Atlas of Pain Management Injection Techniques

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In the most common form of chronic polyneuropathy , only sensation is affected. Usually, the feet are affected first, but sometimes the hands are. A pins-and-needles sensation, numbness, burning pain, and loss of vibration sense and position sense knowing where the arms and legs are are prominent symptoms. Because position sense is lost, walking and even standing become unsteady.

Consequently, muscles may not be used. Eventually, they may weaken and waste away. Then, muscles may become stiff and permanently shortened called contractures. Diabetic neuropathy commonly causes painful tingling or burning sensations in the hands and feet—a condition called distal polyneuropathy. Pain is often worse at night and may be aggravated by touch or by a change in temperature. People may lose the senses of temperature and pain, so they often burn themselves and may have open sores caused by prolonged pressure or other injuries.

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Without pain as a warning of too much stress, joints are susceptible to injuries. This type of joint injury is called neurogenic arthropathy Charcot joints. Polyneuropathy often affects the nerves of the autonomic nervous system , which controls involuntary functions in the body such as blood pressure, heart rate, digestion, salivation, and urination.


Typical symptoms are constipation, sexual dysfunction, and fluctuating blood pressure—most notably a sudden fall in blood pressure when a person stands up orthostatic hypotension. The skin may become pale and dry, and sweating may be reduced. Much less often, control of bowel movements or urination is lost, leading to fecal or urinary incontinence. People who have a hereditary form may have hammer toes, high arches, and a curved spine scoliosis.

Abnormalities in sensation and muscle weakness may be mild. Affected people with mild symptoms may not notice the symptoms or may consider them unimportant. Other people are severely affected. Doctors usually recognize polyneuropathy by the symptoms. A physical examination can help doctors diagnose polyneuropathy and identify the cause.

Neuropathy | Cleveland Clinic

Electromyography and nerve conduction studies are usually done, particularly in the legs and feet. These tests may be used to do the following:. Determine what type of damage is causing the problem—for example, whether the myelin sheath around nerves is damaged called demyelination. After polyneuropathy is diagnosed, its cause, which may be treatable, must be identified. Doctors ask whether other symptoms are present and how quickly the symptoms developed.

This information suggests possible causes. Blood and urine tests may detect a disorder that is causing polyneuropathy, such as diabetes, kidney failure, or an underactive thyroid gland. Sometimes polyneuropathy affecting the hands and feet is the first indication that people have diabetes.

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  5. Sometimes, when extensive testing detects no obvious cause, the cause is a hereditary neuropathy that affects other family members so mildly that the disorder was never suspected. A spinal tap lumbar puncture is done to obtain a sample of cerebrospinal fluid, which surrounds the brain and spinal cord. Spirometry is done to determine whether the muscles that control breathing are affected.

    Spirometry is used to measure how much air the lungs can hold as well as how much and how quickly air can be exhaled. Diabetes : Careful control of blood sugar levels may slow progression of the disorder and occasionally relieves symptoms. Transplantation of islet cells cells that produce insulin , located in the pancreas, is sometimes done and may result in a cure. Multiple myeloma , liver failure , or kidney failure : Treatment of these disorders may result in slow recovery. Cancer : Surgically removing the cancer may be necessary to relieve pressure on the nerve.

    An underactive thyroid gland : Thyroid hormone is given. Autoimmune disorders : Treatments include plasma exchange filtering of toxic substances, including abnormal antibodies, from the blood , immune globulin a solution containing many different antibodies collected from a group of donors given intravenously, corticosteroids, and drugs that inhibit the immune system immunosuppressants. Drugs and toxins : Stopping the drug or avoiding exposure to the toxin can sometimes reverse the polyneuropathy.

    Antidotes are available for certain drugs and toxins and can reverse some toxic effects. Excessive amounts of vitamin B 6 : If the vitamin is stopped, polyneuropathy may resolve. If the cause cannot be corrected, treatment focuses on relieving pain and problems related to muscle weakness. Physical therapy sometimes reduces muscle stiffness and can prevent muscles from shortening and becoming stiff.

