Neuropathy

Neuropathy, also called peripheral [puh-RIF-er-uhl] neuropathy [noo-ROP-uh-thee], is pain, numbness, tingling, or other sensations caused by damage to nerves in the body. The damaged nerves are often in the legs and feet but can also be in the arms, hands, or other places in the body.

Neuropathy is a problem because it can cause pain, weakness, or other discomfort. It’s also a problem because of other things that can happen when you are numb or can’t feel properly. For example, loss of feeling and weakness in the feet and legs can lead to balance problems and falls.

When your feet and hands are numb, you can’t feel it when you have an injury like a cut, blister, or burn. You may not feel the warnings when something is hurting your hands or feet, so they are easy to injure and can become infected. It is important to protect them and to look for injuries often.

These are the most common symptoms of neuropathy:

• Numbness
• Tingling or pinprick sensations
• Stabbing or burning feeling

Some people also have these symptoms:

• Muscle weakness
• Muscle cramps or muscle spasm
• Changes in skin color or temperature
• Changes in how much you sweat (you may not be able to sweat to cool the body off)
• Loss of bladder control
• Problems with regulating blood pressure (for example, getting dizzy or fainting when going from sitting to standing)

See a doctor if you have:

• Symptoms of neuropathy
• Consistent pain that does not get better with medicines prescribed
• Balance problems or falls
• A foot injury or infection

There are many causes of neuropathy:

• Diabetes. Diabetes is the most common cause of neuropathy, and most patients with neuropathy should be tested for it.
• Injury. A sudden accident or fall can injure a nerve. Repeating the same motion can also damage the nerve over time. Carpal tunnel syndrome is an example of this kind of injury.
• Toxic chemicals. Exposure to some chemicals and medicines (like some chemotherapy) can cause nerve damage.
• Infection. Some viruses and bacteria can affect the nerves. Examples include shingles, West Nile virus, herpes simplex, diphtheria, Lyme disease, and HIV.
• B12 deficiency. Not getting enough vitamin B12 (found in meat, eggs, fish, and dairy products) can cause nerve damage .
• Autoimmune conditions. Sometimes the body attacks itself and damages its own nerves. Some examples are Sjogren’s syndrome, lupus, and rheumatoid arthritis.
• Genetic (inherited) conditions. Neuropathy from genetic mutations can be mild or severe. Sometimes a mild problem will not be noticed until young adulthood. More severe problems usually start in childhood.
• Alcohol abuse. Heavy alcohol use can damage the nerves and cause pain and tingling. This damage is usually permanent, but if you stop drinking your symptoms won’t be as bad and you can prevent further damage.

• Your doctor will ask you about your symptoms and perform a physical examination.
• You will likely have some blood work and other tests. More blood work might be ordered to determine a cause.
• Your doctor may order a nerve conduction study, called electromyography [ih-lek-troh-MAHY-uh-graf-ee] or EMG, or an MRI of the brain or spine to help determine the cause or rule out other problems.

Below are common treatments for neuropathy:

• It is important to treat any cause of peripheral neuropathy such as diabetes. In this case, controlling blood sugar will help with the symptoms and keep the neuropathy from getting worse.
• Pain can be treated with many different medicines, but these usually do not make all pain go away. Medicines will likely improve your quality of life and increase the things you can do, but they will not erase all pain. Habit-forming pain medicines (like opioids) are not recommended to treat painful neuropathy unless other options have failed.
• Topical medicines like lidocaine are put right on the skin. They are sometimes used to treat nerve pain for something like shingles.
• Transcutaneous [trans-kyoo-TEY-nee-uh s] electrical nerve stimulation (TENS) may be useful for neuropathic pain, according to some research studies. The therapist puts electrodes on the skin near the injured nerve, and the machine sends a gentle electrical current to the skin.
• Pain can also sometimes be relieved by using a hand or foot brace, or orthopedic shoes, to take pressure off of a nerve.
• For some cases, like carpal tunnel of the wrist, surgery may be a good option if other treatments have not worked.
• Balance problems or muscle weakness that could increase the risk for falls can be treated with physical therapy or by using a cane or walker.

The best way to prevent neuropathy is to prevent the conditions that cause it. For example, you can prevent Type II diabetes by staying at a healthy weight, choosing healthy foods, and adding more activity in your day. But we don’t yet know how to prevent some of the causes of neuropathy, like genetic mutations and autoimmune conditions.

This is a comprehensive resource, but the reading level is a bit high:

• NIH National Institute for Neurological Disorders and Stroke, “Peripheral Neuropathy Fact Sheet”

Other resources:

• Foundation for Peripheral Neuropathy
• American Diabetes Association, “Peripheral Neuropathy”