Concise review for cliniciansPeripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management
Section snippets
Screening for Peripheral Neuropathy
The recognition of peripheral neuropathy in patients with disorders in which it is highly prevalent may affect the management for that disease. Annual screening for peripheral neuropathy is recommended in diabetic patients.10, 11 Physicians must be able to screen these patients in an efficient manner during return office visits that are often focused on other components of the disease and its treatments. Most recommendations for office screening for neuropathy have utilized light touch
Clinically Stratifying Patients With Peripheral Neuropathy
Sensory symptoms (eg, numbness, tingling), weakness, autonomic symptoms (eg, early satiety, impotence, orthostatic hypotension, sweat abnormalities), or neuropathic (burning, stabbing, electrical) pain may suggest the presence of a peripheral neuropathy. Once a neuropathy is suspected (from patient history or screening examination in at-risk patients), the clinical history and a detailed examination (including strength, sensation, reflexes, and gait) allow the neuropathy to be categorized by
Symptomatic Management of Peripheral Neuropathy
The primary goal in the evaluation of neuropathy is to identify the etiology and if possible treat the underlying cause. However, even when the neuropathy has a treatable etiology (such as diabetes mellitus, vitamin B12 deficiency, or toxic exposure), treatment serves primarily to prevent further progression of the neuropathic symptoms. Symptoms present at the start of treatment or when a toxic agent is removed may improve and occasionally resolve. However, more commonly patients are left with
Conclusion
Peripheral neuropathy is commonly encountered in the primary care setting. In patients with systemic disease such as diabetes mellitus, peripheral neuropathy can be efficiently identified or ruled out by screening with a combination of vibration and light touch testing. Most peripheral neuropathies are length dependent, sensory predominant, and clinically mild to moderate in severity without notable functional limitations. These neuropathies can usually be effectively worked up and managed
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