We often talk about neuropathy as a problem for people
with type 2 diabetics. However, there are over two dozen other causes for
neuropathy, and one of them may sound quite surprising to you: it is Menopause. Or, more specifically, it can be attributed
to a sudden drop in estrogen levels, whether caused by menopause, or by
stopping estrogen therapy. Researchers believe that blood flow decreases when
estrogen ceases to be produced. This affects your nerves, muscles, joints, hair
and can cause symptoms similar to peripheral neuropathy. These symptoms often
manifest well before you actually reach menopause.
What is peripheral
neuropathy (PN)?
Neuropathy means “disease of the nerves.” The brain and
the spinal cord make up the central nervous system. The peripheral nerves are
those that branch out from the spinal cord into the trunk and the extremities
(arms and legs).
“The peripheral nervous system is like the body’s
electrical wiring,” says Tina Tockarshewsky, executive director of the
Neuropathy Association, a New York–based national voluntary organization,
serving patients with neuropathy resulting from cancer treatment or other
causes. “When the peripheral nerves are damaged, the electrical system goes
haywire. Sometimes there are sparks, and sometimes the lights go out.”
Pain and numbness, particularly in the hands and feet,
are hallmark symptoms of PN. The condition can also cause a wide variety of
other symptoms, depending on which nerves are damaged.
These symptoms may begin during or after cancer
treatment. They tend to worsen over time, and they may persist for a year or
more after treatment is completed. For many patients, damaged nerves do
eventually heal and symptoms clear up. For others, however, the nerve
damage—and the symptoms—may be permanent.
Symptoms vary depending on type of nerves affected
- and may include:
* Gradual onset of numbness and tingling in feet or hands
- may spread upward into your legs and arms;
* Burning/Searing pain – especially at night, when
it can seriously disrupt ability to sleep;
* Sharp, jabbing or electric-like pain;
* Extreme sensitivity to touch - even light touch;
* Lack of coordination;
More severe cases experience:
* Muscle weakness/wasting or paralysis - if motor
nerves are affected;
* Autonomic nerve dysfunction (Organ/gland
dysfunction) – inability to:
1. Swallow/digest food properly/control bowel function -
lack of esophageal or intestinal muscle control (possibly manifesting as
diarrhea or constipation)
2. Maintain healthy blood pressure - lack of
arterial muscle control for contraction/dilation – experienced as dizziness,
lightheadedness, or even fainting when a person moves suddenly from a seated to
a standing position;
3. Control bladder function - lack of bladder
muscle control can cause incontinence or lead to infection.
4. Sweat normally
5. Have normal sexual function
Causes of nerve
damage/inflammation
Numerous factors can cause neuropathies - which
affect at least 20 million people in the USA. All forms of neuropathy involve
inflammation as a result of damage from:
* Autoimmune diseases – E.g. Lupus, rheumatoid
arthritis and Guillain-Barre syndrome. Some neuropathies are caused by
inflammation resulting from immune system activities, and can develop quickly
or slowly.
* Diabetes (Diabetic peripheral neuropathy)
– more than 50% of diabetics develop some type of neuropathy to several
nerves; nerve endings slowly die leading to loss of sensation in the feet, legs
and hands which at times can be painful and can lead to weakness and difficulty
walking. Nerve damage may result from impaired ability to utilize glucose for
energy.
* Toxin exposure – can cause peripheral nerve
damage:
Heavy metals – E.g. arsenic, lead, mercury,
thallium; Magnesium deficiency allows heavy metal deposition in the brain.
Certain medications - certain anti-cancer
drugs (especially chemotherapy), anticonvulsants, antiviral agents,
and antibiotics.
Environmental toxins
* Infections – the table below lists some viral or
bacterial infections that can cause peripheral neuropathy by directly
attacking and damaging sensory nerves, often producing sharp pain. Viral and
bacterial infections can also cause indirect nerve damage by
provoking autoimmune disorders. In this case, I.S. components attack the neural
myelin sheath or axon.
* Inherited disorders – E.g. Charcot-Marie-Tooth
disease, amyloid polyneuropathy;
* Traumatic injury - can
sever/crush/compress/stretch peripheral nerves.
