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Neuropathies - A Detailed Explanation

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Neuropatias – Uma Detalhada Explanação, Blog Soropositivo.Org
If you understand this photo...

Neuropathies. I put it in the plural because, for example, mine stopped being, a while ago, peripheral neuropathy. Like the small ray mentioned by Dom Casmurro, it became large and castellan and, today, it is axonal, distal and other adjective polyneuropathy.

One of the reasons for the dramatic reduction in my publication rate, and for my bad mood as well, is the volume of inconvenience this causes. I'm looking for a neuro who is able to prescribe cannabidiol oil and I'm looking for my rights to the medicinal cultivation of "weed".

If you can read all this text, you will understand me and you will also end...

 

…understanding neuropathy

Peripheral neuropathy 1 is a medical condition caused by damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (ie, the central nervous system) to all other parts of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that your feet are cold or that a toe is burned.

 

Overview

System damage peripheral nervous interfere with these connections and communications. Like static on a phone line, peripheral neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body. Since each peripheral nerve has a highly specialized function in a specific part of the body, a wide variety of symptoms can occur when nerves are damaged.

Some people might try:

  • temporary dormancy;
  • Tingling 2;
  • Disappearance of limbs or other similar sensations (paraesthesia)
  • Sensitivity to touch (excruciating pain with a kiss)—it almost sounds like punishment to me—(I know who I was), or muscle weakness;

others may experience more extreme symptoms, including:

  • Burning (especially at night);
  • loss of muscle mass;
  • Paralysis 4;
  • Gland or organ dysfunctions;

In some people, peripheral neuropathy can affect the ability to:

  • digest food easily 3;
  • Maintain safe blood pressure levels;
  • perspire normally 2;
  • experience the sexual function normally (...);

In most extreme cases, breathing may become difficult, or lung failure may occur..

 

Formas

Neuropatias podem disseminarse pelo corpoSome forms of neuropathy involve damage to just one nerve and are called mononeuropathies. More often, several nerves that affect all limbs are affected, called polyneuropathies.5

Occasionally, two or more isolated nerves in separate areas of the body are affected, called multiplex mononeurites.

In acute neuropathies such as Guillain-Barré syndrome 7 (also known as acute inflammatory demyelinating neuropathy), the symptoms appear suddenly, progress rapidly and slowly disappear as damaged nerves are healed.

In chronic neuropathies, symptoms begin subtly and progress slowly. Some people may experience periods of relief followed by relapse. Others may reach a plateau stage where symptoms remain the same for many months or years. Some chronic neuropathies get worse over time, but very few forms are fatal unless they are complicated by other diseases.. Occasionally, neuropathy is a symptom of another disorder.

In the most common forms of polyneuropathy, the nerve fibers, the individual cells that make up the most distant nerves in the brain, cause the spinal cord to malfunction. Pain and other symptoms often appear symmetrically, for example, in both feet, followed by a gradual progression in both legs. Then the fingers, hands, and arms may be affected and symptoms may progress to the core of the body. Many people with diabetic neuropathy have this pattern of ascending nerve damage.

Classifications

More than 100 types of peripheral neuropathy have been identified, each with a characteristic set of symptoms, a pattern of development and prognosis.8

Impaired function and symptoms depend on the type of nerves - motor, sensory and autonomic - that are damaged:

  • motor nerves control the movements of all muscles under conscious control, such as those used to walk, grab things, or speak;
  • Sensory nerves convey information about sensory experiences, such as the sensation of a light touch or the pain resulting from a cut;
  • Autonomic nerves regulate biological activities that people don't consciously control, how to breathe, digest food and functions of the heart and glands;

Although some neuropathies can affect the three types of nerves, others mainly affect one or two types. Therefore, when describing a patient's condition, physicians may use terms such as:

  • Predominantly motor neuropathy Neuropathy
  • Predominantly sensory neuropathy
  • sensorimotor neuropathy
  • Autonomic neuropathy

Symptoms

Symptoms of peripheral neuropathy are related to the type of nerve affected and can be seen over a period of days, weeks, or even years. Muscle weakness is the most common symptom of motor nerve damage 9.

