Neuropathy affects the peripheral nervous system, which sends messages between the brain and spinal cord and the rest of the body. The messages are essential for involuntary functions such as heartbeats and sweating, and voluntary ones such as walking and limb movement.
Your doctor will give you a physical and neurological exam to look for causes of neuropathy. Blood tests can check for diabetes, vitamin deficiencies, liver and kidney disease, and autoimmune diseases.
Symptoms
Many people with neuropathy have numbness, tingling or pain. Symptoms often start in your feet and move up to your legs, arms and hands. The type and severity of symptoms depend on the nerves and fibers involved, as well as the underlying cause. Tumors can damage your peripheral nerves, as can certain genetic conditions (like familial amyloidosis or Charcot-Marie-Tooth disease). Infections like HIV/AIDS and Lyme disease have been shown to negatively affect the nervous system. And autoimmune conditions like rheumatoid arthritis can lead to neuropathic pain as a side effect.
There are three main types of nerves in your body: motor, sensory and autonomic. Sensory nerves control things like touch, temperature and movement, while motor nerves control voluntary muscle movement. Autonomic nerves help your digestive and bladder function, as well as regulate your heartbeat and sweating. A dysfunction of any one of these groups can cause different types of neuropathy.
Depending on the cause of your neuropathy, doctors will use different tests to identify the problem. They’ll start with your medical history and do a physical exam. They may also order an EMG test and/or a nerve conduction velocity test. This will show how your nerves work and can pinpoint the type of neuropathy you have. They’ll also likely order a blood test to check your vitamin levels, as vitamin deficiencies can sometimes be a cause of neuropathy. They may also perform a lumbar puncture, or spinal tap, to see if there are any signs of infection.
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In addition to these tests, your doctor will talk with you about your symptoms and the severity of them. They’ll ask you where the pain is, what makes it better or worse, and how long you’ve had it. They’ll also ask about any other problems you’ve been having, such as a change in your bathroom habits or trouble with balance and coordination.
You can reduce the symptoms of neuropathic pain with medications, exercise and good sleep hygiene. You should try to have a regular routine before going to bed, and keep your bedroom comfortable and dark. You can also use soft socks and make sure the surface of your feet aren’t too rough or cold.
Diagnosis
Symptoms of neuropathy include a lack of sensation in the hands, feet or arms and legs. The symptoms are caused by damage to the nerves that convert information from your senses into signals your brain can interpret. Those signals then send your thoughts and actions to your body. Neuropathy can affect one or more nerves (polyneuropathy), a group of nerves (mononeuropathies) or the autonomic nervous system, which controls involuntary actions like breathing and heartbeat. Different types of neuropathies can cause different symptoms.
Your doctor can diagnose neuropathy by taking your medical history and doing a physical exam. They will ask questions about any medications you’re taking, as well as if you have any conditions that increase your risk of nerve damage, such as diabetes, kidney disease, autoimmune disorders, HIV infection or shingles. They will also ask about your alcohol use, family history of inherited neuropathies and any trauma to your body’s extremities.
Doctors will perform a physical exam of your arms, legs and hands to see how your nerves are functioning. They may do pin prick tests on your skin to evaluate how well you can feel sensations, as well as muscle strength and proprioception (your ability to sense where your body is in space). In some cases, doctors will need to order more detailed testing. These might include an MRI scan of the spine, which can help identify herniated discs or spinal stenosis, tumors, or other issues that might be compressing your nerves. Other testing might include an electromyogram (EMG), a nerve conduction velocity test, or lumbar puncture, which is a spinal tap to identify infections and inflammation.
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Once a diagnosis has been made, your doctor can start treatment. They might recommend over-the-counter pain relievers or prescribe oral or topical medications to control neuropathic pain, including gabapentin and lidocaine. They might also recommend a physical therapy program or prescribe canes, walkers or other assistive devices. In some situations, surgery might be recommended to alleviate pressure on a compressed nerve. They might also recommend antidepressants or anti-seizure medication if depression and anxiety are also a symptom.
Treatment
To diagnose neuropathy, your healthcare provider will review your health history and do a physical exam. They’ll look for signs of nerve damage, like numbness, pain and weakness. They may also do tests to measure your muscle strength, the ability to feel sensations and your balance. Blood tests can spot vitamin deficiencies, diabetes, inflammation or other conditions that can cause neuropathy. Tests to check your nerve function include electromyography (EMG) and nerve conduction studies. A lumbar puncture, or spinal tap, can help identify an infection that might be causing your neuropathy.
Once the underlying cause of your neuropathy is identified, treating it can relieve your symptoms. For example, if your doctor believes diabetes is the cause, controlling your blood sugar and taking your medication as prescribed will help. Eating a healthy diet and avoiding excess alcohol will also help. If you have nerve damage in your feet, wearing soft socks and keeping your skin moisturized can ease pain.
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For some types of neuropathy, such as peripheral neuropathic pain, your healthcare provider might recommend acupuncture, chiropractic treatments or specialized shoes with cushioning. They might prescribe a medication that reduces or blocks nerve signals to your brain to control pain and/or to prevent further damage.
Medications used to treat neuropathy include antidepressants and anti-seizure drugs, such as pregabalin and gabapentin. They can be used alone or in combination with other medications to treat the underlying condition that’s causing your neuropathy. These medications can help with both the pain and the numbness.
In some cases, a specialist in nervous system disorders, called a neurologist, may be needed to help you manage your condition and relieve your symptoms. This is especially true if your symptoms are severe or affecting your balance and coordination.
Peripheral neuropathic pain can be difficult to treat. However, it is important to talk with your doctor and follow the treatment plan that’s right for you.
Prevention
In many cases, people who have neuropathy can prevent the condition from getting worse. For instance, keeping blood sugar levels as close to normal as possible helps prevent diabetic neuropathy. Taking vitamin B12 supplements can help with certain types of nerve pain. Changing medications that can cause nerve damage, such as antidepressants and antiseizure drugs, can help. Some types of neuropathy, such as those caused by nerve compression, can be prevented by avoiding pressure on the affected areas.
For example, wearing supportive shoes and using a cushioned seat can prevent leg problems in those with peripheral neuropathy. Wearing gloves when handling sharp objects can help prevent numbness in the hands. And people with a loss of sensation in their feet should inspect them regularly for cuts and other injuries. This is important because neuropathy can make it difficult to feel an injury or sores, and they may not heal as well if left untreated.
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Other prevention strategies include eating a healthy diet, exercising, staying warm, and managing chronic conditions as recommended by your doctor. In particular, people with diabetes should work closely with their health care providers to keep their blood sugar levels in the target range.
Some types of neuropathy are caused by infections or by medical treatments, including surgery. For instance, the herpes simplex virus (which causes shingles) and the varicella-zoster virus that causes chickenpox can damage nerves. And certain bacteria, such as Borrelia burgdorferi (the one that causes Lyme disease), can also directly attack nerve tissue and cause painful neuropathy.
People who have certain genetic conditions, such as familial amyloidosis and Fabry disease, may be predisposed to developing neuropathy. Other risk factors for the condition include a history of smoking or alcohol abuse, and exposure to toxic chemicals. Some experts recommend routine primary care checkups and physical activity, along with a balanced diet rich in fruits and vegetables, lean proteins and legumes, and limited salt and excessive alcohol consumption. In addition, limiting stress and establishing good sleep habits can help reduce symptoms. To encourage better sleep, people with neuropathy should create a relaxing nighttime routine and keep their bedroom as cool as possible, making sure to wear soft socks.
