioners the slow meditative routine aids relaxation,
stress reduction, balance and posture, and increases blood flow.
Diabetic PNers are again reminded to check with their
physicians prior to engaging in exercise programs.
From Numb Toes and Aching Soles: Coping with Peripheral Neuropathy, by
John A. Senneff. Copyright © 1999 by John A. Senneff. Excerpted by arrangement with John
A. Senneff. $19.95. Available in local bookstores or call toll free 888-633-9898 or click here.