Neuropathy

What causes neuropathy ?

Neuropathy describes the effects of damage to the peripheral nervous system. This damage is commonly caused by disease or injury to the nerve. These are some common causes of neuropathy:

• diabetes
• cancer
• nutritional deficiency including low levels of vitamin B12
• medications
• injury to the nerve
• underactive thyroid
• high levels of lead, mercury or arsenic in the body (heavy metal poisoning)
• viral infection including HIV and shingles
• long-term liver or kidney disease
• hereditary conditions such as Charcot-Marie-Tooth (CMT) disease
• alcohol misuse
• Guillain-Barré syndrome (GBS)
• autoimmune disease

What are the symptoms of neuropathy ?

The symptoms of neuropathy depend on what type of neuropathy you have and which nerves are affected.

The nervous system has two parts:

• the central nervous system, consisting of the brain and the spinal cord
• the peripheral nervous system, which is the network of nerves in the rest of the body

There are three main types of nerves in the peripheral nervous system:

• autonomic nerves, which regulate the functions of the body that you don’t control yourself, such as blood pressure and digestion
• motor nerves, which control muscles
• sensory nerves, which transmit signals relating to the senses including pain and pressure, or touch

Peripheral neuropathy can affect just one nerve – this is described as mononeuropathy. It can affect several nerves. This is known as mononeuritis multiplex. Or it can affect nerves throughout the entire body: polyneuropathy.

Neuropathy symptoms can be constant or they may happen from time to time.

What are the symptoms of autonomic neuropathy?

The symptoms of autonomic neuropathy include:

• bowel problems such as constipation or diarrhea or loss of control
• digestive symptoms like nausea, bloating and belching caused food moving too slowly through your stomach (gastroparesis)
• sweating too much (hyperhidrosis) or not sweating at all
• erectile dysfunction in men
• dizziness on standing, caused by low blood pressure
• rapid heartbeat
• problems urinating

What are the symptoms of motor neuropathy?

Motor neuropathy affects the nerves that control muscles. Symptoms include:

• cramps
• twitches
• weakness
• muscle wasting
• finding it hard to lift your foot

What are the symptoms of sensory neuropathy?

The symptoms of neuropathy affecting a sensory nerve include:

• balance problems
• pain in the feet – often burning or shooting
• tingling or pins and needles in feet and hands
• numbness of feet and hands
• inability to feel temperature changes in your hands and feet
• unexpected pain from things that shouldn’t cause pain

What are the symptoms of mononeuropathy?

Mononeuropathy affects just one peripheral nerve and symptoms include:

• altered sensation in fingers and toes
• difficulty focusing the eyes
• pain in shins and feet

Carpal tunnel syndrome, which causes numbness and tingling of the fingers, is a common mononeuropathy.

What are the symptoms of Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is a rare condition characterized by paralysis that comes on very quickly, often starting in the legs or feet and moving up the body. Symptoms of GBS are:

• back pain
• pain in fingers and toes
• numbness
• tingling
• facial weakness

See a doctor quickly if you experience paralysis or numbness.

Does peripheral neuropathy have any complications?

When the underlying cause of neuropathy is not treated, serious complications can develop and some types of neuropathy will get worse over time.

Where the sensory nerves are affected by neuropathy, you may not be able to feel pain, which is why foot ulcers are more likely to occur in people with neuropathy. Diabetes complicates things further because raised blood sugar damages blood vessels, meaning the feet get fewer immune cells that fight infection, which makes wounds more likely to get infected. If this progresses to gangrene the foot may have to be amputated.

Another complication of neuropathy of sensory nerves is that you are more likely to burn or scald yourself because of difficulties detecting temperature.

Neuropathy can affect autonomic nerves. If it involves nerves of the heart and circulation, it is known as cardiovascular autonomic neuropathy. You may need treatment to manage your blood pressure or heart rate.

Neuropathy can cause balance problems, which make slips, trips and falls more likely.

What to do if you think you have neuropathy

See your doctor if you experience the symptoms of neuropathy. Early diagnosis means that peripheral neuropathy can be treated quickly to limit damage so you can avoid complications.

How does a doctor diagnose neuropathy ?

When you go to your doctor with symptoms of neuropathy they will examine you, and run some tests for sensation, reflexes and strength. They may ask questions about your lifestyle, including about drinking and use of recreational drugs. They will commission tests to check for the common underlying causes of peripheral neuropathy, including diabetes and vitamin B12 deficiency.

They may adjust the doses of medicines you are taking for other conditions, as some meds can cause neuropathy.

Should I see a specialist about neuropathy?

In the first instance, it’s best to see your family doctor if you have neuropathy symptoms. If you need to see a specialist, they can arrange a referral. A specialist neurologist can run tests such as a nerve conduction test or electromyography.

They may also run blood tests to check for rarer causes of peripheral neuropathy, such as an inherited or acquired disorder. They might also commission:

• a lumbar puncture to check your cerebrospinal fluid for signs of inflammation
• a nerve biopsy
• an X-ray
• a CT scan
• an MRI scan

How will a doctor treat my neuropathy ?

When your doctor develops a treatment plan for peripheral neuropathy they will attempt to treat any underlying causes, and also recommend treatments to relieve the nerve pain. Doctors can also recommend treatments that will help you to manage other symptoms of neuropathy, such as muscle weakness, constipation and erectile dysfunction.

