Peripheral neuropathy is a condition resulting from damage to the peripheral nervous system, the vast network connecting your brain and spinal cord to the rest of your body.
Affecting an estimated 2.4% of the general population and rising to 8% in older adults, this condition can cause weakness, numbness, and pain, typically in the hands and feet.
There are over 100 distinct types of peripheral neuropathy, each with unique causes, symptoms, and progression patterns.
Understanding these differences is the first step toward effective management and improving quality of life.
This comprehensive guide will explore the various classifications of peripheral neuropathy, from common acquired forms like diabetic neuropathy to rare inherited disorders, providing clarity on their causes, symptoms, and treatment approaches.
In This Article
What Is Peripheral Neuropathy?
Peripheral neuropathy refers to a multitude of conditions that involve damage to the peripheral nervous system.
This system is a complex communications network that transmits signals between the central nervous system (the brain and spinal cord) and every other part of the body.
Think of it as the body’s wiring. When this wiring is damaged, the signals can be disrupted, leading to a wide array of problems.
Peripheral nerves have three primary functions, and damage to any of them can produce distinct symptoms:
- Motor Nerves: These control conscious muscle movement, such as walking, grasping objects, or speaking.
- Sensory Nerves: These transmit information like touch, temperature, vibration, and pain from the skin and joints back to the brain.
- Autonomic Nerves: These regulate functions we don’t consciously control, like heart rate, blood pressure, digestion, and bladder function.
According to the National Institute of Neurological Disorders and Stroke (NINDS), nerve signaling in peripheral neuropathy can be disrupted in three main ways:
- Loss of signals: Numbness or weakness occurs because signals that should be sent, aren’t.
- Inappropriate signaling: Pain or tingling happens when signals are sent when they shouldn’t be.
- Signal errors: Distorted messages can lead to confusing sensations or uncoordinated movements.
While some neuropathies affect only a single nerve (mononeuropathy), most cases involve multiple nerves (polyneuropathy), often starting in the longest nerves that extend to the feet and hands.
How Common Is Peripheral Neuropathy and What Is Its Impact?
Peripheral neuropathy is a significant public health issue with a substantial global burden.
While precise figures vary, studies provide a clear picture of its widespread impact.
The condition’s prevalence increases dramatically with age, affecting an estimated 2.4% of the general population but up to 8% of older individuals, as noted in research published by the National Center for Biotechnology Information (NCBI).
Prevalence and Statistics
- General Population: Up to 7% of adults experience polyneuropathy symptoms. In the U.S., about 14% of adults aged 40 or older have some form of peripheral neuropathy.
- Diabetic Neuropathy: Diabetes is the leading cause of peripheral neuropathy. Approximately 50% of all people with diabetes will develop some form of neuropathy in their lifetime. With the global number of people with diabetes projected to reach 783 million by 2045, the incidence of diabetic neuropathy is set to escalate dramatically.
- Chemotherapy-Induced Peripheral Neuropathy (CIPN): CIPN is a common side effect of cancer treatment, affecting an estimated 30% to 50% of patients undergoing chemotherapy. One systematic review found the prevalence was 68% one month after chemotherapy.
- Idiopathic Neuropathy: In a significant number of cases, no specific cause can be found. This is known as idiopathic peripheral neuropathy, and it accounts for about 23% of all cases, affecting an estimated 5-8 million Americans.
Economic and Quality of Life Burden
The impact of peripheral neuropathy extends far beyond physical symptoms.
It imposes a heavy economic and personal burden on patients, families, and healthcare systems.
- Economic Costs: The financial toll is staggering. In the U.S., the annual cost of diabetic peripheral neuropathy and its complications is estimated to be between $4.6 billion and $13.7 billion. A 2024 study found the total all-cause healthcare cost for a patient with severe painful diabetic neuropathy was over $34.000 annually.
- Quality of Life: Painful peripheral neuropathy is consistently linked to a poorer quality of life. A systematic review published in Pain and Therapy found that chronic pain from neuropathy disrupts sleep, impairs physical function, and increases rates of anxiety and depression.
- Risk of Complications: Loss of sensation, particularly in the feet, dramatically increases the risk of injuries, non-healing ulcers, and infections. Diabetic foot ulcers are the leading cause of non-traumatic lower-limb amputations, with about 85% of such amputations preceded by a foot ulcer.
