What is Neuropathy?
Neuropathy is a general term meaning “nerve problem”. There are two main types of neuropathy and a variety of causes. The first type of neuropathy we will discuss has been the most common type for years but that is starting to change.
The first type is Large Fiber Mono-Neuropathy (Large Fiber meaning the bigger nerve bundles closer to the spine and Mono-meaning “one”). Large Fiber Mono-Neuropathy usually begins at the spine level, either the lower neck or lower back, and typically radiates down one arm or one leg.
The symptoms can be numbness, tingling and/or pain and most of the time will start in the shoulder or buttock region and then progressively begin to travel further down the affected arm or leg until reaching the hand/fingers or foot/toes.
The cause of this type of neuropathy is often trauma to the body like slips, falls, car accidents or other injuries that we can’t even remember and weren’t dealt with properly at the time and then start to affect us years or decades later.
The underlying cause in most cases is a problem involving the whole complex of spinal structures (muscles, ligaments, vertebrae, spinal discs) and first produce an abnormal alignment of the spine which causes pressure on the nerves which then causes the symptoms, or abnormal alignment causes increased pressure on the spinal discs (shock absorbing pads between every two spinal bones) and abnormally wears them causing a “bulging disc” which can contact the spinal nerves and cause the symptoms.
A bulging disc, if left untreated can worsen and eventually lead to a ruptured disc in which a jelly like substance in the center of the disc (think jelly doughnut) can start to leak out and hit the nerve(s) and cause severe pain, numbness, tingling, weakness and eventually loss of muscle function (i.e. drop foot).
If this type of neuropathy is not treated early enough, it usually ends up as a surgical case.
The second type of neuropathy is Small Fiber, Poly-Neuropathy. (Small Fiber meaning the smaller nerve bundles closer to the ends of the extremities and Poly – meaning “many” because there are many more nerves and nerve endings in these regions than there are closer to the spine).
This type is quickly becoming more and more prevalent and estimates are that it affects nearly 46.5 million Americans. This type of neuropathy is also know as Peripheral Neuropathy because it affects the nerves furthest away from the center of the body (like the lower arms, hands, fingers, lower legs, feet and toes).
Peripheral neuropathy is a progressive condition that typically affects the lower legs and feet and then can advance to the hands and fingers. Peripheral neuropathy is characterized by a trilogy of symptoms, usually numbness and tingling and eventually leads to debilitating balance problems. Pain is the variable with peripheral neuropathy. Some people never experience pain and for some people, pain is the first symptom to show up.
The pain of peripheral neuropathy varies from person to person. Some people have a burning type pain. For some it feels like electrical shocks. For others it’s like their feet are being torn apart.
Peripheral Neuropathy is a disorder of the peripheral nerves those are the nerves that go down into your arms hands legs and feet.
The peripheral nerves are anything outside of the central nervous system, which is just the brain and spinal cord. So the peripheral nerves like the ones that go down to your hands and feet are the ones that are typically affected in neuropathy.
If you look at the photo below, you’ll see 3 different types of nerves. On the top there’s a healthy nerve and it has a little blood vessels all wrapped around it underneath these blood vessels you have what’s called themylin sheath. It’s like insulation on an electrical cord and your nerves need it to function properly. In order for that mylin sheath to survive it has to be nourished by blood vessels like the ones you see. When looking at the middle nerve in the picture, it looks like it’s starting to shrink. The constriction of blood vessels in this nerve decreases the amount of blood flow getting to the nerve and it limits the amount of nutrients that receives and eventually if this keeps happening it ends up looking like the bottom nerve for it looks like it’s dying off. This is exactly what happens in neuropathy.
CAUSES OF NEUROPATHY
Estimates put the number of causes for Peripheral neuropathy at over 1000! Despite this number, there are really only three main categories of causes.
– PHYSIOLOGICAL/FUNCTIONAL CAUSES
Physiological or functional causes of neuropathy are basically health conditions that develop in the body. While there can be health conditions that develop with seemingly no cause, such as Type 1 Diabetes, these causes are typically “lifestyle diseases” that develop as a result of not giving the body what it needs to function properly, such as sufficient daily exercise or hydration, as well as overindulgence in things like food and/or alcohol. Most of these causes involve damage to the cardiovascular/circulatory system and reduce blood flow to the nerves of the lower legs and feet or lower arms and hands. Type 2 Diabetes is the most common lifestyle cause of peripheral neuropathy, however, other circulatory conditions such as heart disease, high blood pressure, congestive heart failure, and stroke can cause peripheral neuropathy as well.
– CHEMICAL CAUSES
Chemical causes of peripheral neuropathy include anything that gets into the body by chance or by choice. These include medications like over the counter anti-inflammatories as well as statin drugs commonly used for treating high cholesterol, chemotherapy, radiation treatment, Agent Orange, prolonged and heavy alcohol and/or tobacco use, and finally, sugar. Excessive sugar consumption over time can lead to Type 2 Diabetes which is one of the most common causes of Peripheral Neuropathy.
– PHYSICAL/TRAUMATIC CAUSES
Physical or traumatic causes of neuropathy typically cause the large fiber mono-neuropathies, like sciatica, although they can contribute to the peripheral type as well as being a sole cause of peripheral neuropathy. Before continuing, let’s talk about age. Neuropathy is not solely an age related issue, because if it was then every person would develop it and would develop it at the same time, say, at 1:04 pm at the age of 59 1/2 years of age.
Neuropathy can affect people of all ages depending on the cause. We’ve treated patients as young as 19 years and our oldest was 94 when she developed neuropathy. If we break down what “age” really is, it is a number of accumulated days. So someone who is 10 years old, has lived 3650 days. These days include our normal daily activities like sitting, standing, bending, twisting, lifting, reaching, walking, running and sleeping just to name a few. These days add up and over time, if we don’t take proper preventative maintenance steps, can create neuropathies.
Now, take these normal daily stresses and throw in some slips, falls, accidents and injuries along the way. It’s estimated that the average 5-year old, has fallen down 5000 times! If this happened to us over the next 5 years, we would be bed ridden if not worse!
Typically it’s all the things we did as kids or young adults, when we thought we were invincible, that catch up to us when we’re older.
This accumulation of stresses over time leads to degenerative conditions like Arthritis, Degenerative Disc or Joint Disease, and Spinal Stenosis which then can increase pressure on or irritate nerves and blood vessels and create these neuropathy problems.