Peripheral Neuropathy – The Challenge

Peripheral Neuropathy (P.N.) – burning, cramping, numbness, tingling, sharp pains in the feet and sometimes hands is becoming extremely common. A high percentage of cases can be reversed without surgery or medications. So it is still difficult to fathom the gauntlet a patient suffering from this condition must confront in an attempt to obtain a correct diagnosis or successful treatment.

The medical literature contains abundance of peer reviewed studies cataloging the multitude of causes that create the above symptoms and awareness of the literature should result in a diagnosis of P.N. and its known cause. Indeed, the Contemporary Neurology Series- essentially the medical bible on such matters, in its peripheral neuropathy in chemical practice volume – which is distributed free to most neurologists and neurosurgeons – lists as many as 80 possible causes.

Yet today the P.N. patient is still told “maybe you have P.N.” Tests for diabetes, spinal cord problems, or nerve entrapment in the ankle may or may not be run. If tests are run and are positive for one of these causes medical intervention into the diabetes or surgical intervention for the spinal cord or ankle problems may be performed. If these procedures are not effective (and this list includes post chemo peripheral neuropathy) the patient is regularly told its idiopathic (has no known cause) and you can take these medications for the rest of your life or you just have to live with it, or both. Huh??

Let’s look at a recent case that entered our practice that is representative of the challenges faced by the average P.N. patient. 70 year old Caucasian male comes in with numb toes that he has been unable to move easily since 1998. He went to his PCP who sent him to a neurologist who told him “his nerve endings were dying.” No diagnosis was rendered. The patient researched the symptoms on his own and came to a self diagnosis of Peripheral Neuropathy. For the record, his diagnosis was correct. He developed further symptoms but his primary symptom was still numbness. His legs also felt like “big lumps”, and he currently feels like he is “walking on rocks”, which he described as being uncomfortable. This description of pain alone suggests three probable, separate, but simultaneous causes of his foot symptoms – all of which by the way are listed in the above mentioned medical neurology textbook series.

He does not have diabetes but was started on Lipitor about the same time some of the symptoms started as he has “always had high cholesterol”. He has had his gallbladder removed and has several thyroid symptoms. He has chronic stomach problems which removing his gallbladder did not resolve. He also has restless leg syndrome (RLS). This was expressed as numbness, tingling, and pain and needles in his legs that made him need to move them at night so he could sleep. All of this history is significant.

After a complete neurological and general systems history and examination was completed here’s what was found; His examination was suggestive of what is termed a distal symmetric polyneuropathy involving loss of all of the five different types of nerve endings in his feet. This cannot occur due to only one cause. The exam concluded that the spine, ankles, diabetes and/or chemotherapy were not among the causes for his P.N. It was ultimately found that the statin exposure (the Lipitor) was causing the “Restless leg” symptoms and he was referred back to his MD for this matter. Additionally, he also was found to have a gluten intolerance which can cause gluten related peripheral neuropathy and balance conditions about 8-11% of the time. This gluten intolerance by the way was also the cause of his “stomach” problems and unnecessary gallbladder removal. Two of the many causes of “distal symmetric polyneuropathy” (one of many types of neuropathy listed in the literature) are autoimmune diseases and thyroid conditions. This patient tested positive for two autoimmune diseases – Hashimotos – an autoimmune attack on his thyroid – and Celiac- an autoimmune attack triggered by gluten on his small intestines (remember the stomach problem?). He also had multiple additional food allergies, all of which were affecting his immune system which was in turn attacking and damaging his “nerve endings” and “causing them to die”. Many other causes- as per the medical model’s own literature- were ruled out with fairly minimal and cost effective blood salivary and urinary testing.

Management of the above findings has resulted in a cessation of the patients declining symptoms and a symptomatic reversal of 50-70% of the symptoms to date. The patient is about 2/3 of the way through treatment and further progress is expected.

This case is classic in its representation of the challenges the Peripheral Neuropathy patient faces in obtaining a specific diagnosis of the cause of his P.N. in the medical model. Or in this case, the challenges of obtaining a diagnosis of the multiple causes of his symptoms and/or condition, and obtaining a specific non- drug, non surgical solution to their problem.

The lesson? If you’re told your P.N. is caused by diabetes, spinal, ankle conditions, or chemo and you haven’t responded to treatment for those diagnosis and you have been relegated to live with it, or with a lifetime drug regimen – find a Functional Medicine Doctor or someone practicing Functional Neurology, or preferably both in your area and get a full evaluation before giving up.

Herskovitz, Steven, Stephen Scelsa, and Herbet Schaumburg. Peripheral Neuropathies in Clinical Practice. Pages 31-38 Oxford University Press. 2010 New York, New York