Diagnosing and Managing Peripheral Neuropathy
Garcia, Rebecca Storment
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The successful management of neuropathic pain is measured by the degree of relief and functional improvement experienced by the patient. Neuropathy can be divided into two major types: focal mononeuritis and diffuse polyneuropathy. Symptoms of neuropathy present in many different ways depending on the types of nerve fibers affected. Large nerve fiber neuropathies present with symptoms such as weakness, muscle wasting, deficits in proprioception, deep tendon reflexes and vibratory sense. Small nerve fiber neuropathies present with alterations to heat, cold and pain sensations. Neuropathic pain has been described as intolerable burning, crushing, searing, stabbing, stinging, pins and needles, aching, and electrical shocks. Peripheral neuropathy has a variety of causes such as entrapment, ischemia, hereditary disorders, systemic and metabolic disease, vitamin deficiency, and toxic exposure making an accurate diagnosis difficult. Therefore, a thorough detailed medical history combined with a physical and neurologic exam is the first step in reaching a definitive diagnosis leading to the effective management of neuropathic pain.