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Will nerve block distinguish between a nerve root problem and peripheral neuropathy ?

So for 12 months I have had excruciating pain in my right foot. MRIs showed there was nothing wrong with the foot itself - my GP then thought it might be a peripheral neuropathy but seeing as the main causes of this are diabetes and alcoholism and I don't have either then this is unlikely . I then saw a pain specialist who said that the cause was in my back as a lumbar MRI showed an L5 S1 disc herniation. I had a series of four nerve blocks/ steroid injections into L5 S1 and three of these relieved the foot pain completely ( temporarily). It came back and last week I had a discectomy on L5S1 but this has done nothing for the foot pain - it is still there as strong as ever. My question is : were they on the right track saying the source was in the nerve root ( as evidenced by the success of the nerve blocks) or could this pain have a local cause in the foot itself ??
I have never heard of anyone getting peripheral neuropathy in just one foot have you ?
Does the success of the nerve root blocks 100% confirm that the cause is in the nerve root or could a nerve root block stop pain that has a source elsewhere ???
I am very confused as to what the success of a nerve root block actually shows ??
Thoughts please !
Many thanks.


  • To surgery, it is common for there to be ongoing nerve pain, while the nerve root heals and recovers.
    It should resolve given time as the nerve heals. If it is too painful, talk to your doctor about trying one of the neuropathic pain medications while the nerve heals.

  • itsautonomicitsautonomic LouisianaPosts: 1,806
    edited 06/13/2015 - 7:06 AM
    First the statement you GP made ( if I read correctly ) that only diabetes and alcoholism can cause PN is false, nerve injury through trauma or surgery, allergic reaction to shots, vitamin toxicities, vitamin deficiencies, medication, and several other reasons for PN can be given.
    Second if you are concerned about PN see a neurologist or neuromuscular specialist they are the experts in this realm.
    To answer your questions yes you can have a neuropathy in just one foot, or you can have it where it affects that one foot significantly more. I don't believe it’s typical, but it can occur. I have small fiber neuropathy on right side
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Small fibre neuropathy diagnosed ? Was there any time they thought it could be a radiculopathy ( from nerve root in the spine). I am curious as to how they can differentiate the cause (local or from spine? ) . Thanks for your help.
  • itsautonomicitsautonomic LouisianaPosts: 1,806
    only two ways it can be 1) qsart / sweat test 2) punch biopsy. I was diagnosed initially by QSART and then punch biopsy confirmed. I recommend the punch biopsy, its easy, painless and cheaper. They take small sample of nerves, dye them and look at the density of nerve fiber compared to normal person. Ranking system, but esentially the less nerve distribution in sample means nerves have died off . This cannot and will never be diagnosed by EMG/Nerve conduction as that only tests large fiber nerves.
    Yes radiculopathy was suggested early on as a neck injury started all this. But i had mylopathy from the neck injury so was confusing to doctors.
    As far as the differentiating I suggest you see a neuromuscular specialist they can give you all the answers to those questions . A GP , nor PM are the right choices to diagnose nerve related issues.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • So how did they know to focus on small fibre neuropathy as a working disgnosis rather then radiculopathy ? ( Sorry for all the questions ! )
  • itsautonomicitsautonomic LouisianaPosts: 1,806
    No problem, after years of doctors with many different diagnosis that had no proof to them I was sent to large prestigious teaching hospital and specialized testing was done that revealed this as one of my issues, then I was given punch biopsy to confirm. I am guessing the feeling like I was burning , temperature issues in right side was some of the clues.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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