    Physical and occupational therapists can recommend useful assistive devices. Some drugs that are usually not considered pain relievers can lessen pain due to nerve damage. They include the antidepressant amitriptyline , the anticonvulsants gabapentin and pregabalin , and mexiletine used to treat abnormal heart rhythms. Lidocaine , an anesthetic applied as a lotion, an ointment, or a skin patch, may also help.

    From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The nerves that connect the head, face, eyes, nose, muscles, and ears to the brain cranial nerves. The nerves that connect the spinal cord to the rest of the body, including the 31 pairs of spinal nerves. Moving a muscle usually involves communication between the muscle and the brain through nerves.

    The impetus to move a muscle may originate with the senses. For example, special nerve endings in the skin sensory receptors enable people to sense pain, as when they step on a sharp rock, or to sense temperature, as when they pick up a very hot cup of coffee. This information is sent to the brain, and the brain may send a message to the muscle about how to respond.

    This type of exchange involves two complex nerve pathways:.

    If sensory receptors in the skin detect pain or a change in temperature, they transmit an impulse signal , which ultimately reaches the brain. The impulse crosses a synapse the junction between two nerve cells between the sensory nerve and a nerve cell in the spinal cord.


    The impulse crosses from the nerve cell in the spinal cord to the opposite side of the spinal cord. The impulse is sent up the spinal cord and through the brain stem to the thalamus, which is a processing center for sensory information, located deep in the brain. The impulse crosses a synapse in the thalamus to nerve fibers that carry the impulse to the sensory cortex of the cerebrum the area that receives and interprets information from sensory receptors.

    The sensory cortex perceives the impulse. A person may then decide to initiate movement, which triggers the motor cortex the area that plans, controls, and executes voluntary movements to generate an impulse. The impulse crosses a synapse between the nerve fibers in the spinal cord and a motor nerve, which is located in the spinal cord. At the neuromuscular junction where nerves connect to muscles , the impulse crosses from the motor nerve to receptors on the motor end plate of the muscle, where the impulse stimulates the muscle to move.

    Myelin sheath the membranes that surround the axon and that function much like insulation around electrical wires, enabling nerve impulses to travel quickly. Damage to the myelin sheath is called demyelination , as occurs in multiple sclerosis. Most nerve fibers inside and outside the brain are wrapped with many layers of tissue composed of a fat lipoprotein called myelin. These layers form the myelin sheath. Much like the insulation around an electrical wire, the myelin sheath enables electrical impulses to be conducted along the nerve fiber rapidly.

    One nerve mononeuropathy. Two or more peripheral nerves in separate areas of the body multiple mononeuropathy. Many nerves throughout the body but usually in about the same areas on both sides of the body polyneuropathy. A spinal nerve root the part of the spinal nerve connected to the spinal cord. A plexus a network of nerve fibers, where fibers are sorted and recombined to serve a particular area of the body. The neuromuscular junction where the nerve and muscle connect. If motor nerves which control muscle movement are damaged, muscles may weaken or become paralyzed.

    If sensory nerves which carry sensory information—about such things as pain, temperature, and vibration are damaged, abnormal sensations may be felt or sensation may be lost. Motor nerve neuron diseases are rare, but they are progressive and are often fatal.

    Charcot-Marie-Tooth Disease (CMT)

    Peripheral nerve disorders can be hereditary or acquired caused by exposure to toxins, injury, infections, or metabolic or inflammatory disorders. Motor neuron diseases.

    Hansen's Disease

    Spinal muscular atrophy types I—IV. Polio , infections due to coxsackievirus or other enteroviruses rare , and West Nile virus infection. Amyotrophic lateral sclerosis Lou Gehrig disease , paraneoplastic syndromes , postpolio syndrome , and progressive bulbar palsy. Nerve root disorders. Neurofibromas soft, fleshy growths of nerve tissue. A herniated disk , infections, injuries, and metastatic cancer. Plexus disorders. Acute brachial neuritis , autoimmune disorders , damage during delivery in newborns , diabetes mellitus , a hematoma a pocket of blood , severe injuries such as those due to high-speed motor vehicle accidents , metastatic cancer, neurofibromatosis rare , and nerve tumors.

    Peripheral nerve disorders.