Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 2, 2016

The term neuropathy refers to pain or weakness generated by the peripheral nervous system, or the nerves outside the brain and spinal cord, also called the central nervous system. Neuropathy can be caused by several factors including illness, medication and trauma. The condition can also stem from an unknown source in which case it is said to be idiopathic. The term neuropathy is synonymous with peripheral neuropathy.


Definition & Facts

Neuropathy manifests in one of two ways: polyneuropathy and mononeuropathy. Polyneuropathy is often caused by diabetes mellitus. Damage caused by high blood sugar levels (hyperglycemia) can lead to long-term pain or sensation loss in the extremities (paresthesia).

However, neuropathy can also stem from pinched nerves, such as the damage caused by carpal tunnel syndrome. This form of neuropathy is known as mononeuropathy, or relating to a single nerve. One-third of all neuropathies are idiopathic neuropathy, or neuropathy stemming from no known source.

Neuropathy can impact several factors, depending on the nerves it strikes. Sensory nerve damage causes pain, a weakening of the muscles over time, numbness and/or tingling. Generally these sensations occur in the feet and hands. Motor nerve damage can lead to weakness in the extremities. The autonomic nervous system can also be impacted, leading to digestive problems, urinary bladder disease, hypertension, and changes in heart rate like tachycardia (fast heart rate).

Symptoms & Complaints

Depending on the source of the damage, symptoms can move from chronic to debilitating pain, or from numbness to paralysis. Guillain-Barré syndrome is a very serious polyneuropathy that occurs that can occur suddenly. The immune systems of those who suffer from Guillain-Barré attack the nerves as they branch from the spinal cord.

This condition begins with weakness and tingling in the arms and can move to the heart. Blood pressure and breathing may be impacted. Neuropathy can also impact the digestive and cleansing organs.

Some patients may experience constipation, diarrhea, loss of bladder control, and nausea. Most patients of neuropathy experience pain, a burning sensation, or numbness in their hands and feet.

Over time, this condition can become debilitating and dangerous because injury can occur without the knowledge of the patient. For neuropathy patients with poor circulation, these injuries can lead to dangerous infections.


Peripheral neuropathy is often caused by diabetes. However, other causes of both mononeuropathy and polyneuropathy include nutritional deficiencies, chemotherapy, kidney disease, or infections including shingles, HIV, and Lyme disease.

Chronic alcohol abuse can also lead to pain and numbness in the extremities. It is possible to inherit neuropathies, including Charcot-Marie-Tooth disease. In the United States, approximately one in 2,500 people suffer from this illness, which manifests as weakness in the feet and legs. Over time, this weakness may begin to affect the hands and the tongue. Walking, fine motor skills and speech can be impacted.

Diagnosis & Tests

Anyone suffering chronic nerve pain, burning sensations, and/or extremity weakness or numbness will need to be assessed for neuropathy. These tests will likely include a general medical history including a review of all drug use or alcohol use, sexual history and exposure to environmental toxicants.

Reflexes and touch sensitivity will be tested. Nerve conduction studies will be used to determine the speed at which the body responds to an electric stimulus, because those who suffer from peripheral neuropathy have a slower response to stimuli.

An electromyography test will be done of the patient's muscle tissue to determine the behavior of the muscle under electric stimuli. Biopsies of the nerves and skin may be taken to determine nerve condition and nerve density.

Treatment & Therapy

If the neuropathy is caused by another condition such as drug or alcohol use, diabetes or toxin exposure, getting control of those sources is critical. While removing the patient from exposure to a toxin or stopping a prescription drug may remove the symptoms, the long-term damage done by diabetes and alcohol may be irreversible.'

It's critically important to get and maintain control of blood sugar levels in diabetics to avoid long-term nerve damage. For diabetic patients with chronic numbness in their feet, for example, injuries can go unnoticed until the condition becomes a dangerous infection. Drug treatment for neuropathic pain can include anticonvulsants which are typically used to treat epilepsy or opioids such as oxycodone.

Skin patches or creams containing capsaicin can ease neuropathic pain. For those with digestive issues, dietary changes can help. Patients with bladder control issues may find their symptoms improved with a bladder training program and with antispasmodic medications.

Mononeuropathies can be treated effectively using ice, heat to reduce the inflammation impacting the nerve. For some conditions, braces and splints can help to immobilize the source of the impacted nerve. When other therapeutic methods fail, surgery can be an effective treatment for mononeuropathic conditions.

Prevention & Prophylaxis

Mononeuropathies can often be successfully treated by removing the source of stress on the affected nerve. Physical therapy, strengthening and rehabilitating muscles and joints through which the impacted nerve must pass can help reduce the pain and debilitation of mononeuropathy.

For pleural neuropathy patients, the underlying cause must be determined so the condition can be managed. Diabetics need to determine a healthy blood sugar level and stay within those limits. For diabetics, ceasing all tobacco use is of crucial importance because diabetics who use tobacco put themselves at greater risk of suffering from peripheral neuropathic pain.

Patients exposed to toxins will need to find a way to avoid them. Undernourished individuals can improve their diets and boost supplemental intake to overcome nutritional deficiencies. Patients undergoing chemotherapy should work with their oncologist to determine the most effective way to use, and then stop using, medications to treat their cancer so as to reduce the damage caused by those therapies.

Drug abusers and chronic alcoholics will need to seek treatment for their addictions and determine their best course of action. While many types of neuropathy have no source, others can be avoided by maintaining a healthy diet and engaging in regular exercise. The nerve and tissue damage caused by neuropathy can be permanent and debilitating, so managing conditions such as diabetes before neuropathy develops is critical.