Motor vehicle accidents
Falls
Sports injuries
* Pressure on the nerve – can compress nerve fibers:
Slipped disks between vertebrae
Broken/dislocated bones
Using a cast or crutches / Spending a long time in an
unnatural position
Repetitive Stress /Repeating a motion many times (E.g.
typing) - repetitive flexing of any group of joints for prolonged
periods often leads to entrapment neuropathies, by causing ligaments, tendons,
and muscles to become inflamed and swollen, constricting the narrow passageways
through which some nerves pass. E.g. Carpal tunnel syndrome
A pinched nerve in the back
Tumors - Growths can form directly on the
nerves themselves, or tumors (malignant and benign) can exert pressure on
surrounding nerves contributing to PN;
* Acute and chronic inflammation of connective tissue
– acute inflammation of protective tissue surrounding nerves can spread
directly into nerve fibers. Progressive destruction of connective tissue from
low level chronic inflammation renders nerve fibers more vulnerable to
compression injuries and infections. Inflamed, swollen joints can entrap
nerves, with ensuing pain.
* Vitamin deficiencies /Alcoholism - Vitamins B1
(thiamine), B3 (niacin), B6, B12, E are particularly important to nerve health
and whose deficiency is a factor in PN.
B1 deficiency is typically seen in alcoholics
There are several causes of B12 deficiency:
A strict vegetarian diet - since animal-based
foods such as red meat, dairy products, fish, poultry and eggs are the only
recognized source of dietary B12.
Inability of stomach acids to aid in B12 absorption
– as such, drugs taken to reduce stomach acid should be taken with B12
supplements.
Other conditions/procedures associated with a reduced
ability to absorb B12 - include autoimmune diseases, pernicious
anemia, pancreatic diseases, ileal resection, Crohn's disease, HIV infection,
gastritis, gastric or small intestine surgeries, malabsorption syndromes, M.S.
* Kidney disease, liver disease - by
allowing abnormally high amounts of toxic substances in the blood that can
severely damage nerve tissue. Most patients on dialysis because of kidney
failure develop polyneuropathy.
* Reduced oxygen supply to peripheral nerves
– hypoxia caused by vascular damage or diseases of the blood can seriously
damage or kill nerve tissue. Blood flow is impeded as blood vessels become
inflamed, which reduces lumen size as vessel walls harden, thicken, and develop
scar tissue. Blood vessel constriction is often present with diabetes.
* Hormonal imbalances - can disturb normal metabolic
processes and cause neuropathies.
Underproduction of thyroid hormones (Hypothyroidism)-
slows metabolism, leading to fluid retention and swollen tissues that can exert
pressure on peripheral nerves.
Overproduction of growth hormone - can
lead to acromegaly, a condition where many parts of the skeleton become
abnormally enlarged. Nerves running through enlarged joints can become
entrapped.
Estrogen neuropathy – in women, neuropathy
can start within a decade of approaching menopause.
* Gluten sensitivity – PN may respond to a strict
gluten-free diet
Self-Care &
Coping Skills
Self-Care
The following suggestions can help you manage peripheral
neuropathy:
* Take care of your feet. Tight shoes and socks can
worsen pain and tingling and may lead to sores that won't heal. Wear soft,
loose cotton socks and padded shoes. You can use a semicircular hoop, which is
available in medical supply stores, to keep bedcovers off hot or sensitive
feet.
* Quit smoking. Cigarette smoking can affect circulation,
increasing the risk of foot problems.
* Eat healthy meals. If you're at high risk of neuropathy
or have a chronic medical condition, healthy eating is especially important.
Emphasize low-fat meats and dairy products and include lots of fruits,
vegetables and whole grains in your diet. Drink alcohol in moderation.
* Massage your hands and feet, or have someone massage
them for you. Massage helps improve circulation, stimulates nerves and may
temporarily relieve pain.
* Avoid prolonged pressure. Don't keep your knees crossed
or lean on your elbows for long periods of time. Doing so may cause new nerve
damage.
