A Step-by-Step Guide for Diagnosing and Treating Peripheral Neuropathies by Primary Care Physicians

Abstract

Purpose:  Peripheral neuropathies affect up to 8% of the population, have many causes, and usually present first in primary care settings where structured guidance for assessment, diagnosis and management is limited. Our motivation was to provide a practical diagnostic tool that will enhance the scope and efficiency of management of peripheral neuropathies and improve outcomes through early intervention. 

Methods:  A systematic review yielded 34 articles describing paresthesia, autonomic or motor deficit symptoms stemming from causes that are addressable in primary care.  

Results:  We classified four categories of neuropathies: 1) urgent acute symptoms; 2) neuropathies caused by alcohol use disorder, exposure to toxins, or dietary deficiencies; 3) mononeuropathies involving cranial nerves, that should be referred to a neurologist; or 4) polyneuropathies that should be referred to appropriate specialists. We developed a comprehensive Diagnostic Flow Chart to help guide primary care physicians to identify the cause of a patient’s neuropathy and to expedite appropriate treatment and/or referral. 

Summary:  This paper presents a practical framework to support efficient diagnosis of peripheral neuropathies and a structured guide for identifying cases that can be managed by primary care physicians and more complex cases that should be referred to neurologists or other specialists. The Diagnostic Flow Chart provides a practical tool to optimize primary care delivery, facilitate peripheral neuropathy diagnosis and treatment, minimize delays and improve patient outcomes. Early diagnosis and treatment of peripheral neuropathies can greatly improve the patient’s quality of life and also reduce the strain that peripheral neuropathies place on the healthcare system.