Other symptoms may include:

  • painful cramps and fasciculation (uncontrolled muscle contracting visible under the skin);
  • Loss of muscle mass 2,
  • bone degeneration;
  • Changes in skin, hair, and nails 4;

More general degenerative changes can also result from loss of sensory or autonomic nerve fibers. Sensory nerve damage causes a more complex range of symptoms because sensory nerves have a broader and highly specialized range of functions.

Larger sensory fibers 

Larger sensory fibers encased in myelin (a fatty protein that coats and insulates many nerves) register vibration, light touch, and a sense of position. Damage to large sensory fibers decreases the ability to sense vibrations and touch, resulting in an overall feeling of numbness, especially in the hands and feet.

People can feel like they're wearing gloves and socks, even when they're not. many patients cannot recognize the shapes of small objects by touch or distinguish between different shapes. This damage to sensory fibers can contribute to loss of reflexes (as well as damage to the motor nerve), as well as loss of position sense often makes people unable to coordinate complex movements, such as walking or pressing buttons, or maintaining the balance when the eyes are closed.

Neuropathic pain is difficult to control and can seriously affect emotional well-being and overall quality of life. I must say that there came a time when I didn't know whether to cry or cut my two carotids simultaneously. I chose to cry, I love to live… Neuropathic pain is often worse at night, seriously affecting sleep and increasing the emotional charge of the damaged sensory nerve.10

 

https://soropositivo.org/causas-da-neuropatia-periferica/

Minor Sensory Fibers

Neuropatias danificam nervosSmaller sensory fibers may or may not have small myelin sheaths and are responsible for transmitting sensations of pain and temperature. Damage to these fibers can interfere with the ability to feel pain or temperature changes.

People may not realize that they have been injured by a cut or that a wound is becoming infected. Others may not detect pains that warn of an impending heart attack.and or other acute conditions. Loss of pain sensation is a particularly serious problem for people with diabetes, contributing to the high rate of lower limb amputations in this population. 11

Skin pain receptors can also become more sensitized, and people may experience pain (allodynia) from stimuli that are normally painless (for example, some may experience pain due to sheets placed lightly on the body).

Autonomic nerve damage

Symptoms of autonomic nerve damage are diverse and depend on which organs or glands are affected. Autonomic neuropathy (autonomic nerve dysfunction) can be fatal and may require emergency medical attention when breathing is impaired or when the heart begins to beat irregularly. Common symptoms of autonomic nerve damage may include:

  • An inability to sweat normally (which can lead to heat intolerance)
  • Loss of bladder control (which can cause infection or incontinence) 12
  • An inability to control expanding muscles or blood vessels to maintain safe levels of blood pressure.

Loss of control over blood pressure can cause dizziness, fainting, or even fainting when a person suddenly moves from a sitting to a standing position (a condition known as postural or orthostatic hypotension).

Gastrointestinal symptoms often accompany autonomic neuropathy.13 The nerves that control the contractions of the intestinal muscles often malfunction, causing diarrhea, constipation, or incontinence. Many people also have problems eating or swallowing if certain autonomic nerves are affected.

Causes

Peripheral neuropathy can be acquired or hereditary. Causes of acquired peripheral neuropathy include:

  • physical injury (trauma) to a nerve;
  • Tumors 9;
  • Toxins;
  • autoimmune responses;
  • nutritional deficiencies;
  • Alcoholism 14;
  • vascular and metabolic disorders;

HIV and Immunoness – Premature Aging is Fact

Acquired peripheral neuropathies are grouped into three general categories:
  • Those caused by systemic disease;
  • Those caused by trauma from external agents;
  • Those caused ​​by infections or autoimmune diseases that affect nervous tissue;

An example of acquired peripheral neuropathy is trigeminal neuralgia 15

(also known as tic douloureux). painful "tick" in French

Causes damage or pressure to the trigeminal nerve (the great nerve of the head and face) episodic attacks of excruciating lightning-like pain on one side of the face.

In some cases, the cause is a previous viral infection, pressure exerted on a nerve by a tumor or swollen blood vessel, or, rarely, multiple sclerosis.

