Leg Pain

Others may complain of extreme sensitivity leading to an intense experience of touch (allodynia). In such cases, pain may occur in response to a stimulus that does not normally provoke pain.

In the majority of cases, the source of leg pain is peripheral neuropathy.

Peripheral nerves send sensory information back to the brain and spinal cord, such as a message that the feet are cold. Peripheral nerves also carry signals from the brain and spinal cord to the muscles to generate movement.

Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and spinal cord and the rest of the body.

Leg pain, if not the result of direct injury to the area or repetitive use, can be due to damage to the peripheral nervous system or of a neurological disorder that causes weakening of muscles. It is best to consult a Neurologist for an accurate diagnosis.

People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy.

Signs and symptoms of peripheral neuropathy might include:

• A sensation of wearing an invisible “glove” or “sock”
• Burning sensation or freezing pain
• Sharp, jabbing, shooting, or electric-like pain
• Extreme sensitivity to touch
• Difficulty sleeping because of feet and leg pain
• Loss of balance and coordination
• Muscle weakness
• Muscle cramping/twitching
• Difficulty walking or moving the arms
• Unusual sweating
• Abnormalities in blood pressure or pulse

Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves.

Peripheral neuropathy has many potential causes. Besides a physical exam, diagnosis usually includes:

• A full medical history including your medical history, symptoms, lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases.
• Neurological examination including tendon reflexes, muscle strength and tone, ability to feel certain sensations, as well as posture and coordination.

Your doctor may order tests, including:

• Blood tests to detect vitamin deficiencies, diabetes, abnormal immune function and other conditions that can cause peripheral neuropathy.
• Imaging tests like CT or MRI scans to look for herniated disks, tumors or other abnormalities.
• Nerve function tests Electromyography to record electrical activity in your muscles and detect nerve damage.
• Other nerve function tests which might include an autonomic reflex screen to record how the autonomic nerve fibers work, a sweat test, and sensory tests to record how you feel touch, vibration, cooling and heat.
• Nerve biopsy which involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.
• Skin biopsy which removes a small portion of skin to look for a reduction in nerve endings.

It is common for people with peripheral neuropathy to experience different degrees of pain. Your doctor will work with you to identify the type of pain medication that will best manage your symptoms and work with your body chemistry, and other treatments.

Acute pain accompanies illness, inflammation, or injury to tissues. The onset of acute pain is sudden and may occur with emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain will go away over time. Occasionally, acute pain can become chronic.

Chronic pain may be part of the disease itself. Environmental and psychological factors may make it become worse. Chronic pain lasts for longer periods of time than acute pain and is more difficult to treat.

Today, many treatment options exist (over-the-counter), doctor prescribed and alternative/complementary treatments) to alleviate symptoms, and aide in peripheral neuropathy pain relief, and it’s important to find the treatment option that will work best for you.

Treatment goals are developed to manage the condition that is causing your neuropathy which will relieve symptoms.

Medications used to relieve peripheral neuropathy signs and symptoms include:

• Pain relievers: Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.

Medications containing opioids can lead to dependence and addiction, so these drugs generally are prescribed only when other treatments fail.

• Anti-seizure medications: Medications developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.
• Topical treatments: Capsaicin cream can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.

Lidocaine patches are another skin treatment that might offer pain relief. Side effects can include drowsiness, dizziness, and numbness at the site of the patch.

• Antidepressants: Certain tricyclic antidepressants have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

Others might also ease the pain of peripheral neuropathy caused by diabetes. Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite, and constipation.

If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.

Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.

• Transcutaneous electrical nerve stimulation (TENS) calls for electrodes to be placed on the skin to deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.
• Plasma exchange and intravenous immune globulin which help suppress immune system activity might benefit people with certain inflammatory conditions.

Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).

• Physical therapy can help improve muscle weakness and movements. Some people may also need hand or foot braces, a cane, a walker, or a wheelchair.
• Surgery may be suggested if you have neuropathies caused by pressure on nerves, such as pressure from tumors.

Diabetic neuropathy is one of the most common forms of peripheral neuropathy. In this case, nerve damage occurs in an ascending pattern.

The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.