What is neuropathy?
Neuropathy refers to damage to the peripheral nerves that transmit information between the brain and spinal cord and the rest of the body. Peripheral neuropathy often causes weakness, numbness, tingling, and pain in the hands and feet. Neuropathy can be caused by a number of conditions, including diabetes, chemotherapy, infections, autoimmune disorders, toxin exposure, trauma, and inherited disorders. The most common cause is diabetes, which can cause diabetic peripheral neuropathy.
Peripheral nerves have the ability to regenerate after injury. However, in some cases the nerve damage is severe and regeneration may be incomplete, leading to persistent symptoms of neuropathy. Even when regeneration occurs, it may take months for nerves to heal after an initial injury. During this time, people may continue experiencing neuropathy symptoms like numbness, pain, and weakness.
What causes neuropathy flares?
Neuropathy flares refer to periods where neuropathy symptoms suddenly worsen. There are a few potential causes of these flare ups:
– Nerve compression or entrapment – Flare ups may occur when nerves become compressed due to posture or repetitive motions. Carpal tunnel syndrome is an example where the median nerve becomes compressed at the wrist.
– New nerve injury – Actions that injure nerves, like repetitive stress or accidents, can spur neuropathy flares. The new nerve damage leads to swelling and inflammation, provoking symptoms.
– Chemical imbalances – Neuropathy can flare up if levels of nutrients and chemicals that support nerve health fall out of balance. Deficiencies in vitamin B12, folate, and thiamine are linked to worsening neuropathy.
– Blood sugar changes – For people with diabetic neuropathy, fluctuations in blood glucose can trigger temporary worsening of symptoms. High blood sugar is especially likely to aggravate neuropathy.
– Weather changes – Some people have worsening neuropathy symptoms during damp, cold weather due to changes in circulation and blood vessel constriction.
– Emotional stress – Stress may amplify neuropathy pain signaling through effects on the nervous system.
– Infections – Bacterial or viral infections can cause swelling, inflammation and heightened neuropathy symptoms.
– Medication changes – Certain medication adjustments, withdrawals, or interactions may worsen neuropathy. An example is changing thyroid medication dosage.
– Unknown causes – Sometimes, clear reasons for neuropathy flares are not identified. Spontaneous flares do occur.
When are neuropathy patients most vulnerable to flares?
There are certain times when neuropathy patients are most susceptible to experiencing symptom flares:
– Morning – Many people with peripheral neuropathy have worse symptoms first thing in the morning. Sitting or lying for hours during sleep can compress nerves. The morning stiffness and lack of movement compounds compression issues. Symptoms like numbness and tingling may be more pronounced after waking up as nerves have had prolonged contact.
– During sleep – The nerves of neuropathy patients are vulnerable during hours of bed rest. Maintaining one position for too long allows nerves to be compressed. Symptoms may actually disrupt sleep as tingling, burning, or discomfort worsens at night. Using night splints or braces can help reduce neuropathy flares during sleep.
– Weather changes – Prior to and during cold, damp weather, some individuals have more intense neuropathy pain and sensations. Barometric pressure changes, rain, and falling temperatures are commonly reported to precede worsening of neuropathic symptoms.
– High-risk activities – Repetitive motions, awkward positions, and performing forceful tasks can compress, entrap, or otherwise stress nerves. Flares often emerge while doing activities that put excessive pressure on the peripheral nervous system. High-risk tasks depend on which nerves are damaged. For foot neuropathy, standing for prolonged periods and athletic training may exacerbate symptoms while hand neuropathy can flare up with typing or gripping objects.
– Stress and exhaustion – Physical exhaustion, emotional stress, and sleep deprivation may make individuals more prone to neuropathy flares. Stress hormones and inflammation tend to aggravate nerve pain signaling. Setting boundaries and minimizing stress is important for reducing flares.
– Blood sugar fluctuations – For diabetic neuropathy patients, dynamic shifts in blood glucose outside the normal range can trigger temporary worsening of neuropathic symptoms. Maintaining stable glycemic control can help prevent blood sugar-related flares.
How long do neuropathy flares last?
