From the Guidelines
Peripheral neuropathy should be assessed and managed promptly to prevent complications and improve quality of life, with a focus on strict blood sugar control, annual 10-g monofilament testing, and consideration of medications like gabapentin, pregabalin, or duloxetine for pain management, as recommended by the most recent guidelines 1.
Key Considerations
- Diabetic neuropathy is a diagnosis of exclusion, and nondiabetic neuropathies may be present in people with diabetes and may be treatable 1.
- Up to 50% of diabetic peripheral neuropathy may be asymptomatic, and if not recognized, people with diabetes are at risk for injuries, diabetic foot ulcers, and amputations 1.
- Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life 1.
Assessment and Management
- All people with diabetes should be assessed for diabetic peripheral neuropathy starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes, and at least annually thereafter 1.
- Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation and vibration sensation using a 128-Hz tuning fork 1.
- Annual 10-g monofilament testing should be performed to identify feet at risk for ulceration and amputation 1.
- Medications like gabapentin, pregabalin, or duloxetine may be considered for pain management, with a tailored and stepwise pharmacological strategy to achieve pain reduction and improve quality of life 1.
Lifestyle Modifications
- Regular exercise, maintaining a healthy weight, limiting alcohol consumption, and following a balanced diet are crucial for managing peripheral neuropathy 1.
- Proper foot care is especially important for those with decreased sensation to prevent injuries and infections 1.
- Physical therapy can help maintain strength and mobility, while occupational therapy may assist with adaptive techniques for daily activities.
From the FDA Drug Label
CNS and Neuromuscular: Coma; seizures; hallucinations; delusions; confusional states; disorientation; incoordination; ataxia; tremors; peripheral neuropathy; numbness, tingling and paresthesias of the extremities; The peripheral neuropathy is listed as a potential adverse reaction of amitriptyline 2.
From the Research
Definition and Prevalence of Peripheral Neuropathy
- Peripheral neuropathy is a common neurologic problem that can be classified clinically by the anatomic pattern of presenting symptoms 3.
- The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years 3.
- Peripheral neuropathy is idiopathic in 25% to 46% of cases 3.
Causes and Risk Factors of Peripheral Neuropathy
- Common identifiable causes of peripheral neuropathy include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies 3, 4.
- Diabetes mellitus is a major cause of peripheral neuropathy, with up to 50% of patients with diabetes mellitus developing diabetic peripheral neuropathy 5.
- Other risk factors for peripheral neuropathy include poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity 5.
Diagnosis and Evaluation of Peripheral Neuropathy
- Diagnosis of peripheral neuropathy requires a comprehensive history, physical examination, and judicious laboratory testing 3, 4.
- Initial laboratory evaluation includes a complete blood count, comprehensive metabolic profile, fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels, and serum protein electrophoresis with immunofixation 3.
- Nerve conduction studies and electrodiagnostic studies can help determine the phenotype (axonal versus demyelinating) and severity of peripheral neuropathy 3, 4.
Treatment and Management of Peripheral Neuropathy
- Treatment of peripheral neuropathy focuses on managing the underlying etiology 3, 6.
- First-line drug therapy for painful diabetic peripheral neuropathy includes duloxetine, gabapentin, amitriptyline, and pregabalin 5.
- Nondrug therapies with low- to moderate-quality evidence include exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation 5.
- Opioids should generally be avoided in the treatment of peripheral neuropathy 5.