How Are the Types of Peripheral Neuropathy Classified?
With over 100 identified types, classifying peripheral neuropathy is essential for accurate diagnosis and targeted treatment.
The classification can be based on several factors, including the number of nerves affected, the type of nerve fiber damaged, and the underlying cause.
1. By Number of Nerves Affected
- Mononeuropathy: This type involves damage to a single peripheral nerve. A classic example is Carpal Tunnel Syndrome, where the median nerve in the wrist is compressed.
- Multiple Mononeuropathy (or Mononeuritis Multiplex): This involves damage to two or more separate nerves in different parts of the body. It often occurs in the context of systemic diseases like vasculitis.
- Polyneuropathy: This is the most common pattern, characterized by widespread, symmetrical damage to many nerves, usually starting in the feet and hands and progressing upwards. This is often described as a “stocking-glove” distribution.
2. By Type of Nerve Fiber Damaged
As mentioned, symptoms vary depending on whether motor, sensory, or autonomic nerves are affected. Most neuropathies are mixed, but some predominantly affect one type.
- Sensory Neuropathy: Affects sensory nerves, causing tingling, pain, numbness, or difficulty sensing temperature and vibrations.
- Motor Neuropathy: Affects motor nerves, leading to muscle weakness, cramps, twitching (fasciculations), and muscle wasting (atrophy).
- Autonomic Neuropathy: Affects autonomic nerves, causing issues with blood pressure regulation (dizziness upon standing), sweating, digestion, and bladder control.
- Sensorimotor Neuropathy: A common mixed form affecting both sensory and motor nerves.
3. By Pathophysiology (How the Nerve is Damaged)
Understanding the mechanism of nerve injury is crucial for researchers developing new treatments.
- Demyelinating Neuropathy: The protective myelin sheath that insulates the nerve axon is damaged. This slows down or blocks nerve signal conduction. Guillain-Barré syndrome is a prime example.
- Axonal Neuropathy: The nerve axon itself degenerates. This is the more common mechanism, seen in conditions like diabetic neuropathy. Recovery is often slower as the axon must regrow.
4. By Cause (Acquired vs. Inherited)
This is the broadest and most clinically useful classification.
- Acquired Neuropathies: These develop during a person’s lifetime due to an external cause, such as a disease, injury, toxin, or nutritional deficiency. This category includes the vast majority of peripheral neuropathy cases.
- Inherited (Hereditary) Neuropathies: These are caused by genetic mutations passed down through families. While rarer, they are a significant group of disorders, with Charcot-Marie-Tooth disease being the most common.
What Are the Main Types of Acquired Peripheral Neuropathy?
Acquired neuropathies are those you are not born with but develop due to other factors.
They represent the majority of peripheral neuropathy cases and are often linked to treatable underlying conditions.
Diabetic Peripheral Neuropathy (DPN)
DPN is the most common type of peripheral neuropathy worldwide.
It is a direct consequence of prolonged high blood sugar (hyperglycemia), which damages both nerves and the small blood vessels that supply them.
According to the American Diabetes Association, about half of all people with diabetes have some form of nerve damage.
- Key Features: Typically presents as a symmetrical polyneuropathy, starting with numbness, tingling, or burning pain in the feet that gradually moves up the legs.
- Phenotypes: DPN can be broadly categorized into painful, painless, and mixed forms. Painless DPN is particularly dangerous as it leads to a loss of protective sensation, increasing the risk of foot ulcers and amputation.
Chemotherapy-Induced Peripheral Neuropathy (CIPN)
CIPN is a disabling side effect of many common cancer-fighting drugs (e.g., platinum-based drugs, taxanes).
These agents can be toxic to nerve cells, causing damage that may persist long after treatment ends.
The mechanisms are complex, involving mitochondrial dysfunction and changes in ion channels.
- Key Features: Symptoms often include pain, tingling, and numbness in a stocking-glove pattern. It can be severe enough to require a reduction in chemotherapy dosage, potentially compromising cancer treatment.
Immune-Mediated Neuropathies
In these conditions, the body’s own immune system mistakenly attacks the peripheral nerves.
- Guillain-Barré Syndrome (GBS): A rare but serious acute neuropathy where the immune system attacks the myelin sheath of peripheral nerves. It often follows a viral or bacterial infection and causes rapidly progressing weakness, which can lead to paralysis. Most people recover, but it can be life-threatening.
- Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): Considered the chronic counterpart to GBS, CIDP involves a longer-term immune attack on nerve myelin. It causes progressive or relapsing weakness and sensory loss over months or years.
Idiopathic Peripheral Neuropathy
When extensive testing fails to identify a cause, the condition is termed idiopathic.
This is a common diagnosis, especially in people over 60. According to The Foundation for Peripheral Neuropathy, it may affect up to 8 million Americans.
The progression is often slow, and treatment focuses on managing symptoms.
Other Acquired Types
- Nutritional/Vitamin Deficiencies: Lack of certain vitamins, especially B12, B6 (both deficiency and excess), B1, and E, can cause significant nerve damage. Alcohol use disorder is a major contributor due to poor nutrition and the toxic effects of alcohol itself.
- Infectious Causes: Viruses and bacteria can directly attack nerves or trigger an immune response that does. Examples include shingles (varicella-zoster virus), Lyme disease, HIV, and hepatitis C.
- Toxin Exposure: Heavy metals (lead, mercury, arsenic) and industrial chemicals can be neurotoxic.
- Trauma/Compression: Physical injury from accidents, falls, or repetitive stress can sever, crush, or compress nerves. Carpal tunnel syndrome is a form of compression neuropathy.
| Type of Neuropathy | Primary Cause | Common Symptoms | Typical Onset/Progression |
|---|---|---|---|
| Diabetic Neuropathy (DPN) | High blood sugar (diabetes) | Numbness, burning, tingling in feet/hands (“stocking-glove”) | Gradual, chronic, progressive |
| Chemotherapy-Induced (CIPN) | Neurotoxic cancer drugs | Pain, tingling, numbness, cold sensitivity | Acute or during treatment, can be long-lasting |
| Guillain-Barré Syndrome (GBS) | Autoimmune attack, often post-infection | Rapidly ascending weakness/paralysis, tingling | Acute, rapid (days to weeks), often followed by recovery |
| Chronic Inflammatory (CIDP) | Chronic autoimmune attack on myelin | Progressive or relapsing weakness and sensory loss | Slowly progressive or relapsing over months/years |
| Idiopathic Neuropathy | Unknown | Primarily sensory (numbness, tingling), balance issues | Slowly progressive, often in older adults |
What Are the Main Types of Inherited Peripheral Neuropathy?
Inherited, or hereditary, neuropathies are caused by genetic mutations.
While much rarer than acquired forms, over 80 different genetic causes have been identified.
According to a study in Hereditary Neuropathies, the overall prevalence is about 1 in 2.500 people.
Charcot-Marie-Tooth Disease (CMT)
CMT is not a single disease but a group of inherited disorders that affect peripheral nerves.
It is the most common inherited neurological disorder.
CMT is caused by mutations in genes responsible for the structure and function of either the nerve axon or the myelin sheath.
- Key Features: It primarily causes muscle weakness and wasting, along with sensory loss, in the feet, lower legs, hands, and arms. This often leads to characteristic foot deformities like high arches (pes cavus) and hammertoes.
- Progression: Symptoms typically begin in adolescence or early adulthood and progress slowly over a lifetime.
Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)
HNPP is a genetic disorder that makes nerves extremely sensitive to pressure.
Minor pressure or stretching that would be harmless to others can cause episodes of numbness, tingling, and weakness in people with HNPP.
These episodes can last for minutes, hours, or even months.
Other Inherited Types
- Friedreich’s Ataxia: A progressive genetic disease causing damage to the nervous system, leading to movement problems (ataxia), sensory loss, and heart conditions.
- Giant Axonal Neuropathy (GAN): A rare, severe disorder that usually appears in early childhood. It causes axons to swell, leading to problems with movement and sensation that worsen over time.
What Are the Underlying Causes of Peripheral Neuropathy?
The causes of peripheral neuropathy are incredibly diverse.
Identifying the root cause is the most critical step in management, as treating the underlying condition can often halt or even reverse nerve damage.
The Mayo Clinic provides a comprehensive list of potential causes, which can be grouped into several categories:
Systemic and Metabolic Diseases
- Diabetes Mellitus: The number one cause in the United States.
- Kidney and Liver Disorders: These conditions can lead to a buildup of toxins in the blood that are damaging to nerves.
- Hormonal Imbalances: An underactive thyroid (hypothyroidism) can cause fluid retention that puts pressure on nerves.
- Vascular and Blood Problems: Conditions that reduce oxygen supply to nerves, such as atherosclerosis, smoking, and high blood pressure, can lead to nerve tissue damage.
Autoimmune Diseases
- In these diseases, the immune system attacks the body’s own tissues. Examples include:
- Sjögren’s syndrome
- Lupus
- Rheumatoid arthritis
- Guillain-Barré syndrome and CIDP
- Vasculitis (inflammation of blood vessels)
Infections
- Viral: Shingles, HIV, Hepatitis C, West Nile virus.
- Bacterial: Lyme disease, diphtheria, leprosy.
Other Factors
- Physical Trauma or Injury: Accidents, falls, sports injuries, or repetitive motions can sever or compress nerves.
- Tumors: Both cancerous (malignant) and noncancerous (benign) growths can press on or infiltrate nerve fibers.
- Alcohol Use Disorder: Chronic alcohol misuse leads to nerve damage from both the direct toxic effects of alcohol and associated vitamin deficiencies.
- Exposure to Toxins: Heavy metals like lead and mercury, as well as certain industrial chemicals.
- Medications: Besides chemotherapy, certain antibiotics, heart medications, and anticonvulsants can cause peripheral neuropathy as a side effect.
- Vitamin Deficiencies: A lack of vitamins B12, B6, B1, E, and copper are crucial for nerve health.
What Are the Symptoms of Peripheral Neuropathy?
The symptoms of peripheral neuropathy are highly variable and depend on which nerves—sensory, motor, or autonomic—are damaged. Symptoms can range from mild to debilitating.
Symptoms of Sensory Nerve Damage
This is often the most noticeable type of symptom. It can include:
- Positive Symptoms (new sensations):
- Gradual onset of numbness, prickling, or tingling (“pins and needles”).
- Sharp, jabbing, throbbing, or burning pain.
- Extreme sensitivity to touch (allodynia), where even bedsheets can feel painful.
- Negative Symptoms (loss of sensation):
- Feeling as if you’re wearing gloves or socks when you’re not.
- Inability to feel vibrations, touch, or changes in temperature.
- Loss of position sense (proprioception), leading to poor coordination and balance, especially with eyes closed.
Symptoms of Motor Nerve Damage
Damage to nerves that control muscles can cause:
- Muscle weakness, making it difficult to walk, grip objects, or perform fine movements like buttoning a shirt.
- Painful muscle cramps.
- Uncontrolled muscle twitching visible under the skin (fasciculations).
- Muscle shrinking or wasting (atrophy).
Symptoms of Autonomic Nerve Damage
Damage to nerves that regulate involuntary body functions can lead to:
- Heat intolerance and altered sweating (either excessive or reduced).
- Drops in blood pressure upon standing, causing dizziness or fainting (orthostatic hypotension).
- Problems with sexual function.
How Is Peripheral Neuropathy Diagnosed?
Diagnosing peripheral neuropathy and its underlying cause can be a complex process due to the vast number of potential causes and symptoms.
A neurologist will typically use a combination of approaches.
1. Medical History and Physical Exam
This is the cornerstone of the diagnostic process.
Your doctor will ask detailed questions about your symptoms, lifestyle, work environment, alcohol use, exposure to toxins, and family history of neurological diseases.
A thorough physical and neurological exam will assess your reflexes, muscle strength, tone, and your ability to feel different sensations.
2. Blood and Body Fluid Tests
These tests are crucial for identifying underlying systemic causes. They can detect:
- Diabetes (HbA1c test)
- Vitamin deficiencies (B12, B6, etc.)
- Kidney or liver dysfunction
- Abnormal immune system activity (autoimmune markers)
- Infections (Lyme, HIV, etc.)
- Abnormal proteins (associated with certain blood disorders)
3. Electrophysiological Tests (Nerve and Muscle Function)
- Nerve Conduction Study (NCS): This test measures the speed and strength of electrical signals traveling through your nerves. Electrodes are placed on the skin over a nerve, and a small electrical shock is used to stimulate it. Slowed signals suggest demyelinating neuropathy, while reduced signal strength suggests axonal neuropathy.