Coping Skills
Living with chronic pain or disability presents daily
challenges. Some of these suggestions may make it easier for you to cope:
* Set priorities. Decide which tasks you need to do on a
given day, such as paying bills or shopping for groceries, and which can wait
until another time. Stay active, but don't overdo.
* Get out of the house. When you have severe pain, it's
natural to want to be alone. But this only makes it easier to focus on your
pain. Instead, visit a friend, go to a movie or take a walk.
* Seek and accept support. It isn't a sign of weakness to
ask for or accept help when you need it. In addition to support from family and
friends, consider joining a chronic pain support group. Although support groups
aren't for everyone, they can be good places to hear about coping techniques or
treatments that have worked for others. You'll also meet people who understand
what you're going through. To find a support group in your community, check
with your doctor, a nurse or the county health department.
* Prepare for challenging situations. If something especially
stressful is coming up in your life, such as a move or a new job, knowing what
you have to do ahead of time can help you cope.
* Talk to a counselor or therapist. Insomnia, depression
and impotence are possible complications of peripheral neuropathy. If you
experience any of these, you may find it helpful to talk to a counselor or
therapist in addition to your primary care doctor. There are treatments that
can help.
Peripheral
Neuropathy and Sleep
Sleep is an essential part of living—sleep helps us avoid
major health problems and it is essential to our mental and physical
performance. It affects our mood and
stress and anxiety levels. Unfortunately, sleep disturbance or insomnia is
often a side effect of the pain. It is a common complaint among people with
living with chronic pain.
It’s no surprise that about 70 percent of pain patients,
including those suffering from PN, back pain, headaches, arthritis and
fibromyalgia, report they have trouble sleeping according to the Journal of
Pain Medicine.
Pain can interfere with sleep due to a combination of
issues. The list includes discomfort, reduced activity levels, anxiety, worry,
depression and use of medications such as codeine that relieve pain but disturb
sleep.
Most experts recommend a range of seven to nine hours of
sleep per night for adults, regardless of age or gender. This may seem
impossible to people with chronic pain, but there are steps you can take to
improve your sleep, which may lead to less pain and lower levels of depression
and anxiety. First, talk with your doctor to see if there are medications that
may lessen your sleep disturbance. You should also check with your doctor to
make sure your current medications aren't causing some of your sleep
disturbance.
Beyond medication, there are several things you can do
yourself to improve your sleep. Here are some methods to try and help you fall
asleep more quickly, help you sleep more deeply, help you stay asleep, and
ultimately help keep you healthy.
Following are tips for improving your sleep:
* Reduce your caffeine intake, especially in the
afternoons
* Quit smoking
* Limit and/or omit alcohol consumption
* Limit naps to less than one hour, preferably less
* Don’t stay in bed too long—spending time in bed without
sleeping leads to more shallow sleep
* Adhere to a regular daily schedule including going to
bed and getting up at the same time
* Maintain a regular exercise program. Be sure to
complete exercise several hours before bedtime
* Make sure your bed is comfortable. You should have
enough room to stretch and turn comfortably. Experiment with different levels
of mattress firmness, foam or egg crate toppers, and pillows that provide more
support
* Keep your room cool. The temperature of your bedroom
also affects sleep. Most people sleep best in a slightly cool room (around 65°
F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold
can interfere with quality sleep.
* Turn off your TV and Computer, many people use the
television to fall asleep or relax at the end of the day. Not only does the
light suppress melatonin production, but television can actually stimulate the
mind, rather than relaxing it.
* Don't watch the clock – turn your alarm clock around so
that it is not facing you
* Keep a notepad and pencil by your bed to write down any
thoughts that may wake you up at night so you can put them to rest
* Refrain from taking a hot bath or shower right before
bed; the body needs to cool a degree before getting into deep sleep
* Try listening to relaxing soft music or audio books
instead, or practicing relaxation exercises.
* Visualizing a peaceful, restful place. Close your eyes
and imagine a place or activity that is calming and peaceful for you.
Concentrate on how relaxed this place or activity makes you feel.
It may take three to four weeks of trying these
techniques before you begin to see an improvement in your sleep. During the
first two weeks, your sleep may actually worsen before it improves, but
improved sleep may lead to less pain intensity and improved mood.
Sources and
Additional Information: