StemCell Therapy

What Is Neuropathy?

Neuropathy is a term that refers to general diseases or malfunctions of the nerves. Nerves at any location in the body can be damaged from injury or disease. Neuropathy is often classified according to the types or location of nerves that are affected. Neuropathy can also be classified according to the disease causing it. (For example, neuropathy from the effects of diabetes is called diabetic neuropathy.)

Types of Neuropathy

Peripheral neuropathy: Peripheral neuropathy is when the nerve problem affects the nerves outside of the brain and spinal cord. These nerves are part of the peripheral nervous system. Accordingly, peripheral neuropathy is neuropathy that affects the nerves of the extremities- the toes, feet, legs, fingers, hands, and arms. The term proximal neuropathy has been used to refer to nerve damage that specifically causes pain in the shoulders, thighs, hips, or buttocks.

Cranial neuropathy: Cranial neuropathy occurs when any of the twelve cranial nerves (nerves that exit from the brain directly) are damaged. Two specific types of cranial neuropathy are optic neuropathy and auditory neuropathy. Optic neuropathy refers to damage or disease of the optic nerve that transmits visual signals from the retina of the eye to the brain. Auditory neuropathy involves the nerve that carries signals from the inner ear to the brain and is responsible for hearing.

Autonomic neuropathy: Autonomic neuropathy is damage to the nerves of the involuntary nervous system. These nerves that control the heart and circulation (including blood pressure), digestion, bowel and bladder function, the sexual response, and perspiration. Nerves in other organs may also be affected.

Focal neuropathy: Focal neuropathy is neuropathy that is restricted to one nerve or group of nerves, or one area of the body.

What Causes Neuropathy?

Nerve damage may be caused by a number of different diseases, injuries, infections, and even vitamin deficiency states.

What Are the Symptoms of Neuropathy?

Regardless of the cause, neuropathy is associated with characteristic symptoms. Although some people with neuropathy may not have symptoms, certain symptoms are common. The degree to which an individual is affected by a particular neuropathy varies.

Damage to the sensory nerves is common in peripheral neuropathy. Symptoms often begin in the feet with a gradual onset of loss of feeling, numbness, tingling, or pain and progress toward the center of the body with time. The arms or legs may be involved. The inability to determine joint position may also occur, which can result in clumsiness or falls. Extreme sensitivity to touch can be another symptom of peripheral neuropathy. The sensation of numbness and tingling of the skin is medically known as paresthesia.

The loss of sensory input from the foot means that blisters and sores on the feet may develop rapidly and not be noticed. Because there is a reduced sensation of pain, these sores may become infected and the infection may spread to deeper tissues, including bone. In severe cases, amputation may be necessary.

When damage to the motor nerves (those that control movement) occurs, symptoms include weakness, loss of reflexes, loss of muscle mass, cramping, and/or loss of dexterity.

Autonomic neuropathy, or damage to the nerves that control the function of organs and glands, may manifest with a wide variety of symptoms, including:

When to Seek Medical Care for Neuropathy

If you have any unusual or troubling symptoms suggestive of neuropathy, it is appropriate to seek medical care by consulting a healthcare professional.

Certain prescription medications have been shown to bring relief for those with neuropathy. In severe cases, a combination of medications may be necessary. Oral medications that have been successfully used to help the pain of neuropathy include:

Antidepressants such as:

Anticonvulsants such as

Opioids and opioid-like drugs such as:

Topical medications that may bring pain relief include capsaicin cream and lidocaine patches (Lidoderm, Lidopain).

What Are the Exams and Tests to Diagnose Neuropathy?

All exams and tests performed depend on the clinical presentation of the symptoms of the patient with suspected neuropathy. The diagnosis of neuropathy and its cause involve a thorough medical history and physical examination to help your health care professional determine the cause and severity of neuropathy. A neurological examination, testing the reflexes and function of sensory and motor nerves, is an important component of the initial examination.

Although there are no blood tests that are specific for determining whether of not neuropathy is present, when neuropathy is suspected, blood tests are often used to check for the presence of diseases and conditions (for example, diabetes or vitamin deficiencies) that may be responsible for nerve damage.