The duration of a neuropathy flare can vary substantially depending on the cause and severity. Here is an overview of how long certain flares may last:
– Nerve compression – Symptoms from compressed nerves may resolve within minutes to hours if pressure on the nerve is relieved. Promptly changing positions or adjusting activities is key. However, ongoing compression can cause longer-lasting flares until the precipitating issue is addressed. Carpal tunnel flares may persist for weeks until wrist braces are used.
– Chemical imbalances – Correcting a nutritional deficiency, like low vitamin B12, often leads to improvement in neuropathy symptoms within several weeks as nerves regain function.
– Blood sugar spikes – High blood glucose often causes temporary neuropathy flaring lasting a few days. After blood sugar returns to normal ranges, symptoms typically improve.
– Weather changes – For weather-related flares, symptoms may spike for several days when irritating weather begins, lasting throughout the cold or damp period.
– Medication changes – Medication adjustments can provoke symptom flares lasting about 2-4 weeks until the body adjusts. Withdrawal of certain drugs can spur protracted flares.
– Infections – Bacterial and viral illnesses often worsen neuropathy for as long as the infection is active- from several days up to 2-3 weeks. Symptoms usually revert once the infection clears.
– Unknown causes – Spontaneous flares may last anywhere from a couple days up to several weeks. Symptoms persisting for longer periods may require medical evaluation to uncover any underlying medical issues.
Keeping flare periods as brief as possible requires identifying and addressing any precipitating factors, such as high blood sugar. Patients should alert their doctors about flares lasting more than several weeks.
How can you manage and prevent neuropathy flares?
While neuropathy flares cannot always be prevented, the following self-care tips may help reduce their frequency and severity:
– Careful blood sugar monitoring – For diabetes patients, maintain blood glucose within recommended targets to minimize high and low blood sugar episodes that may worsen neuropathy. HbA1c levels under 7% are ideal.
– Massage and stretching – Gently massaging and stretching compressed nerves may help relieve symptoms during flares. Proper stretching can also keep nerves mobile.
– Mindful movement and positioning – Avoid staying still in one position for too long. Change positions frequently and take movement breaks to prevent nerve compression. Use braces or splints to relieve pressure.
– Low-impact exercise – Light physical activity improves circulation and nerve health. Non-weight bearing activities like swimming are ideal.
– Stress management – Use relaxation techniques, social support, or counseling to control stress levels. Lowering stress may lessen flares.
– Healthy diet – Eat a balanced diet rich in B vitamins and nutrients that support nerve function and cell energy like vitamin D, omega-3 fatty acids, magnesium, and ALA.
– Stay warm and dry – Insulate feet and hands in cold damp weather. Wear socks and gloves to improve circulation and reduce weather-related flares.
– Physical therapy – Stretching, strengthening exercises, and modalities like transcutaneous electrical nerve stimulation may help control neuropathy flare ups.
– Medications – Prescription medications like anti-seizure drugs and tricyclic antidepressants can reduce the frequency of flares. Topical treatments like capsaicin cream, lidocaine patches and counter-irritants applied to the skin may temporarily relieve flare ups. Injections of steroids or numbing agents can also ease severe flares.
Promptly communicating with your doctor when flares arise is crucial, as medication adjustments or additional interventions may be warranted. Consistent attention to diet, activity, stress reduction, nerve protection, and other self-care behaviors can help maintain quality of life by preventing flare ups.
When to seek emergency medical care for neuropathy flares
Most neuropathy flares are mild and temporary. But in some instances rapidly worsening symptoms should be treated as a medical emergency requiring urgent evaluation.
Seek emergency care if you experience any of the following:
– Sudden loss of feeling or inability to move a limb
– Bowel or bladder incontinence
– Difficulty breathing, swallowing, or speaking
– Dizziness, weakness, falling
– Rapid muscle wasting
– Fever along with flaring neuropathy
These signs can indicate extremely severe nerve damage, autoimmune reaction, or nerve compression requiring decompression surgery.
Some examples of medical emergencies that may occur along with a neuropathy flare include:
– Guillain-Barre syndrome – Severe nerve inflammation
– Myasthenia gravis crisis – Worsening muscle weakness
– Spinal cord compression – Nerve impingement in the neck or back
Without rapid treatment, these conditions can sometimes lead to paralysis or permanent nerve damage. So do not delay seeking emergency care if your flaring neuropathy is profoundly affecting your limbs or vital functions.
What doctor treats neuropathy flares?
If you are experiencing recurring neuropathy flare ups, consult the following medical specialists:
– Primary care physician – Your primary doctor can provide initial evaluation of flares and order lab work or diagnostic testing to uncover any treatable cause such as vitamin deficiencies, infections, or blood sugar problems. They may prescribe medications to control flares or refer you to a specialist.
– Neurologist – A neurologist specializes in conditions impacting the peripheral nervous system. They can accurately diagnose the type of neuropathy based on symptoms and test results. They may order tests like EMG/nerve conduction studies. Treatment may include infusions, immune therapies, or nerve blocks for flares.
– Pain specialist – A pain medicine specialist can provide targeted treatment to ease neuropathy flare ups and painful symptoms. They may prescribe nerve pain medications, injections, or alternative treatments. Approaches like cognitive behavioral therapy help cope with flares.
– Physical medicine doctor – Physiatrists specialize in therapy to improve mobility and function. They may recommend braces, custom footwear or orthotics to protect nerves and prevent flares when walking or standing. Physical therapy and exercise programs can improve strength, flexibility, and balance.
– Podiatrist – For peripheral neuropathy affecting the feet, a podiatrist can assess gait and prescribe foot care strategies like toe spacers, custom shoes, and foot cushions to prevent irritation that leads to flares. They treat any foot ulcers or deformities contributing to symptoms.
Ongoing follow-up care with your doctors is key for finding an optimal management plan and medication regimen to minimize the impact of neuropathy flares on your health and quality of life.
What diagnostic tests help evaluate neuropathy flares?
Diagnostic testing can help pinpoint the underlying cause of neuropathy flares. Tests your doctor may order include:
– Blood tests – These check for diabetes, kidney disease, deficiencies of vitamins B1, B6, B12, E and D, immune disorders, hypothyroidism, and cancer. Complete blood count, metabolic panel, thyroid hormones, serum albumin, serum protein electrophoresis, and hemoglobin A1C should be evaluated.
– Nerve conduction velocity test – This records how fast electrical signals move through a nerve. Slowed nerve impulses can confirm a neuropathy diagnosis and determine specific affected nerves.
– Electromyography – Needle electrodes analyze muscles’ electrical activity. Unusual activity signifies nerve damage.
– Quantitative sensory testing – This quantifies sensory thresholds and patient reaction time to stimuli like vibration, hot/cold, and touch. It evaluates how well sensory nerves are functioning.
– MRI or CT scan – Scans of the spine evaluate compressed, herniated, or damaged nerves. MRI best visualizes soft tissues like nerves and discs. CT provides images of bones.
– Nerve or skin biopsy – Removing a small nerve or skin sample can reveal cell damage and patterns of nerve fiber loss confirming neuropathy. It distinguishes neuron damage from myelin sheath dysfunction.
Diagnostic testing lets doctors gauge the severity of nerve damage and determine whether neuropathy is progressing or stable. Results direct appropriate treatments to manage flares.
Conclusion
Neuropathy flares are exacerbations of nerve pain and other symptoms. They have numerous potential causes, including compressed nerves, nutrient deficiencies, blood sugar changes, infections, weather, and emotional stress. Flares may arise during sleep, strenuous activity, cold exposure, or periods of poor glycemic control in diabetics. Peripheral neuropathy patients can take steps to prevent flares by stabilizing blood sugar, correcting nutritional deficiencies, practicing mindful movement and positioning, staying warm in cold weather, reducing anxiety, and taking medications if needed. Seeking emergency care for debilitating flares involving loss of limb function or control of bowels and bladder is essential. Ongoing follow-up with healthcare providers helps create an effective treatment approach to minimize and control neuropathy flaring.