Jenny L. F. Andrus, MD
Nerve pain is varied, and patients may describe it in the following terms: stinging, burning, stabbing, numb, heavy, tickling, sore, aching, throbbing, shocking, tingling, pressure, “pins and needles” or just plain weird. It can also make the affected area sensitive to touch or cold and make normal pleasurable stimuli feel uncomfortable.
Diagnosing a patient with polyneuropathy can happen in several ways. For example, if a patient has an underlying disease, such as diabetes, the diabetes may be diagnosed as a result of the pain of the polyneuropathy, or the polyneuropathy may be the reason that the diabetes is uncovered. Often, the patient has seen many physicians for treatment before they are seen by me, so they may have an underlying diagnosis already, but not always. I do a thorough investigation of their medical records, a detailed physical examination, running the appropriate diagnostic tests (if they have not already been ordered), and really talking to the patient and listening carefully to what they have to say about their health, lifestyle, activities and overall condition.
The diagnostic tests which I usually order would include blood work, an MRI and a nerve function study, commonly known as an EMG. The blood work could help to find diabetes, auto-immune disorders, vitamin deficiencies or other reasons for polyneuropathy. The MR scan will show any problems with the spine, spinal cord and the nerves that come from the spinal cord, and illuminate any pinched nerves, bulging or herniated spinal discs, spinal stenosis or other spinal conditions that could be affecting the nerves. The EMG is really two tests, one to measure electrical activity as the muscle is contracted in a specific body part, and a nerve conduction study, where specific affected nerves are stimulated by an electric current to see how fast they respond.
If I uncover an underlying condition, such as diabetes, cancer, auto-immune disease, spinal stenosis, etc., I may refer the patient to another physician to treat that condition first. Often times, the polyneuropathy will improve on its own and become much more manageable. I am available to continue to see the patient for treatment of chronic pain as well, but I want to make sure that serious underlying condition is addressed first or concurrently with my treatment, depending on the condition.