The information that you are about to read was first published in a Neuropathy Trust publication entitled 'Peripheral Neuropathy & Neuropathic Pain Under the Spotlight'. Please note that a 'hard-copy' version of this booklet is available for purchase via this web site. Alternatively, you can access all of our educational materials (in digital format) via our subscribers area.

We sincerely hope that this information gives you a clearer insight into this neuropathic condition, what causes it, and what you can do to help yourself if you are so affected.

Kind Regards, Carpe Diem,

Andrew Keen
Chief Executive Officer & Founder of The Neuropathy Trust

Peripheral Neuropathy: What is it?

Peripheral Neuropathy [pron. - new-rop-athy] is a generic phrase denoting functional disturbances and/or pathological changes in the peripheral nervous system.

If the involvement is in one nerve it is commonly referred to as mononeuropathy, in several nerves, mononeuritis multiplex and if diffuse and bilateral, polyneuropathy.

Peripheral Neuropathy is not a specific disease but rather a manifestation of many conditions that cause damage to the peripheral nerves. There are believed to be in excess of one hundred different causes of peripheral neuropathy.

Many of our subscribers are affected by what is known as a cryptogenic or idiopathic neuropathy, which simply means that they have been diagnosed as having a peripheral neuropathy but the underlying cause has yet to be determined. We also have an ever-increasing number of subscribers who are affected by neuropathies of known origin, such as diabetes mellitus, HIV, nutritional deficiency, and as a result of the neurotoxic effects of certain prescribed treatments and therapies.

The symptoms of peripheral neuropathy often affect the arms and legs. Common characteristics, depending on the type of neuropathy may include muscle weakness, chronic neuropathic pain (including - numbness, sensory disturbance, pins & needles, burning sensations etc.), and paralysis.

Additional complications reported by a significant number of our subscribers include amongst others; fatigue, memory retention deficit, mood swings, swallowing difficulty, acid reflux/generalised stomach complaints, and ataxia. Ataxia is a term used to describe a general lack of co-ordination, position sense and manual dexterity.

The symptoms of Peripheral Neuropathy often vary from person to person and can affect people to a lesser or greater degree. However, in some cases, the symptoms may tend to necessitate a change in lifestyle which not only can affect the person directly, but also may possibly have a knock on effect on the family.

One of the hardest things about coming to terms with peripheral neuropathy is not necessarily the disabling effect that it can cause. It is quite natural to experience –

Feelings of isolation – because the chance of meeting other people with a similar condition may appear remote.

Feelings of frustration – because you quite naturally want to know what is happening to your body. These feelings can be exacerbated if no definitive diagnosis has been reached.

Peripheral Neuropathy affects people in different ways. It is quite natural to think that you are on your own and you may find it difficult to explain to others what it feels like.

Peripheral Neuropathy: Associated Symptoms

Symptoms tend to vary depending upon the location and types of nerves affected. In most people the problems seem to commence with numbness, pain and/or weakness.

Paraesthesia, dysaesthesia and anaesthesia

If you experience spontaneous sensations such as tingling, pins and needles, electric shocks, burning or cold etc, these are called paraesthesia. For most people these sensations seem to be more troublesome during the night. Some neuropathies are painful and this can be quite severe. If you experience unusual sensations by touching or other stimulation this is known as dysaesthesia.

If you experience a lack of or diminished sensation, for example, if you are prone to burning yourself without realising that you have done so, this is called anaesthesia.

Diminished = Hypoaesthesia Absent = Anaesthesia

'Glove and Stocking’ sensory loss

Many neuropathies give rise to loss of sensation in the hands, feet and lower legs, the distribution resembling gloves and stockings. This can cause manual dexterity problems or difficulty walking, as your sense of touch and feeling may be affected.

Weakness in the upper and lower limbs

If there is damage to the motor nerves this may cause weakness in the upper and lower limbs. You may find that you cannot lift your feet because of foot drop. You may find that your legs feel heavy and you fatigue very easily. You may find walking very difficult and may be prone to tripping. You may also find that you are not able to carry much because of weakness in your arms, and you may find yourself dropping things. All of these symptoms are common and it may mean that you get frustrated with yourself and others around you.

Loss of position sense

Another unusual feeling: it’s as though your brain knows where your feet should go but your feet have a mind of their own. You may become conscious about the way that you walk but can’t understand why it has altered. Without realising it you will probably re-educate the way that you walk, possibly widening your gait or throwing your leg. You may have difficulty keeping your balance especially in the dark and find that you have to look at the ground to compensate for the loss of position sense.

Peripheral Neuropathy: Causes and Management

Why does it occur?

Peripheral neuropathy is not a complete diagnosis but simply a statement that the peripheral nerves are not working properly. In the same way as anaemia can be due to lots of different reasons such as poor diet, heavy periods or occasionally more serious problems like ulcers or bowel cancer, peripheral neuropathy can similarly result from a variety of different causes. It is important to realise that the peripheral nerve can be damaged in a number of different ways.

A peripheral nerve cell consists of -

1. A cell body - which contains the genetic messages and produces most of the energy needed for the health of the cell.
2. An axon - or connecting part of the cell which transmits the electrical messages to the muscles.
3. An insulating lining, or myelin, which ensures rapid electrical conduction and prevents messages jumping from one axon to the adjacent one.
   
   All three of these components can be damaged by disease.

Disease of the cell body

The cell body is the most common site of damage and will be affected by any poison or toxin that interferes with the energy processes that the nerve uses. Alcohol or chemicals such as industrial hydrocarbons are examples of such toxins.

General medical disorders such as liver and kidney failure will also cause the energy processes in many parts of the body including the peripheral nerve to fail. When this happens the long connecting process or axon will start to suffer the loss of nutrients from the cell body and the longest nerve processes will start to fail. Since the longest nerves extend to the feet it is not uncommon, for example, for patients to experience sensory disturbance in the toes and weakness in the feet.

Disease of axons

The axon can also be damaged by diseases that interfere with its blood supply. This is usually a patchy process akin to throwing sand on the nerves. Where each grain lands a small bit of axon is damaged, thus reducing its ability to transmit messages down to the muscles and, ultimately, to forward messages about sensation back up to the brain.

As a result patients often develop sudden weakness such as foot or wrist drop or patches of numbness scattered over the limbs and trunk. This is the usual problem when disorders of the joints such as rheumatoid arthritis involve the nerves. Such conditions are called arteritis to describe an inflammation of the small arteries going to nerves as well as the internal organs and joints. Examples of these types of disorders include, amongst many others; Systemic Lupus Erythematosis [SLE], Polyarteritis nodosa, Sjogren's Syndrome, and Wegener's arteritis.

Diseases of myelin

Another way in which the nerves may become dysfunctional is when the outer insulating layer of myelin is damaged. This tends to occur in inherited disorders of which the most common is Charcot Marie Tooth disease. In certain types of this condition there is an inherited fault in the chemical make up of the myelin which leads to it becoming thinner and as a result conduction down nerve becomes very slow.

Some inflammatory disorders such as Guillain Barre Syndrome and Chronic Inflammatory Demyelinating Polyneuropathies [CIDP] can also do this. In these disorders there is a problem with the immune system so that myelin becomes attacked by the body's own immune defences. This leads to patchy damage to myelin and weakness of many muscles as well as variable numbness which is usually not as severe as the weakness. These inflammatory disorders respond very well to treatments that alter the immune system such as plasma exchange, intravenous immunoglobulin and anti- rejection drugs such as steroids, azathioprine and cyclosporine.

Management

The easiest way to help the symptoms of peripheral neuropathy is to recognise any toxin or drug that might be causing the syndrome and if possible stop using it. Sometimes it is possible to give a vitamin or food supplement that will protect the nerves from further damage. Folic acid and thiamine are examples that are sometimes used.

If a neuropathy turns out to be a sign of a general medical problem such as diabetes mellitus or kidney failure then treatment of the underlying medical problem will often help the neuropathy.

In the genetic disorders it is not yet possible to correct the deficient protein or the imbalance in chemical that results but much research is going into this at the moment and it may be possible to correct some of these disorders in the distant future. However, the resultant foot deformity may be helped by correct footwear and by orthotic advice to support the arch of the foot and prevent excessive wear or callous formation.

Genetic advice can help assess the risk of passing the disease on to children and may make recognition of early neuropathies better. Physiotherapy and occupational therapy can often make life much more bearable for individuals with severe neuropathies. Pain is another important symptom that can be treated and is dealt with in another section of this web site.

Disorders of the immune system have already been mentioned and many of these diseases respond very well to treatment often achieving a complete remission of the disease. Such treatments are very specialised and may need to be taken for many years under careful supervision to minimise side effects.

Summary

The treatment of peripheral neuropathy is very much dependent on diagnosing the underlying cause, therefore early recognition and intervention is paramount. If the underlying cause of the neuropathy is diagnosed quickly then there is likely to be less damage to the nerves and obviously an increased chance that the neuropathy can be slowed down, halted, or reversed.

Peripheral Neuropathy [and neuropathic pain] can be an indicator, sometimes the first indicator, of a underlying medical disorder. Sometimes this can be a disorder that is potentially life threatening if appropriate treatment is not prescribed soon enough.

If you are a patient (or a doctor presented with a patient) who displays the symptoms of peripheral neuropathy or neuropathic pain, particularly if you are unsure of the aetiology, then you should seek advice from an appropriate specialist department.

Peripheral Neuropathy: The Peripheral Nerve

Walking, talking, eating etc. are common tasks that most people take for granted; but have you ever wondered what helps us to do these things?

The answer is the nervous system, which constantly monitors changes taking place within your body and outside your body. The information about these changes is carried through the sensory neurons (nerve cells) to the interneurons in the central nervous system. Here those messages are processed, integrated with messages from the brain and then more nerve impulses are sent along nerve cells, called motor neurons, to your muscles, which in turn move your body.

The best way to describe what the peripheral nerve looks like is to draw a comparison. Imagine an electric cable; it is made up of individual strands of wire bundled together each in its own protective casing. The cable is held together by an outer insulating sheath which protects the wires within and allows electric current to be passed through it quickly and safely. This may seem like a very basic comparison but, like an electric cable, nerve fibres are held together in parallel bundles, which are called nerve trunks. A sheath called the perineurium surrounds these bundles. The nerve fibres lie within the endoneurium, which contains vital nutrients derived from the blood vessels that supply the nerves.

Each of the nerve fibres carries along it impulses from sensory receptors in the skin and internal organs and conducts these back to the spinal cord and brain (central nervous system). Motor nerve cells in the spinal cord and the lower part of the brain give rise to nerve fibres that travel out to the muscles and internal organs.

Axons are wrapped many times with a membrane known as the myelin sheath, which is made up of segments laid end to end. The myelin sheath allows nerve impulses to travel quickly, effectively, and up to speeds exceeding two hundred and fifty miles per hour.

Myelin is produced by a different cell, the Schwann Cell, which surrounds the axon. Nerve fibres possessing a myelin sheath are said to be myelinated. Other axons, although accompanied by Schwann cells, do not possess myelin and are termed unmyelinated. They conduct nerve impulses much more slowly.

The large majority of the nerve cells in your body are in the brain and spinal cord. They process information received from the sensory nerve fibres to carry out responses such as voluntary movements, controlling balance etc.

You can now see from our initial comparison that it is not difficult to imagine the nervous system as a vast, extremely complex electro-chemical network. Unlike the conventional ‘hard wired’ electrical systems that most of us are familiar with, however, the nervous system in our bodies is subject to changes which may affect the way in which it normally operates.

Peripheral Neuropathy: The Peripheral Nervous System

The nervous system is your body’s control centre and is made up of two main divisions: the Central Nervous System (CNS), which consists of the brain and spinal cord and the Peripheral Nervous System (PNS), which forms links between the brain, spinal cord and the rest of your body.

The basic units of the peripheral nervous system are the neurones (nerve cells). They give rise to three types of nerve fibres (axons) that can be found inside the bundles:

Sensory fibres -

which carry messages from all sensory receptors around your body. These messages are called nerve impulses, and enable us to appreciate physical feelings such as pain, touch and vibration. They also make us aware of our position sense. The messages are sent to the central nervous system in your brain and your spinal cord.

Motor fibres -

which carry messages from the central nervous system to organs such as your muscles. Once the muscle has received the message it will react with an action or movement. Motor neurons are responsible for our voluntary movements, i.e. those we can control. The cell bodies of motor neurons (nerve cells) are inside your spinal cord. The cell body and muscle cells are connected by the axon. The dendrites make synaptic connections with nerve fibres from other neurons.

Autonomic fibres - (which are often unmyelinated)

As the name suggests, the autonomic nerves are not under our control. Working automatically they control our involuntary functions, regardless of whether we are awake or asleep. Obvious autonomic functions are breathing, regulation of blood pressure, sweating, digestion and bladder, bowel and sexual function.

Peripheral Neuropathy: Diagnosing

Diagnosing Neuropathic Conditions

In an attempt to diagnose neuropathic conditions, the specialist will need to collate as much information about you as possible. Apart from using his own skill and knowledge, he may refer you for what seems like a barrage of tests. Here we will try to describe some of the techniques used.

Electromyography (commonly referred to as an EMG)

This test consists of two parts (a) an electrical nerve conduction study (NCS) and (b) an electrical muscle study (EMG). The NCS records the speed at which your nerves are able to conduct a nerve message. They also measure the size of the electrical response of the sensory nerve or of the muscle. The EMG records the electrical activity inside your muscles. If a problem occurs with either the muscles or the nerves, the EMG may be used to pinpoint where the problem lies. The tests may confirm the presence of a Peripheral Neuropathy and can determine whether the myelin sheaths or axons are primarily affected.

How is the EMG test done?

You will be asked to lie down and then you will be connected to a machine using wires. A fine needle will be inserted into some of your muscles; then the apparatus will record the activity of your muscles. The NCS involves placing electrodes on your skin in the area to be tested. A stimulating electrode is placed on your skin and through that a low intensity electrical current will be applied to the nerve. The apparatus once again records the response.

Will the EMG test hurt?

A natural question, but try not to over worry. We are all a little afraid of the unknown, but rest-assured that during the test you will probably only feel mild, transient discomfort. Some people do feel more pain than others. If the discomfort becomes unpleasant, then ask the electrophysiologist to stop or modify the tests.

Are there any risks involved with the EMG tests?

The risks are negligible. The equipment used is sterile and there is no electrical danger. You should notify the examiner if you are either a haemophiliac, have a pacemaker, had a positive HIV (AIDS) test, had hepatitis type B, or take a blood thinner.

Electro encephalogram (commonly known as an EEG) - this is not a test for peripheral neuropathy but is carried out to check the brain is electrically normal.

The EEG measures the electrical activity of your brain, as a series of brain waves recorded by an instrument as paper traces. It can display the general state of arousal of different parts of the brain. It can also show areas of the brain that are not functioning correctly either because of too little or too much electrical activity.

How is the EEG test done?

The technician will mark and measure your head with a measuring tape and a non-toxic grease pencil. A scalp abrasive solution will be used to rub those marks taking off any excess dead skin cells. Finally, several electrodes will be attached to your scalp using adhesive paste or a rubber hair net. The test may take 30 minutes to complete; all you need to do is lie still and relax.

Are there any risks involved in an EEG?

There are generally no risks involved with this test. The equipment used is sterile. You should notify the examiner if you are either a haemophiliac, have a pacemaker, had a positive HIV (AIDS) test, had hepatitis type B, or take a blood thinner.

Lumbar Puncture (‘Spinal Tap’)

A lumbar puncture can give a wide variety of information depending on the tests that your doctor chooses. It can show signs of inflammation, many types of infection, abnormal proteins, abnormal cells, or blood in the spinal fluid. It can also give information on pressure inside the head. It can be useful in the diagnosis of meningitis, bleeding, high or low spinal fluid pressure, multiple sclerosis, and many other neurological diseases. Some inflammatory peripheral neuropathies have high protein in the spinal fluid.

How is the Lumbar Puncture done?

You will normally be asked to lie down on your side in a foetal position, although sometimes it is done in the sitting position. A local anaesthetic will be given in the skin at the site of the lumbar puncture in your lower back; this will numb the area. The physician will remove approximately 10ml (two tea-spoons) of cerebrospinal fluid. Your body will replace this fluid in a very short space of time, normally within two hours. Normal spinal fluid is clear and colourless, similar to water in appearance.

Are there any side effects from a Lumbar Puncture?

Approximately 30% of patients suffer headaches after the procedure. It tends to occur in the back of the head and is eased by lying down. If a headache occurs you should get plenty of rest and have plenty to drink. Some people also complain of a mild local back pain. This pain usually resolves itself within a few days and does not require treatment. Bleeding is a complication that arises whenever the skin is broken.

You may also get some bruising at the puncture site. Because a sterile technique is adopted, local skin infection is not normally a problem. During the procedure itself, some people experience a transient sharp pain [‘electric shock’] going down the leg. This normally resolves itself within a few seconds.

What happens after the lumbar puncture?

You are normally asked to stay lying down for between 60-120 minutes after the procedure. After that time you should attempt to get up slowly. If you feel any light-headedness, you should lie down again and get up more slowly. Research suggests that lying down for long periods (hours) does not prevent headache.

Other Tests

Nerve and Muscle Biopsies

Sometimes it may be necessary to undergo a nerve and/or muscle biopsy, both of which can give valuable information about the type and cause of the neuropathy. This is only performed infrequently when other tests have returned negative or inconclusive or when further confirmation/information is needed.

Blood Screening / Urine Tests

Both the blood and the urine are examined for evidence of any underlying condition or defect that may have triggered the neuropathy.

Imaging Techniques

Various imaging techniques are used in the diagnosis of neurological disorders. These are not tests for peripheral neuropathy, but are carried out to exclude other causes of similar symptoms.

Examples are:-

Computed Tomography (CT Scan) - The scanner rotates around the head, or body collecting X-rays from all directions. These images are processed by the computer, which then produces an image that is a ‘slice’ of the head, spine or elsewhere revealing internal structures.

Magnetic Resonance Imaging (MRI) - is a powerful tool for studying the ever-changing activity of the brain on a moment to moment basis. Once limited to visualising structures, MRI has become the leading technology for examining the living brain at work.

Peripheral Neuropathy: Implications

Peripheral Neuropathy, particularly when there is a neuropathic pain element attached to it, can have a huge impact on the patient’s overall quality of life and mental well being. Furthermore, a combination of these neuropathic conditions may bring about, for example, -

• An apathy towards life in general, and/or, a self imposed social isolation
• An inability to properly perform the normal activities of day to day living
• Disrupted sleep pattern
• Memory retention difficulties
• Mood swings
• Feelings of isolation, frustration and despair
• Suicidal tendency
  

Taking all of these factors into consideration would indicate, to us at least, that in order to provide an effective treatment regime, a multidisciplinary approach must be adopted from the outset, or at least considered where appropriate. Furthermore, critical to the success of any treatment programme is the communication and relationship between the multidisciplinary team and the patient.

What do patients affected by peripheral neuropathy and neuropathic pain need?

Quality of life – If you ask most people affected by peripheral neuropathy and neuropathic pain what they want most, the answer that you would probably receive would be ‘quality of life’, or at the very least, ‘a chance to regain a part of their former selves’. Ideally this could be brought about by either finding a cure for the underlying problem or, at the very least, by providing an effective symptomatic treatment regime thus enabling them to lead a relatively normal life.

Support & Encouragement – both from organisations such as the Neuropathy Trust and from the people directly in charge of the patient’s individual care. We believe that many of the psychological and emotional issues may well be addressed at a very early stage by simply taking the time to listen to the patient, and involving them to a reasonable degree in their own treatment. How this could best be achieved is obviously open to discussion but a good start would be to offer the patient an explanation of the condition itself. This could then lead on to detailing the available treatment options and subsequently describing the side effects of the various treatments in question so that it would enable the patient to make an informed choice. Finally, a certain degree of empathy, and practical advice would not go amiss.

A comprehensive neurological and pain assessment strategy – In the case of a cryptogenic neuropathy these strategies should be applied early on as a matter of course so as to increase the prospects of discovering an underlying cause, and to ensure that the pain is neither under-treated, nor under-reported.

A comprehensive psychological assessment strategy – In the case of a cryptogenic neuropathy, this particular issue has to be addressed with a high degree of sensitivity. One has to bear in mind that patients with this neurological condition have, in the majority of cases, undergone many diagnostic tests in order to try to pinpoint the underlying cause of the disorder. In a relatively high percentage of cases [possibly up to 50% of cases presented to a neurologist] most of these tests actually yield negative or inconclusive results thus leaving the patient feeling rejected, without proper diagnosis, with a lack of prognosis, and very often psychologically vulnerable.

In our experience we have found that patients who have been informed that they are being referred for a psychological assessment seem to get the impression, quite naturally, that this is in some way a reflection on their own state of mental wellbeing. It is not uncommon, for example, for patients to tell us that they have been left with a feeling that the person in charge of their care is possibly insinuating that the problem may well be "in the mind".

The interesting thing is that a number of patients who have approached us under these circumstances have been further referred to more specialist physicians and have ultimately received a definitive diagnosis, and subsequent treatment. This, at the very least, shows the importance of early recognition, early referral to an appropriate specialist, improved communication, greater awareness and further education amongst all parties.

Peripheral Neuropathy: Getting the Best out of the Medical Profession

By Dr. Simon J. Ellis
Consultant Neurologist, North Staffordshire Royal Infirmary, UK

The relationship between doctors and patients is changing. From being a very unequal relationship doctors and patients are now trying to make healthcare a more equal partnership. This is particularly important in long term neurological conditions where doctors do not have all the answers. There are still too many examples of arrogant and rude doctors about. Anyone can have a bad day, but in general the medical profession is trying to get better at communicating. This process is more advanced in some countries than others. The UK has lagged behind other countries, perhaps because of anachronisms like our class system.

Many patients are frightened of appearing too pushy. As a patient you are not there to make the doctor feel good but get the best care you can. The truth is patients who push for their rights get better care than those who do not. It helps to have thought through what you want out of a consultation. Many patients find they have forgotten what they wanted to ask until after the end of the consultation, so it is a good idea to write a list of the questions you want answered in order of priority and also what you want out of the consultation. Bringing another person along to the consultation with you can provide emotional support and help with remembering what the doctor has said.

As a patient you have many rights. You have the right to have things explained to you in clear language.

Doctors have their own language, which they often forget is not understood by the rest of humanity! There is no shame in asking the doctor what he/she means when they use words like "demyelinating" or "lesion". Some words have two meanings. For example "chronic" is often taken to mean very severe or bad, but doctors usually use it to mean going on over a long period of time. This can cause a lot of confusion and distress to patients. You have a right to an expert opinion. Too often patients are fobbed off and do not get to see an expert. In addition if that expert cannot give you an answer, in the NHS you have a right to a second opinion.

If you start medication you need to know about potential side effects. All drugs can cause side effects and when you take medication you are balancing the possible risks against the benefits. This should be explained to you so you know what to expect and what to look out for.

If you have an illness that goes on for a long time you are likely to know more about your illness than your doctor. Firstly, you are the expert on your own illness, no one else knows what it feels like. Secondly, often patients will have read a lot about their problem and become experts in the field, so it is not surprising that they may know more than a generalist doctor. Some doctors find this a little disconcerting.

One of the major problems doctors face is that of time. This is one of the reasons to think out clearly what you want from a consultation so you can help the doctor give you what you want. Straight questions like, "How long have we got for this consultation?" and statements like "By the end of this consultation I would like to know what is wrong with me and what the future is likely to hold." are reasonable ways to get a consultation off to a business like start.

Different doctors have different roles in your care. Your GP (family doctor) is not a neurological expert, but often knows a lot about you and your family. Good GP's act as advocates for their patients making sure they get good opinions from experts and that treatment plans are sensible in your particular circumstances.

Among neurologists there are different levels of expertise. Most neurologists have areas of special interest. If your condition is proving difficult to diagnose it is worthwhile considering getting an opinion from a neurologist who has a special interest in that particular field.

Like any relationship things go wrong from time to time between patients and doctors. Not everyone will get on with everyone else. Usually this is no one's fault, but it can undermine the trust that is very important in a doctor - patient relationship. The best thing to do under those circumstances is change your doctor. Sometimes doctors are rude or arrogant or just unthinking, the same can be true of patients. Most doctors do want to get on well with their patients, or they should not be in practice. It is difficult to point out when a doctor has made a mistake. Often this is easier done through another person, such as the clinic nurse, a patient's representative or the official complaints procedures.

For you to get the best care the doctor-patient relationship is important. Deciding what you want can be helpful and both parties should be straight forward and honest. Often over a period of time doctors and patients become good friends.

Peripheral Neuropathy: Coping

Peripheral Neuropathy is often referred to as the 'Silent Disease' simply because many people are currently not aware of its existence. This is a situation that we intend to change, hopefully with your assistance.

In actual fact there are many people who are affected by peripheral neuropathy, and many of whom are probably unaware of this. It is vital that these issues are addressed, and we must work together to do this.

So what can you do to help?

The simple answer is anything that you feel capable of doing. Join a support group & make contact with other people similarly affected. Help with fundraising and assist in the distribution of educational materials, such as our poster for example, to your local hospital, GP's surgery, and anywhere else that you feel may be beneficial.

The Neuropathy Trust is a voluntary, non-profit making organisation and has members from many different countries, working together to towards one goal, improving the current situation for people affected by these neuropathic conditions.

Prior to subscribing to the Neuropathy Trust many people have said how isolated they felt. We are pleased to say that this situation has now improved for the better as there is now somewhere where people like ourselves can turn for information, support, and reassurance.

Peripheral Neuropathy: Definitions

A-beta fibres
Nerve fibres associated with the transmission of touch impulses. They are myelinated, have an extremely fast transmission rate and respond to low threshold mechanical stimulation.

A-delta fibres
Nerve fibres associated with the transmission of pain impulses. They are myelinated, have a fast transmission rate, respond to touch or thermal stimuli and are responsible for the sensation of sharp pain.

Afferent Neurone
A fibre that carries impulses from the sensory nerve endings in the body to the central nervous system. (See also sensory neurone).

Allodynia
A painful response to a normally non-painful stimulus.

Autonomic nervous system
The part of the nervous system that controls the automatic ‘housekeeping’ functions of the body, e.g. blood pressure and pulse rate which are not under our conscious control.

Axon
The elongated part of the neurone that carries impulses from the cell body to other nerve cells or effector organs. Neurones only have one axon. Damage to the axon may produce neuropathy or neuropathic pain.

Brainstem
The portion of the brain that links the brain with the spinal cord. It consists of the medulla oblongata, pons and midbrain.

C- fibres
Nerve fibres associated with the transmission of pain impulses. They are unmyelinated, have a slow transmission rate, respond to thermal, mechanical and chemical stimuli, and give rise to more prolonged dull or aching pain, and burning or itching sensations.

Central nervous system (CNS)
Part of the nervous system that consists of the brain and spinal cord and that monitors and controls all bodily activity.

Central sensitisation
Changed spinal sensory processing due to altered membrane excitability in the dorsal horn.

Channel
A pore in a cell membrane through which molecules or ions may pass.

Chronic pain
Chronic pain is often defined as pain that persists for more than three months or that outlasts the usual healing process. Some authors choose six months as the cut off.

What is Neuropathic Pain - Click Here