Neuropathy

There are more than 100 kinds of peripheral neuropathy. Doctors classify them using the types of nerves they affect:

• Autonomic neuropathies involve nerves that regulate functions you do not consciously control. This includes organ and gland function, such as breathing, digestion and sweating.

• Motor neuropathies involve nerves that control skeletal muscles and movement. They affect functions like talking or walking.

• Sensory neuropathies involve nerves that control the sense of touch or position. They can result in diminished or abnormal feelings of touch, pain, temperature or sensation. These neuropathies can also make it hard to coordinate your body and complex movements in space.

Most neuropathies are some combination of the three. Sometimes, neuropathy only affects one type of nerves. Mixed neuropathies often have a predominant nerve type, such as predominantly sensory. The most common type of peripheral neuropathy is a mixed sensorimotor neuropathy.

Neuropathy generally develops slowly, over months, as nerve damage progresses. A wide variety of symptoms can occur, depending on the types of peripheral nerves the neuropathy affects.

Common symptoms of neuropathy often affect the sensory or motor nerves in the arms and legs. Symptoms include:

• Abnormal muscle reflexes

• Muscle twitching or cramps

• Muscle weakness and atrophy (wasting of muscle tissue)

• Poor coordination and balance, leading to falls

• Poor muscle control and body movement

• Problems with swallowing

• Sores or lesions that do not heal, leading to infections

• Unusual sensations, such as pain, numbness, pins and needles, tingling, burning, or prickling, that begin in the feet. In later stages of neuropathy, the hands can be affected as well. In some cases, the abnormal sensations can extend to the arms, legs and trunk.

Other symptoms can occur with autonomic neuropathy. These symptoms relate to bodily functions, such as sweating, digestion, breathing, and blood pressure.

Symptoms of autonomic neuropathy include:

• Abdominal bloating

• Blurred vision due to abnormal pupil dilation and constriction

• Constipation or diarrhea

• Drop in blood pressure and feeling light-headed

• Heat intolerance due to impaired sweating. Excessive sweating is also possible.

• Increased heart rate

• Nausea and vomiting due to slow emptying of the stomach

• Problems with urination, such as incontinence and hesitancy with urination

• Sexual dysfunction, such as impotence (erectile dysfunction) and vaginal dryness

Over time, neuropathy can lead to serious and possibly life-threatening complications, such as cardiac arrhythmias and gangrene. Seek immediate medical care (call 911) for any of these symptoms:

• Change in alertness or consciousness, such as passing out, lethargy or unresponsiveness

• Chest pain or palpitations

• Difficulty breathing or shortness of breath

• Difficulty or inability to swallow

• Hot, dry skin and a lack of sweat

• Severe dizziness that does not resolve

While there are not defined stages of neuropathy, it is a progressive condition. In the early stages, people often have worsening symptoms of pain, burning or numbness. These symptoms usually occur in the nerve endings farthest from the torso. Doctors often refer to the pattern as stockings and gloves because it affects the feet or hands. As the neuropathy progresses, symptoms can start to affect nerves closer to the center of the body.

Neuropathy is caused by damage to the peripheral nervous system. The peripheral nerves are responsible for relaying messages from the brain and spinal cord to the rest of the body. Widespread nerve damage can result from nerve compression, metabolic disorders, infections, malignancy, inflammation, vitamin deficiencies, toxins, inherited conditions, and other abnormal processes.

A common cause of neuropathy is diabetes. Uncontrolled diabetes causes chronically elevated high blood sugar levels that interfere with adequate blood flow to nerves over time. Neuropathy can also be caused by long-term pressure or compression of a nerve or nerves.

A number of factors increase your risk of nerve damage and neuropathy. Risk factors include:

• Alcohol abuse disorder

• Certain diseases, such as diabetes, cancer, lupus, Charcot-Marie-Tooth disease, rheumatoid arthritis, hepatitis, vasculitis, hypothyroidism, and HIV/AIDS

• Certain medications, including chemotherapy

• Chronic nerve degenerative conditions (multiple sclerosis)

• Exposure to certain toxins, such as insecticides, lead, mercury, glues, solvents and arsenic

• Long-term pressure on a nerve due to such conditions as a tight cast, a long surgical procedure, or carpal tunnel syndrome

• Nerve trauma

• Poor circulation

• Vitamin B deficiency and vitamin E deficiency

You may be able to prevent or lower your risk of neuropathy and permanent nerve damage by:

• Avoiding exposure to toxins, such as insecticides, lead, mercury, glues, solvents and arsenic

• Not drinking alcohol or limiting alcohol intake to one drink per day for women and two drinks per day for men

• Seeking regular medical care throughout your life and following your treatment plan for diseases and disorders, such as diabetes, hypothyroidism, vasculitis, and other diseases and conditions that can cause neuropathy

• Taking frequent breaks and using proper techniques for repetitive activities that can cause pressure or compression of a nerve, such as keyboarding or using a jackhammer

• Using proper technique when using crutches and notifying your healthcare provider if a cast is too tight or if other orthopedic devices cause discomfort

There are several underlying conditions related to neuropathy. However, diabetes is the leading one. Up to 70% of people with diabetes have peripheral nerve damage of some sort. The damage ranges from mild to severe. It can affect all three types of peripheral nerves: autonomic, motor and sensory. Nerve damage is the result of consistently elevated blood sugar levels that leads to inadequate blood circulation and oxygenation.