Imaging studies such as X-rays, CT scans, and MRI scans may be performed to look for sources of pressure on or damage to nerves.

Specific tests of nerve function include:

What is Neuropathy Treatment?

The treatment of neuropathy involves measures to control the symptoms as well as treatment measures that address the underlying cause of neuropathy, if appropriate. Medical treatments for diabetes, autoimmune diseases, infections, kidney disease, and vitamin deficiencies are varied and are directed at the specific underlying condition. In many cases, treatment of the underlying disease can reduce or eliminate the symptoms of neuropathy. Some cases, especially those involving compression or entrapment of nerves by tumors or other conditions, can be relieved by surgery.

Control of blood glucose (sugar) levels is important in the treatment of diabetic neuropathy to help prevent further damage to nerves.

Clinical trials are underway to help find new and more effective treatments for neuropathy. For example, treatments that involve electrical nerve stimulation or magnetic nerve stimulation are being studied.

Are There Home Remedies for Neuropathy?

Special and careful care of the feet is important in people with neuropathy to reduce the chance of developing sores and infections. The nerves to the feet are the nerves most commonly affected by neuropathy. Proper foot care includes:

What Medications Are Used to Treat Neuropathy?

A number of medications have been useful in controlling the pain of peripheral neuropathy.

What Are Neuropathy Medications?

Typical pain medications sold over-the-counter such as acetaminophen (Tylenol and others) and ibuprofen (Motrin and others) are not generally effective for controlling the pain of neuropathy. These drugs may be effective for lessening pain or joint damage and deformities associated with neuropathy, but they should be used with caution because there is some concern that these drugs may worsen nerve injury.

Certain prescription medications have been shown to bring relief for those with neuropathy. In severe cases, a combination of medications may be necessary. Oral medications that have been successfully used to help the pain of neuropathy include:

Topical medications that may bring pain relief include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Alternative or complementary therapies like acupuncture, biofeedback, and physical therapy have been shown to be helpful in some cases.

The antioxidant alpha-lipoic acid (ALA, taken in one oral 600 mg dose daily) has been shown to be effective in treatment of diabetic neuropathy in several short-term trials; evidence for its effectiveness over the long term is not yet available.

For those whose pain is not controlled by medications, a procedure known as trans-cutaneous electrical nerve stimulation (TENS) may be an option. Although data are limited on the effectiveness of this method, a 2010 guideline issued by the American Academy of Neurology stated that TENS is probably effective for reducing pain from diabetic neuropathy.

Follow-up for Neuropathy Treatment

Follow-up is dependent upon the cause of the neuropathy and they type of treatment. Always follow recommendations of your health care professional regarding follow-up examinations and visits.

How Do I Prevent Neuropathy?

Neuropathy is preventable only to the extent that the underlying condition or cause is preventable. For those with diabetes, studies have conclusively shown that long-term control of blood glucose levels is critically important in preventing the development of neuropathy and other complications of diabetes. Neuropathy that arises due to poor nutrition or alcohol abuse may be preventable if these causes can be eliminated. Genetic or inherited causes of neuropathy are not preventable.

What Is the Prognosis for Neuropathy?

The outlook for nerve damage depends upon its cause. If the underlying medical condition or cause can be effectively treated with medicine and/or surgery and severe damage has not occurred, the prognosis can be excellent or very good. Nerves that have been affected by neuropathy can take time to recover, even when the underlying cause is appropriately treated. In other conditions, such as genetic conditions, there may be no effective treatment. Severe nerve damage from any cause is typically not reversible.

Reviewed on 11/21/2017

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology

REFERENCES:

Dubinsky RM; Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. Epub 2009 Dec 30.

eMedicine.com. Diabetic neuropathy.< http://emedicine.medscape.com/article/1170337-overview>

MedlinePlus. Peripheral Neuropathy.<http://www.nlm.nih.gov/medlineplus/ency/article/000593.htm>

National Institutes of Health. Diabetic Neuropathies: The Nerve Damage of Diabetes.<http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/>

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Neuropathy Types (Diabetic), Causes, Treatment, & Medication

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