By Jeffrey W. Ralph, MD

As with any medical problem, the proper diagnosis of a peripheral neuropathy requires that a physician take a history and perform a physical examination. The history must include a review of any currently prescribed medications because some medications can cause a peripheral neuropathy. The physician will also inquire about any relatives that may also have similar symptoms. If they do, there is an increased chance that the patient has a genetic peripheral neuropathy.

In cases in which the cause of the neuropathy is not obvious, bloodwork and potentially an analysis of urine is necessary to help make the specific neuropathy diagnosis.

The physician may also order electrodiagnostic testing. Nerve conduction studies (NCS) require electrical stimulation of the nerves. Responses are recorded on a machine. An electromyogram (EMG) may also be ordered. This test involves the placement of fine needle electrodes into muscles. With the needle inserted, the patient is asked to move the limb. The resulting electrical activity from the muscle is then amplified and displayed for the physician. These tests are very safe but uncomfortable. Some patients do not mind the test in the least; others run for the door after the first nerve is stimulated! It is very helpful for patients to be mentally prepared beforehand that the test involves electrical stimulation and needle placement. Oral pain relievers may be taken prior to the test and do not affect the test results.