Use of other tests must rely on knowledge of the specific hazard or illness in question. Once a chemical or another environmental hazard has been identified as an important contributor to an illness, the next step is to prevent further exposure. For others, the physician must be willing to become an active advocate for the patient. This advocacy may involve writing a letter stating that the patient should no longer be exposed to a hazard or should remain out of work. Alternatively, it may involve contacting appropriate officials in government, industry, or labor or other advocates who can deal with a hazardous exposure.
Treatment is dependent on the specific hazard.
In few areas of medicine does a physician deal with more scientific uncertainty. Comprehensive information on toxicants is available for only a small percentage of chemicals. Clues to the diagnosis of specific peripheral neuropathies often lie in unnoticed or forgotten events occurring weeks or months prior to the onset of symptoms. Most neuropathies involve nerve fibers of all sizes, but damage sometimes is restricted to either large or small fibers. In a polyneuropathy affecting mainly small fibers, diminished pinprick and temperature sensation, often with painful, burning dysesthesias, may predominate along with autonomic dysfunction, but with relative sparing of motor power, balance, and tendon jerks.