In many cases, however, a specific cause cannot be identified. Doctors often refer to neuropathies without a known cause as idiopathic neuropathies.

Physical Injury: Physical injury (trauma) is the most common cause of nerve damage. Sudden injury or trauma, from:

Listing Facts

 

Esta é uma dor neuropática que sinto muitoA traumatic injury can cause the nerves to be partially or completely cut, crushed, compressed or stretched, sometimes with such force that they are partially or completely detached from the spinal cord. Less dramatic trauma can also cause serious nerve damage.

Fractured or dislocated bones can put detrimental pressure on neighboring nerves, and discs slipping between the vertebrae can compress the nerve fibers from which they emerge from the spinal cord.

Systemic diseases: systemic diseases, including many disorders that affect the whole body., usually cause metabolic neuropathies. These disorders can include metabolic and endocrine disturbances.

Nervous tissues are highly vulnerable to damage caused by diseases that impair the body's ability to transform nutrients into energy, process waste, or manufacture the substances that make up living tissue.

 

In search of relief for patients with pain and AIDS

 

diabetes

Diabetes: Diabetes mellitus, characterized by chronically elevated blood glucose levels, is a major cause of peripheral neuropathy, in the US about 60 percent to 70 percent of people with diabetes have mild to severe forms of nano nervous system.

Kidney and Liver Diseases

Kidney Disorders: Kidney disease can lead to abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. Most patients who require dialysis because of kidney failure developed by polyneuropathy. Some liver diseases also lead to neuropathies as a result of chemical imbalances.

Hormonal Disorders

Hormones: Hormonal imbalances can disrupt normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones slows metabolism, leading to fluid retention and swollen tissues that can put pressure on peripheral nerves.

Overproduction of growth hormone can lead to acromegaly, a condition characterized by abnormal enlargement of many parts of the skeleton., including the joints. The nerves that run through these affected joints are often trapped.

Vitamin Deficiency

Vitamin Deficiencies and Alcoholism: Vitamin deficiencies and alcoholism can cause widespread damage to nervous tissue.14

Vitamins E, B1, B6, B12 and niacin are essential for healthy nerve function. Thiamine deficiency, in particular, is common among people with alcoholism because they often also have poor eating habits. Thiamine deficiency can cause painful neuropathy in the extremities.

Peripheral Neuropathy and Symptoms. Article No. 2

 

Alcoholism

Some researchers believe that excessive alcohol consumption may, by itself, directly contribute to nerve damage, a condition known as alcoholic neuropathy..

Vascular Diseases

Vascular Damage and Blood Disease: Vascular damage and blood disease can diminish the supply of oxygen to peripheral nerves and quickly lead to serious damage or death to nerve tissue, much as a sudden lack of oxygen to the brain can cause a AVC. Diabetes often leads to damage to blood vessels.16

Various types of vasculitis (inflammation of blood vessels) often causes hardening of the vessel walls or thickening, and develops scars in vascular tissues, reducing their diameter by preventing blood flow. This category of nerve damage (called multiple mononeuropathy or multifocal mononeuropathy) occurs when isolated nerves in different areas are damaged.

Connective Tissue Diseases

Connective tissue disorders and chronic inflammation: Tissue disorders connective tissue disorders and chronic inflammation cause direct and indirect damage to nerves. When the multiple layers of protective tissue around the nerves become inflamed, the inflammation can spread directly to the nerve fibers.

Chronic Inflammation (...)

Chronic inflammation also leads to progressive connective tissue destruction, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and pinch nerves, causing pain.17:

Tumors and Neoplasms

 

Peripheral HIV Neuropathy and Its Causes

 

Cancers and Tumors Cancers and benign tumors can infiltrate or exert harmful pressure on nerve fibers. Tumors can also arise directly from cells in nervous tissue. THE generalized polyneuropathy it is often associated with neurofibromatosis, genetic diseases in which several benign tumors grow in nervous tissue. Neuromas, benign masses of overgrown nervous tissue that can develop after any penetrating injury that disrupts nerve fibers, generate very intense pain signals and sometimes engulf neighboring nerves, causing more damage and even more pain. — It's crazy —

Neuroma formation may be an element of the most widespread neuropathic pain a condition called complex regional pain syndrome or reflex sympathetic dystrophy syndrome, which can be caused by traumatic injuries. or surgical trauma.

