How To Diagnose Peripheral Neuropathy?
The first step in the diagnosis of peripheral neuropathy is the history of the patient and physical examination which includes tests like passive movements, sensations recognition, deep tendon reflexes, tuning fork test, etc. In the next step various biochemical tests are done like a complete blood panel, metabolic profile, random blood sugar, thyroid function test, liver function test, kidney function test, triple H test including HIV, HCV and HBV, vitamin and mineral levels etc. which helps to find out the cause of peripheral neuropathy.
But these are all preliminary tests and do not confirm the diagnosis of peripheral neuropathy. For confirmation of its diagnosis, electrophysical studies are done like electromyography, nerve conduction studies, etc. This can detect the functioning and speed of impulse travel from the nerves and can measure the dip in conduction velocity. The autonomic nervous testing is very important for the confirmatory diagnosis of autonomic neuropathy and is done in a controlled environment because the chances of complication and undesirable events are high in autonomic neuropathy. Few other diagnostic tests include lumbar puncture, nerve biopsy, muscle and skin tissue histopathology. Various imaging studies like computed tomography scanning, magnetic resonance imaging of the spine are recommended when other tests fail to detect the cause of it.
The most common cause responsible for peripheral neuropathy is diabetes mellitus. The control of blood sugar levels in patients of diabetes and prediabetes should be strict and regular monitoring should be done. The prevention of rising blood glucose levels significantly alters the course of microangiopathic complications suffered in it including peripheral neuropathy which could be avoided to a great extent. After the neuropathy has been caused, various groups of drugs are given only to relieve the symptoms of it because usually, the damage incurred is irreversible.
What Is The Best Medicine For Peripheral Neuropathy?
Medical treatment is the first line of therapy for relieving the pain and other symptoms of peripheral neuropathy. Antiepileptic group of drugs remains the mainstay of treatment and gabapentin which is also an antiepileptic remains the drug of choice. The efficacy and effectiveness of herbal medications and ayurvedic drugs have not been established and therefore are best to be avoided.
The treatment may also depend upon the type of pain and other symptoms suffered in it. The patients of peripheral neuropathy usually suffer from neuropathic pain and are treated by antidepressants and an antiepileptic group of drugs. Antiepileptic drugs are found to be most efficient in relieving neuropathic pain. Gabapentin is the most efficient and suitable drug for its treatment. Other examples of antiepileptics used are pregabalin, sodium valproate, carbamazepine, levetiracetam, topiramate, etc.
Antidepressants are the second-line drugs in the treatment of neuropathic pain which includes tricyclic antidepressants like amitriptyline, nortriptyline, etc. or selective serotonin reuptake inhibitors like fluoxetine, venlafaxine, duloxetine, etc.
For the treatment of physical pain, normal painkillers are given for example a nonsteroidal anti-inflammatory group of drugs like naproxen, acetaminophen, etc. But if the physical pain doesn’t subside then opiates can be tried like morphine, fentanyl, buprenorphine, etc. A few other latest modalities in its treatment have been developed, one of which is Transcutaneous Electrical Nerve Stimulation commonly known as TENS. Although it is a costly treatment method and only limited research is present on its benefits and therefore has not been established completely but it has seen to be successful in relieving the neuropathic pain in many cases.
The history was given by the patient and physical examination remains the mainstay for the diagnosis of peripheral neuropathy because these are relatively the cheaper methods and are reliable on the experience on the doctor. But for quantification and diagnosis of the exact cause, various other tests and investigations are to be done. For the confirmatory diagnosis, nerve conduction studies are the best investigation because it can not only diagnose the conduction loss but also can quantify it for the measurement of the extent of disease.
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