Neuropathy

Neuropathy is a condition that affects the peripheral nerves (the nerves that connect the spinal cord to the rest of the body). It causes weakness, numbness, tingling, burning sensations, and pain, primarily affecting the hands and the feet. It can be debilitating, interfering with work, sleep, and normal daily activities. Some people are concerned that this pain is related to circulation, which it is not. About a third of neuropathy is "idiopathic"—meaning the cause is not known. The rest are effects of other diseases such as diabetes or kidney failure. It is estimated that about 20 million people in the United States have neuropathy.

Even though there are many reasons for neuropathy, diabetes is the most common cause. If you've had diabetes longer than 25 years, have poorly controlled blood sugar, or have diabetes and are over age 40, your risk of developing neuropathy is much greater. Getting your blood sugar under control early in the disease may prevent neuropathy but may not reverse it once it has occurred. Other conditions that can cause neuropathy are the following:

• Alcohol abuse
• Vitamin deficiency (particularly B1 or B12)
• Auto-immune disorders or immunocompromised state
• Cancer
• Kidney or liver disease
• Repetitive stress or pressure on one nerve area
• Exposure to toxic substances
• Inherited disorders
• Amyloidosis (a disease in which proteins are deposited in areas of the body)
• Bacterial or viral infections (may cause an acute neuropathy called Guillain-Barre Syndrome)

If you have diabetes or poor arterial circulation, make sure you see your health-care provider regularly and have your feet checked. If you have a cut or open sore on your foot that is not healing, seek medical help promptly. If you notice tingling, numbness, pain, or weakness in your hands or feet, be sure you tell your health-care provider. If the pain or numbness interferes with your sleep, there may be something your provider or a pain specialist may do.

Neuropathy may be difficult to diagnose, and sometimes the cause is unknown. The examination will include a full history, physical examination, and neurological exam (which may include testing reflexes, muscle strength, and ability to feel something such as a pin prick). Testing may include testing for diabetes, a B12 level, thyroid tests, and an EMG (electromyolography), also known as a nerve conduction test. Occasionally a nerve biopsy may be necessary.

Treatment of neuropathy depends on the cause. With diabetes, you and your health-care provider will work on getting your blood sugar close to normal, and vitamin deficiencies can be helped with specific supplements. Autoimmune disorders each have their specific treatment, as do repetitive stress and toxic-substance exposure. Pain relievers may be used as well as anti-seizure medications. Anti-depressants may be used in mild to moderate neuropathy. Transcutaneous electrical nerve stimulation (TENS), biofeedback, hypnosis, and acupuncture may also be recommended.

If you smoke, you should stop smoking. Take care of your feet and check them daily for cuts or sores. Protect your feet and always wear closed-toe, well-fitting shoes. With your health-care provider's permission, you should engage in regular exercise. Make sure to eat healthy foods—particularly low-fat food, and lots of fruits and vegetables.