Concise review for clinicians
Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management

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Abstract

Peripheral neuropathy is one of the most prevalent neurologic conditions encountered by physicians of all specialties. Physicians are faced with 3 distinct challenges in caring for patients with peripheral neuropathy: (1) how to efficiently and effectively screen (in less than 2 minutes) an asymptomatic patient for peripheral neuropathy when they have a disorder in which peripheral neuropathy is highly prevalent (eg, diabetes mellitus), (2) how to clinically stratify patients presenting with symptoms of neuropathy to determine who would benefit from specialty consultation and what testing is appropriate for those who do not need consultation, and (3) how to treat the symptoms of painful peripheral neuropathy. In this concise review, we address these 3 common clinical scenarios. Easily defined clinical patterns of involvement are used to identify patients in need of neurologic consultation, the yield of laboratory and other diagnostic testing is reviewed for the evaluation of length-dependent, sensorimotor peripheral neuropathies (the most common form of neuropathy), and an algorithmic approach with dosing recommendations is provided for the treatment of neuropathic pain associated with peripheral neuropathy.

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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