Differences Between Peripheral Neuropathy and MS

Which is the disease and which is the symptom?

There are over 100 types of peripheral neuropathy, according to the National Institute of Neurological Disorders and Stroke, and they are classified based on the type of nerve damage they cause.

For instance, some peripheral neuropathies affect only one nerve (called mononeuropathies) whereas others affect multiple nerves (called polyneuropathies). In addition, some peripheral neuropathies result from damage to nerve fibers whereas others result from damage to the myelin sheath (and others both).

While peripheral neuropathy shares a few common symptoms with multiple sclerosis (MS), like pain and abnormal sensations, it's important to understand these are completely different diseases. Let's take a closer look at some of the key differences..

Differences in Pathology

The first key difference between peripheral neuropathy and MS is which part of the nervous system they affect. The workings of a disease or disorder is referred to as the pathology.

Peripheral Neuropathy

Peripheral neuropathy refers to nerve damage involving the peripheral nervous system, which is those nerves outside the brain and spinal cord. The damaged peripheral nerves malfunction and provoke abnormal sensations, pain, and numbness. These sensory abnormalities most commonly affect the feet, lower legs, and hands. Muscle weakness can also occur in people with severe or long-standing peripheral neuropathy.

Multiple Sclerosis

MS affects the central nervous system, which is comprised of the brain, optic nerve, and spinal cord. The nerves in the central nervous system sustain damage over time, which interferes with their ability to communicate with the peripheral nervous system. This damage can then cause abnormal sensations, pain, and numbness indistinguishable from that caused by peripheral neuropathy.

Differences in Causes

Peripheral neuropathy and MS are both associated with demyelination. Demyelination is an abnormal process in which the insulating membrane around nerves (called myelin) is stripped away, causing the electrical impulses between nerve cells to fire abnormally.

Peripheral Neuropathy

Peripheral neuropathy is associated with a number of conditions that directly or indirectly trigger demyelination. While diabetes is the most common cause of peripheral neuropathy among Americans, many other health conditions may be the culprit. Some examples include:

  • Chronic kidney disease
  • Hypothyroidism
  • Some autoimmune diseases (for example, systemic lupus erythematosus or rheumatoid arthritis)
  • HIV infection
  • Herpes simplex virus (HSV) infection
  • Toxins, such as lead, mercury, and heavy alcohol intake
  • Injury-related nerve damage
  • Alcohol abuse
  • Certain medications (for example, certain HIV medications and chemotherapies)

Multiple Sclerosis

While there are numerous causes of peripheral neuropathy, with MS, it is the person's own immune system that is responsible for demyelination.

MS is characterized by an immune system gone awry, resulting in an assault on the myelin sheath or the cells that produce and maintain it. This causes inflammation and injury to the sheath and the scarring (sclerosis) of nerve tissues that it surrounds.

While both peripheral neuropathy and MS are associated with demyelination, peripheral neuropathy is ultimately a symptom of a demyelinating condition, while MS is a progressive disease that causes demyelination.

Differences in Diagnosis

Determining the cause of your symptoms and making a diagnosis begins with a complete medical history, including a careful review of all of the symptoms you've been experiencing. Next is a thorough physical with a complete neurological examination.

Peripheral Neuropathy

Depending on the outcomes of these initial assessments, if your doctor suspects a peripheral neuropathy, he may recommend additional testing that may include blood work, an MRI, and/or nerve tests, like an electromyography (EMG) and/or a nerve conduction velocity (NCV) test. 

Multiple Sclerosis

For the diagnosis of MS, your doctor will also order an MRI or perform a lumbar puncture to obtain spinal fluid for analysis. Blood work willl also be done to rule out health conditions that can mimic that of MS.

MS is diagnosed by exclusion, meaning that all other causes must be excluded before a diagnosis is confirmed. Peripheral neuropathy can be confirmed if there is an abnormal EMG or a skin biopsy reveals a reduction in nerve endings.

Differences in Treatment

From the point of view of treatment, it is important to remember that peripheral neuropathy is a symptom, while MS is a disease. The treatment of the peripheral neuropathy would, therefore, be focused on the underlying cause, while the treatment of MS would involve inhibiting the very mechanism of the disease (also known as the disease pathway).

Peripheral Neuropathy

When treating peripheral neuropathy, your doctor will consider the underlying cause. For example, if diabetes is the culprit, then getting your blood sugar under control is a primary goal. 

If a medication or toxin is causing the side effect, removing or stopping the offending agent (if possible) is important. The good news is that nerve fibers in your peripheral nervous system can regrow, so treating the underlying condition can improve (even cure, in some instances) a person's peripheral neuropathy. 

For the acute pain of peripheral neuropathy, your doctor may recommend one or more of the following medications:

  • Nonsteroidal anti-inflammatories (NSAIDs)
  • Certain antidepressants like Elavil (amitriptyline) or Cymbalta (duloxetine)
  • Certain anticonvulsants like Lyrica (pregabalin) or Neurontin (gabapentin)
  • Topical medications like topical lidocaine or capsaicin
  • Tapentadol (only for diabetic neuropathy)

Besides medication, other pain-alleviating therapies that may be advised, include:

  • Transcutaneous electrical nerve stimulation (TENS)
  • Complementary therapies like acupuncture or massage
  • Lifestyle habits (for example, smoking cessation, exercise, and regular foot care if you have diabetes)
  • Surgery—for certain peripheral neuropathies in which a single nerve is compressed (for example, carpal tunnel syndrome)

Multiple Sclerosis

The treatment of multiple sclerosis is two-fold, involving both a disease-modifying medication (to combat the inflammation of MS) and medications to help a person manage their unique symptoms.

For abnormal sensations in MS, your doctor may recommend some of the same medications used to treat the discomfort in peripheral neuropathy like Cymbalta (duloxetine) or Neurontin (gabapentin). If your neuropathy is part of an MS relapse or is particularly bothersome, your doctor may prescribe a short course of corticosteroids. 

With peripheral neuropathy, the demyelination can sometimes be reversed, albeit slowly, once the underlying cause is treated. Because MS is progressive, demyelination may be slowed but not reversed by treatment.

A Word From Verywell

Although you may be tempted to delay seeing your doctor, nervous system symptoms should not be ignored. If you're experiencing symptoms that could be related to either peripheral neuropathy or MS, your doctor will do the necessary assessments to make the correct diagnosis. 

While you're waiting for your appointment date, it's helpful to keep a log of your symptoms so you can describe them in detail, along with any patterns in their occurrence, and any aggravating or provoking factors.

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