Treating the underlying causes of neuropathy

When your doctor identifies the underlying cause of your neuropathy, they will start treatment to relieve your symptoms. It is not always possible to treat the underlying causes of neuropathy, however.

Diabetes and neuropathy

Diabetes is a very common cause of neuropathy, and the doctor will support you to get your diabetes under control to relieve the symptoms of neuropathy. This may include some lifestyle changes, and medication. To learn more about how diabetes is controlled, see our diabetes page.

People living with diabetes should be alert to the symptoms of neuropathy, and see their doctor promptly if they have any worries about numbness, unusual sensations or pain that doesn’t seem to have a cause.

Foot care is an important part of a diabetes management routine because neuropathy of the feet may prevent you from noticing a wound or sore that is getting worse and not healing. And diabetes can make wounds slower to heal as well. Check your feet daily for cuts, blisters and sores, and get your feet checked by a doctor, diabetes nurse or a podiatrist or chiropodist.

Cardiovascular autonomic neuropathy (CAN) is linked to diabetic neuropathy. It results in low blood pressure and sometimes unusual heartbeat patterns (arrhythmia). Your doctor will want you to have regular check-ups if you have CAN to keep an eye on your heart function.

To manage low blood pressure caused by CAN, stand up or sit up very slowly, and wear compression stockings. Stay hydrated, as this will keep your blood volume up and raise your blood pressure. You can also raise the head of your bed.

There are meds you can take for low blood pressure caused by CAN. These include fludrocortisone and midodrine.

The arrhythmia caused by CAN is treated with medications such as flecainide, beta blockers and amiodarone.

Vitamin B12 deficiency and neuropathy

Supplements of vitamin B12 can relieve neuropathy caused by a vitamin deficiency. B12 can be given as an injection or in tablet form.

Alcohol misuse and neuropathy

Alcohol misuse can cause neuropathy. Your doctor can help you get treatment for excessive drinking, and give advice on reducing your alcohol intake to ensure it stays within government recommended limits. Recovery from alcohol misuse can be very difficult for some people, but with the right support it is possible.

HIV and neuropathy

Infection with HIV is linked to neuropathy. Your doctor can help you get appropriate treatment for HIV and help you to manage any related neuropathy. If you are living with HIV, mention any neuropathy symptoms to your doctor, as it warrants further investigation.

Heavy metal poisoning and neuropathy

Some heavy metals can cause neuropathy. Heavy metal poisoning is treated by identifying the source of exposure and ending it. You may be offered chelating agents for heavy metal poisoning. Chelating agents are medications that bind to the metal molecules so they can be excreted by the body in the urine. Your doctor may also give you advice on avoiding future exposure to heavy metals.

Relieving neuropathic nerve pain with medication

The pain caused by neuropathy cannot be treated with over-the-counter pain relief meds like NSAIDs.

Your doctor will prescribe a low dose of one of the common medications used for neuropathic pain. It may not work at first: your doctor will increase the dose gradually until the medication is effective. They will want to prescribe the smallest effective dose because the meds used to treat neuropathy can cause side-effects like dizziness and tiredness if the dose is too high.

Some common medications used for nerve pain are:

• amitriptyline
• duloxetine
• gabapentin
• pregabalin

You may also be prescribed some medications to relieve severe pain for a short time and pain that is confined to one part of your body. These include capsaicin cream and tramadol.

Do the meds that treat neuropathy have side-effects?

It is possible that you may experience side-effects from your neuropathy medications. These might include dizziness, tiredness and feeling drunk or stoned. If this happens, let your doctor or pharmacist know, as it means the medication may not be suitable for you at that dose. Your doctor or pharmacist can give advice on adjusting your dose or help you to try a different med for neuropathy.

How do I get medications for neuropathy ?

Most of the medications used to treat neuropathy are available only on prescription. You should only take them under supervision from your doctor.

In Canada you can depend on NX Pharmacies for your neuropathy meds. We serve all areas of Canada and can fill your prescription of neuropathy medication. We can help with renewals and refills. Our discretion is assured, and you can depend on us for authentic Health Canada-approved medications.

If something changes with your neuropathy , talk to your doctor or neurologist. And if your meds stop working, or you start to get uncomfortable side-effects, ask for a medicines review. Your pharmacist may also be able to advise on managing side-effects of your neuropathy meds.

Other therapies used to treat neuropathy

Your doctor will offer a range of therapies to treat other symptoms of neuropathy. For example, there are remedies available for:

• constipation
• erectile dysfunction
• difficulty emptying your bladder
• sweating too much (hyperhidrosis)

Doctors may only be able to partially relieve the symptoms of neuropathy with standard treatments. If you wish to try alternative therapies like acupuncture or herbal medicine, speak with your doctor as you should get advice on potential interactions with neuropathy treatments that you are already receiving.

Physical therapy and rehabilitation for neuropathy

For muscle weakness caused by neuropathy your doctor may arrange a course of physio. A physiotherapist can teach you exercises that will strengthen your muscles so you can move more easily and safely. You will need to keep doing the exercises at home in between appointments with your physio, and also after the course of physio has ended.