The risk of developing neuropathy with diabetes increases with age and the length of time you have had diabetes. Controlling your blood sugar levels is the most important step you can take to prevent it or slow its progression.

To diagnose neuropathy, your doctor will take a medical history, perform an exam, and order testing. Questions your doctor may ask about your symptoms and medical history include:

• What symptoms are you experiencing?

• When did your symptoms start? Did they start gradually or suddenly?

• Are your symptoms constant or do they come and go?

• How severe are your symptoms? Do they interfere with daily activities?

• What, if anything, seems to make your symptoms better or worse?

• Do you have a family history of nerve problems or nervous system disorders?

• What other medical conditions do you have?

• What medications do you take?

The exam will include a neurological evaluation. Your doctor will check your muscle strength, reflexes, posture, and your ability to feel sensations. Your doctor may also need to observe you walking to evaluate your gait and coordination.

Tests your doctor may order include:

• Blood tests to check for underlying conditions, such as diabetes

• Imaging exams, including CT (computed tomography) and MRI (magnetic resonance imaging), to look for problems with the spine, bones or blood vessels

• Nerve function tests, including electromyogram (EMG), a nerve study to evaluate how well your nerves send signals and how your muscles respond to them. Other tests include nerve conduction test, sensory tests, and sweat testing.

• Skin or nerve biopsies to take a tissue sample for microscopic examination. In a skin biopsy, doctors are looking for nerve endings in a patch of skin.

Treatment plans for neuropathy depend on the underlying cause, coexisting diseases, and complications. Treatment generally involves a multifaceted plan to address the underlying cause, minimize pain and abnormal sensations, and reduce the risk of complications. The goal is to help you achieve and maintain an independent and active life.

In addition to treating the underlying cause of neuropathy, treatment may include:

• Medications to relieve pain, inflammation, and other symptoms, including pain relievers, anti-seizure medicines, and antidepressants

• Physical therapy and occupational therapy to maintain and increase your strength and function and relieve symptoms

• Surgery to relieve pressure on a damaged nerve

• Walkers, canes, and other assistive devices, such as grab rails in the bathroom, to maintain your independence and maximize safety

Self-care for neuropathy focuses on living a healthy lifestyle. Regular exercise is one of the main strategies in this regard. It can help relieve pain and improve muscle strength and tone. For people with diabetes, it has the added benefit of helping control blood sugar levels. Talk with your doctor about the types and amount of exercise that are safe for you.

Other self-care tips include quitting smoking, limiting alcohol, and eating a healthy diet with plenty of whole grains and fresh fruits and vegetables. Ask your doctor if vitamin supplements would be useful in treating your neuropathy. If you have diabetes, daily foot care is essential. Ask your doctor for specific recommendations to keep your feet healthy.

Many people seek out alternative or complementary treatments to manage symptoms and diseases. Acupuncture is a popular choice for people with painful disorders. This therapy is generally safe when you work with an experienced practitioner.

There are several other potential alternative therapies for neuropathy. This includes alpha-lipoic acid, various herbal supplements, and amino acids, such as l-carnitine. Research on these types of supplements is generally inconclusive as far as effectiveness. Supplements can also cause side effects and drug interactions. Talk with your doctor before starting an alternative supplement to make sure you can safely take it.

Research consistently shows that neuropathy affects quality of life. Pain is the symptom with the biggest influence on quality of life. About two-thirds of people with peripheral neuropathy have pain, regardless of the underlying cause.

Pain is the most physically disabling symptom. It also leads to the most decline in mental health and well-being. The more intense the pain is, the more it lowers quality of life. Early diagnosis and treatment can reduce the detrimental effect neuropathy has on quality of life.

Your doctor will likely assess your quality of life on a regular basis if you have neuropathy. Tell your doctor if you notice a change in your stress or sleep or if you begin to experience symptoms of anxiety or depression. Treating pain and other neuropathy symptoms can improve these aspects of quality of life.

Untreated neuropathy can lead to serious complications. Following the treatment plan you and your healthcare provider develop specifically for you will minimize the risk of complications including:

• Adverse effects of treatment for neuropathy

• Cardiac arrhythmias

• Choking due to problems with swallowing

• Difficulty breathing

• Falls

• Gangrene and amputation

• Impotence

• Incontinence (of the bladder and bowel)

• Passing out

• Permanent loss of nerve function

• Permanent physical disability

• Poor wound healing and infection