Paraneoplastic syndromes, a group of rare degenerative diseases that are triggered by a person's immune system response to a cancerous tumor, can also indirectly cause generalized nerve damage.

LER

 

Neuropatias debilitamRepetitive stress: repetitive stress usually leads to compression neuropathies, a special category of compression injury.18

Cumulative damage can result of repetitive, forced and uncomfortable activities that require flexing of any group of joints for prolonged periods.

The resulting irritation can cause ligaments, tendons and muscles. become inflamed and swollen, compressing the narrow passages through which some nerves pass. These injuries become more frequent during pregnancy, probably because weight gain and fluid retention also compress the nerve pathways.

Toxins

Toxins: Toxins can also damage peripheral nerves. People exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins often develop neuropathy.

Drug Neuropathies

Neuropatias MedicamentosasCertain anticancer drugs, anticonvulsants, antivirals and antibiotics have side effects that can cause neuropathy secondary to the drugs, thus limiting its long-term use.

Viruses and Bacteria

Infections and Autoimmune Diseases: Infections and autoimmune diseases can cause peripheral neuropathy. You viruses and the bacteria that can attack nerve tissue include:

  • herpes varicella zoster (shingles) 19
  • Epstein-Barr virus 20
  • cytomegalovirus (CMV),21
  • herpes simplex22

These viruses severely damage sensory nerves, causing attacks of cut pain, or electrical discharges. Postherpetic neuralgia usually occurs after a herpes zoster attack. and it can be particularly painful.

The human immunodeficiency virus (HIV), which causes AIDS, also causes major damage to systems. central and peripheral nervous. The virus can cause several forms of neuropathy, each strongly associated with a specific stage of active immunodeficiency disease. A painful and rapidly progressive polyneuropathy affecting the feet and hands may be the first clinical sign of HIV infection.

Bacterial diseases such as Lyme disease, 23 diphtheria 24 and leprosy 25 are characterized by extensive damage to peripheral nerves.

  • Diphtheria and leprosy in the United States are rare.
  • Lyme disease is on the rise. Lyme disease can cause a wide range of neuropathic disorders that can develop weeks, months, or years after a tick bite if the disease is not treated.

Viral and bacterial infections can also indirectly damage nerves, causing conditions known as autoimmune diseases, in which specialized cells and antibodies from the immune system attack the body's own tissues. These attacks usually cause destruction of the nerve axon's myelin sheath.

Autoimmune Activities

Some neuropathies are caused by inflammation resulting from the activity of the immune system, rather than from direct damage by infectious organisms.26

Inflammatory neuropathies can develop quickly or slowly, and chronic forms can exhibit a pattern of remissions alternating with relapses.

  • Guillain-Barré syndrome (acute inflammatory demyelinating neuropathy) can damage motor, sensory, and autonomic nerve fibers. Most people recover from this syndrome, although severe cases can be fatal.
  • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is generally less dangerous, often damaging sensory and motor nerves, leaving the autonomic nerves intact.
  • Multifocal motor neuropathy is a form of inflammatory neuropathy that exclusively affects the motor nerves; it can be chronic or acute.

 

Neuropatias – Uma Detalhada Explanação, Blog Soropositivo.Org

 

Inherited neuropathies: Inherited peripheral neuropathies are caused by inborn errors in the genetic code or by new genetic mutations.

  • Some genetic errors lead to mild neuropathies with symptoms that begin in early adulthood and result in little impairment.
  • More severe hereditary neuropathies usually appear in infancy or childhood.

The most common hereditary neuropathies are a group of diseases collectively known as Charcot-Marie-Tooth disease (resulting from failures in the genes responsible for making neurons or the myelin sheath). Symptoms include:

  • extreme weakness and atrophy of muscles in legs and feet
  • Disorders in the way of walking27
  • Loss of tendon reflexes
  • numbness in the lower limbs
Treatment

There are now medical treatments. Cannot Cure Hereditary Peripheral Neuropathy. However, there are therapies for many other ways. Here are the key points for treating peripheral neuropathy.