- Electromyography (EMG): Often performed with an NCS, an EMG involves inserting a very fine needle electrode into a muscle to record its electrical activity. It helps determine if your weakness is caused by a muscle disorder or a nerve disorder.
4. Quantitative Sensory Testing (QST)
QST is a sophisticated method to measure sensory thresholds for various stimuli like temperature and vibration.
As described in a guide by the British Journal of Anaesthesia, it is particularly useful for assessing the function of small nerve fibers, which are not evaluated by standard NCS. This can help diagnose small fiber neuropathy.
5. Biopsy
- Nerve Biopsy: In rare cases, a small piece of a sensory nerve (usually from the ankle) is removed and examined under a microscope. This can provide detailed information about the type of nerve damage but is an invasive procedure reserved for complex cases.
- Skin Biopsy: A much less invasive procedure where a tiny punch of skin is taken to examine the density of small nerve fiber endings. This is the gold standard for diagnosing small fiber neuropathy.
6. Imaging and Genetic Tests
- Imaging: MRI or CT scans may be used to look for structural issues like tumors, herniated discs, or nerve compression.
- Genetic Testing: If an inherited neuropathy is suspected based on family history and clinical presentation, genetic tests can identify specific mutations.
How Is Peripheral Neuropathy Treated?
Treatment for peripheral neuropathy is a two-pronged approach: 1) treating the underlying cause to prevent further damage, and 2) managing the symptoms, especially pain.
1. Treating the Underlying Cause
This is the most effective strategy for stopping the progression of nerve damage.
- Diabetes: Strict blood glucose control is paramount.
- Vitamin Deficiencies: Supplementation with the deficient vitamin (e.g., B12 injections).
- Autoimmune Conditions: Treatments may include corticosteroids, immunosuppressive drugs, or therapies like intravenous immunoglobulin (IVIg) and plasmapheresis to modulate the immune system.
- Compression/Trauma: Physical therapy, splints, or in some cases, surgery to relieve pressure on a nerve.
- Toxin/Alcohol-Induced: Eliminating exposure to the offending substance.
2. Managing Neuropathic Pain and Symptoms
Neuropathic pain often does not respond well to standard painkillers like ibuprofen or acetaminophen.
Instead, doctors use a tiered approach with medications that target nerve signaling.
First-Line Medications
According to guidelines from organizations like the American Academy of Neurology (AAN), first-line treatments include:
- Anticonvulsants (Gabapentinoids): Medications like gabapentin and pregabalin are often the first choice. They work by calming overactive nerve signals.
- Antidepressants: Certain classes of antidepressants are highly effective for neuropathic pain.
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Duloxetine and venlafaxine.
- Tricyclic Antidepressants (TCAs): Amitriptyline and nortriptyline.
Second-Line and Third-Line Treatments
If first-line treatments are ineffective or cause intolerable side effects, other options include:
- Topical Treatments: For localized pain, lidocaine patches or capsaicin cream/patches can provide relief with fewer systemic side effects.
- Opioid-like Medications: Tramadol or tapentadol may be considered, but strong opioids are generally reserved as a last resort due to risks of dependence and side effects.
- Interventional Therapies:
- Transcutaneous Electrical Nerve Stimulation (TENS): A device that delivers a gentle electrical current to the skin to disrupt pain signals.
- Spinal Cord Stimulation (SCS): An implantable device that sends electrical pulses to the spinal cord to mask pain signals.
Non-Pharmacological and Lifestyle Approaches
- Physical and Occupational Therapy: To improve strength, balance, and function. Braces or splints can help with weakness.
- Lifestyle Changes: Regular exercise, a healthy diet, maintaining a healthy weight, and avoiding smoking and excessive alcohol.
- Complementary Therapies: Some people find relief with acupuncture, massage, or meditation to help cope with chronic pain.
Can Peripheral Neuropathy Be Prevented?
While inherited neuropathies cannot be prevented, many forms of acquired peripheral neuropathy can be.
Prevention focuses on managing risk factors and making healthy lifestyle choices.