  • Any underlying condition is usually treated first, followed by symptomatic treatment.;
  • Peripheral nerves are able to regenerate as long as the nerve cell itself has not been killed;
  • Symptoms can usually be controlled and eliminating the causes of specific forms of neuropathy can prevent further damage;
  • Positive changes and healthy habits ​​usually create conditions that stimulate nerve regeneration;
  • Timely treatment of injuries can help prevent permanent damage;

In general, the treatment of peripheral neuropathy involves the adoption of healthy habits to reduce physical and emotional effects, such as:

  • Keeping an ideal weight,
  • Avoid exposure to toxins 3;
  • follow a doctor-supervised exercise program;
  • Eat a balanced diet;
  • Correcting vitamin deficiencies 3;
  • limit or avoid alcohol consumption;
Other treatments for peripheral neuropathy include:
    • Exercise: Active and passive forms of exercise can reduce cramps, improve muscle strength, and prevent muscle loss in paralyzed limbs.
    • Diet and Nutrition: Various Diet Strategies Can Improve gastrointestinal symptoms;
  • Quit smoking: Quitting smoking is particularly important because smoking constricts blood vessels that supply nutrients to peripheral nerves and may worsen neuropathic symptoms.
  • Self-care skills: Self-care skills, such as meticulous foot care and careful wound care in people with diabetes, and others who have a diminished ability to feel pain, can alleviate symptoms and improve quality of life. 28
systemic diseases

Systemic diseases often require more complex treatments. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage.

Inflammatory and autoimmune conditions that lead to neuropathy can be controlled in a number of ways, including immunosuppressive drugs such as:

  • prednisone 29;
  • Cyclosporin (Neoral, Sandimmune);
  • Imran (azathioprine);

Plasmapheresis: plasmapheresis, a procedure in which blood is removed, cleaned of immune system cells and antibodies, and then returned to the body – they can limit inflammation or suppress immune system activity. High doses of immunoglobulins, proteins that function like antibodies, can also suppress abnormal immune system activity.

Pain relief:

Neuropathic pain is often difficult to control.30

Mild pain can sometimes be relieved with over-the-counter pain relievers. Several classes of medications have been shown to be useful for many patients who suffer from more severe forms of chronic neuropathic pain. These include:

  • mexiletine, a drug designed to correct irregular heart rhythms (sometimes associated with serious side effects);
  • Various antiepileptic drugs, including Neurontin (gabapentin), Lyrica (pregabalin), phenytoin and carbamazepine;
  • Some classes of antidepressants, including tricyclics, such as amitriptyline – to me, Claudio, it caused tachycardia – (Elavil, Endep);

Injections of local anesthetics such as lidocaine or topical patches containing lidocaine can alleviate the most intractable pain.

In more serious cases, doctors can surgically destroy the nerves; however, the results are usually temporary. and the procedure can lead to complications.

Assistive Devices: Mechanical assists and other assistive devices can help reduce pain and lessen the impact of a physical disability.

    • Compressing socks and gloves for the hands or feet can compensate for muscle weakness or relieve nerve compression;
    • Orthopedic shoes can improve gait disturbances and help prevent foot injuries in people with loss of pain sensation;
  • Mechanical ventilation can provide essential life support if breathing is severely impaired. Don't do this to me. Let me go...

Surgery: Surgical intervention can often provide immediate relief from mononeuropathies caused by compression or compression injuries.

  • Repairing a slipped disc can reduce pressure on the nerves where they emerge from the spinal cord;
  • Removal of benign or malignant tumors can also relieve pressure on nerve damage 31;
  • Nerve compression can often be corrected by surgically releasing ligaments or tendons;

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Translated in its own cause by Cláudio Souza on July 03, 2021 from the text in Understanding Periphefal Neuropathy de Carol Eustice Clinically Revised by Nicholas R. Metrus, MD on April 22, 2021

Sources of the original article, in English

  1. Hughes RA. Peripheral neuropathyBMJ. 2002;324(7335):466–469. doi:10.1136/bmj.324.7335.466
  2. Neuropathy (Peripheral Neuropathy). Cleveland Clinic. December 2019.
  3. Peripheral Neuropathy. US National Library of Medicine. April 2018.
  4. Peripheral Neuropathy. Columbia University Department of Neurology.
  5. Sommer C, Geber C, Young P, Forst R, Birklein F, Schoser B. PolyneuropathiesDtsch Arztebl Int. 2018;115(6):83–90. doi:10.3238/arztebl.2018.083
  6. Ekiz E, Ozkok A, Ertugrul NK. Paraneoplastic mononeuritis multiplex as a presenting feature of adenocarcinoma of the lungCase Rep Oncol Med. 2013;2013:457346. doi:10.1155/2013/457346
  7. Sudulagunta SR, Sodalagunta MB, Sepehrar M, et al. Guillain-Barré syndrome: clinical profile and managementGer Med Sci. 2015;13:Doc16. doi:10.3205/000220
  8. Peripheral Neuropathy. Johns Hopkins Medicine.
  9. Peripheral Neuropathy Fact Sheet. National Institutes of Health. August 2019.
  10. Why is neuropathy worse at night?. Cleveland Clinic. January 2020.
  11. Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases. February 2018.
  12. Bladder Control Problems & Nerve Disease. National Institute of Diabetes and Digestive and Kidney Diseases. June 2012.
  13. Pang LY, Ding CH, Wang YY, Liu LY, Li QJ, Zou LP. Acute autonomic neuropathy with severe gastrointestinal symptoms in children: a case series. BMC Neurol. 2017;17(1):164.  doi:10.1186/s12883-017-0943-x
  14. Chopra K, Tiwari V. Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012;73(3):348-62.  doi:10.1111/j.1365-2125.2011.04111.x
  15. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and researchNeurology. 2016;87(2):220–228. doi:10.1212/WNL.0000000000002840
  16. Six Diabetes-Related Vascular Complications – And How To Avoid Them. Society for Vascular Surgery. November 2016.
  17. Lee YC. Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep. 2013;15(1):300.  doi:10.1007/s11926-012-0300-4
  18. Tapadia M, Mozaffar T, Gupta R. Compressive neuropathies of the upper extremity: update on pathophysiology, classification, and electrodiagnostic findings. J Hand Surg Am. 2010;35(4):668-77.  doi:10.1016/j.jhsa.2010.01.007
  19. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev. 1996;9(3):361-81.
  20. Stanfield BA, Luftig MA. Recent advances in understanding Epstein-Barr virusF1000Res. 2017;6:386. doi:10.12688/f1000research.10591.1
  21. Gupta M, Shorman M. Cytomegalovirus, In: StatPearls [Internet]. 2019 Jan-.
  22. Saleh D, Sharma S. Herpes Simplex Type 1, In: StatPearls [Internet]. 2019 Jan-.
  23. Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: reviewArch Med Sci. 2012;8(6):978–982. doi:10.5114/aoms.2012.30948
  24. Cooperate. diphtheriaPediatric Child Health. 2002;7(3):205. doi:10.1093/pch/7.3.205
  25. Bhat RM, Prakash C. Leprosy: an overview of pathophysiologyInterdiscip Perspect Infect Dis. 2012;2012:181089. doi:10.1155/2012/181089
  26. Ellis A, Bennett DL. Neuroinflammation and the generation of neuropathic pain. Br J Anaesth. 2013;111(1):26-37.  doi:10.1093/bja/aet128
  27. Wojciechowski E, Sman A, Cornett K, et al. Gait patterns of children and adolescents with Charcot-Marie-Tooth disease. Gait Posture. 2017;56:89-94.  doi:10.1016/j.gaitpost.2017.05.005
  28. Diabetes and Foot Problems. National Institute of Diabetes and Digestive and Kidney Diseases. January 2017.
  29. Highlights Of Prescribing Information: Prednisone. US Food & Drug Administration.
  30. The Voice of the Patient: Neuropathic Pain Associated with Peripheral Neuropathy. US Food & Drug Administration. February 2017.
  31. Spinal Cord Tumors. Harvard Medical School. February 2019.

Additional Reading

  • NIH Publication No. 04-4853


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