- Manage Underlying Medical Conditions: The single most important preventive step is to manage conditions that put you at risk. For diabetes, this means keeping blood sugar levels within your target range. For other conditions like kidney disease or hypothyroidism, following your treatment plan is crucial.
- Adopt a Healthy Lifestyle:
- Eat a Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean protein provides the vitamins and minerals essential for nerve health. For vegetarians and vegans, ensuring adequate vitamin B12 intake is critical.
- Exercise Regularly: Aim for at least 30-60 minutes of moderate exercise most days of the week, with your doctor’s approval. Exercise improves circulation and can help control blood sugar.
- Maintain a Healthy Weight: This reduces the risk of diabetes and can lessen pressure on nerves.
- Avoid Nerve-Damaging Factors:
- Limit Alcohol: Excessive alcohol consumption is a direct cause of peripheral neuropathy.
- Quit Smoking: Smoking constricts blood vessels and can worsen nerve damage.
- Avoid Toxin Exposure: Be mindful of exposure to industrial chemicals and heavy metals.
- Protect Against Injuries: Use ergonomic setups for repetitive tasks and take precautions to avoid falls and injuries.
Frequently Asked Questions (FAQ)
1. Can peripheral neuropathy be cured?
There is no cure for most chronic types of peripheral neuropathy. However, if the underlying cause is identified and treated (like a vitamin deficiency), nerve damage can sometimes be halted or even reversed. Treatment focuses on managing symptoms and preventing further progression.
2. Is peripheral neuropathy fatal?
Peripheral neuropathy itself is rarely fatal. However, it can lead to serious complications like falls, infections from unnoticed injuries, and problems with heart rate and blood pressure, which can increase mortality risk, especially in older adults or those with autonomic neuropathy.
3. What is the most common type of peripheral neuropathy?
Diabetic peripheral neuropathy (DPN) is the most common type, affecting about 50% of people with diabetes. It typically manifests as a length-dependent sensorimotor polyneuropathy, starting with symptoms in the feet and hands.
4. What does neuropathic pain feel like?
Neuropathic pain is often described as burning, stabbing, shooting, or like an electric shock. People may also experience tingling (“pins and needles”) or extreme sensitivity to touch (allodynia), where a light touch feels painful.
5. Can stress make peripheral neuropathy worse?
While stress doesn’t cause peripheral neuropathy, it can worsen the perception of pain and other symptoms. Chronic pain and stress create a vicious cycle, negatively impacting sleep and overall quality of life. Managing stress is an important part of a comprehensive treatment plan.
6. What is idiopathic neuropathy?
Idiopathic neuropathy means that no specific cause for the nerve damage can be found despite a thorough medical evaluation. It is a common diagnosis, particularly in individuals over the age of 60, and often progresses slowly.
7. What is the difference between mononeuropathy and polyneuropathy?
Mononeuropathy affects a single nerve (e.g., carpal tunnel syndrome). Polyneuropathy, the more common form, involves damage to multiple nerves throughout the body, typically in a symmetrical pattern starting in the hands and feet.
8. Which vitamins are important for nerve health?
B vitamins—especially B12, B6, and B1 (thiamine)—are crucial for nerve function. Vitamin E and copper are also important. Deficiencies in these can lead to peripheral neuropathy, but it’s also important to avoid excessive intake of vitamin B6, which can be toxic to nerves.
Conclusion
Peripheral neuropathy is a complex and multifaceted group of disorders with a profound impact on millions of lives.
From the widespread challenge of diabetic neuropathy to the disabling effects of CIPN and the mysteries of idiopathic forms, understanding the specific type is the key to effective management.
While a cure remains elusive for many, a combination of treating the root cause, targeted symptom management, and healthy lifestyle choices can significantly slow progression and improve quality of life.
Advances in diagnostics, like QST and genetic testing, are providing more precise diagnoses, while ongoing research funded by institutions like NINDS continues to uncover new therapeutic targets.
If you are experiencing symptoms of peripheral neuropathy, such as persistent tingling, numbness, or pain in your hands or feet, seeking a prompt and thorough medical evaluation is the most important step you can take.
We encourage you to share this article to raise awareness and leave a comment below with your experiences or questions. Your journey can help others navigate this challenging condition.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for, and should never be relied upon for, professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.