Definition

Neuropathy is a condition caused by damage to the peripheral nerves, which are nerves outside the brain and spinal cord. Neuropathy is generally characterized by weakness, numbness, and pain in the hands or feet. It can also disrupt other body functions, such as digestion, blood circulation, and the urinary system.

The human nervous system is divided into the peripheral nervous system and the central nervous system. The central nervous system consists of the brain and spinal cord. The peripheral nervous system transmits information from the brain and spinal cord to all body organs. Neuropathy can be caused by injury, infection, metabolic problems, hereditary conditions, and exposure to toxins. However, the most common cause of neuropathy is diabetes. Early symptoms of neuropathy include sensations like tingling, burning, and numbness. In various conditions, symptoms may improve as the underlying cause is addressed.

Causes

Neuropathy can be caused by several conditions, including:

• Diabetes is the main cause of neuropathy. More than half of people with diabetes will experience neuropathy.
• Autoimmune diseases, such as arthritis, Sjogren's syndrome, Guillain-Barre syndrome, vasculitis, and other autoimmune diseases.
• Infections such as Epstein-Barr virus, hepatitis B, hepatitis C, leprosy, diphtheria, HIV, and others.
• Hereditary conditions such as Charcot-Marie-Tooth disease.
• Tumors. Growths, whether malignant (cancerous) or benign, can press on nerves. This pressure can disrupt nerve function directly or indirectly (through inflammation).
• Alcohol consumption can lead to a decrease in certain vitamins, causing neuropathy.
• Exposure to toxic substances such as industrial chemicals and heavy metals like mercury can cause neuropathy.
• Nerve pressure caused by injuries, traffic accidents, sports injuries, or prolonged typing can cause neuropathy.
• Vitamin B and E deficiencies.

Risk factor

Factors that can increase the risk of neuropathy include:

• Having a history of diabetes.
• Consuming alcohol.
• Vitamin deficiencies, especially B vitamins.
• Infections.
• Autoimmune diseases.
• Kidney, thyroid, and liver disorders.
• Exposure to toxic substances.
• Family history of neuropathy.

Symptoms

Each nerve in the peripheral nervous system has a specific function, so symptoms depend on which nerves are affected. Nerves can be classified into:

• Sensory nerves, for sensations such as temperature, pain, vibration, and touch on the skin.
• Motor nerves, for controlling movements.
• Autonomic nerves, for regulating body functions such as blood pressure, heart rate, digestion, and urinary system.

Symptoms of neuropathy include:

• Numbness, tingling, or prickling in the hands or feet that may spread to the arms or legs.
• Sharp, stabbing, or burning pain.
• Sensitivity to touch.
• Pain during activities that should not cause pain.
• Muscle weakness.
• Feeling like wearing 'gloves' and 'socks.'
• Inability to move hands or feet.
• If autonomic nerves are involved, symptoms may include:
• Heat intolerance.
• Excessive sweating in one area or no sweating at all.
• Digestive and urinary problems.
• Decreased blood pressure causing dizziness.

Neuropathy can affect one nerve (mononeuropathy) or multiple nerves (polyneuropathy). Generally, people with neuropathy experience polyneuropathy.

Diagnosis

Neuropathy can be caused by various factors, so your doctor will perform several examinations to find the source, including:

• Medical history. Your doctor will ask about your complaints, medications you've taken, and other medical conditions you have.
• Neurological examination. Your doctor will conduct a neurological exam to check reflexes, muscle strength, muscle tone, and specific sensations such as touch or temperature and coordination.
• Additional tests may be done based on indications, including:
• Complete blood count to check for vitamin deficiencies, diabetes, abnormal immune function, and other conditions causing neuropathy.
• Radiological examinations to look for herniated discs (HNP) or pinched nerves.
• Nerve function tests using electromyography (EMG).
• Nerve or skin biopsy if your doctor suspects reduced nerve numbers in a specific area.

Management

Medical therapy

Treatment for neuropathy will depend on its cause or any complications. Some medications can help relieve neuropathy symptoms but do not fully treat the underlying cause. Medications like over-the-counter pain relievers (analgesics), nerve medications (gabapentin or pregabalin), and topical medications can help relieve pain.

Specific therapies or procedures that can help alleviate neuropathy symptoms include transcutaneous electrical nerve stimulation (TENS), physical therapy for muscle weakness, and surgery if there is an abnormality pressing or pinching nerves like a tumor.

Self-Care at Home

• Take care of your feet, especially if you have diabetes. Check your feet daily for calluses or wounds you might not notice. Wear soft socks that protect your feet. Clean your feet daily.
• Exercise. Regular exercise, such as walking three times a week, can reduce neuropathy pain, strengthen muscles, and control blood sugar.
• Quit smoking. Smoking can disrupt circulation and increase the risk of nerve damage.
• Eat a healthy diet. Good nutrition is essential for nerve health. Consume fruits, vegetables, and whole grains to meet your daily mineral and vitamin needs.
• Reduce alcohol consumption.
• Regularly monitor your blood sugar. If you have diabetes, good blood sugar control can prevent and improve neuropathy symptoms.

Complications

Complications that may occur include:

• Foot infections. Feet and other less sensitive areas are prone to injuries without being noticed. Untreated wounds can lead to local or systemic infections. Severe foot infections may require amputation.
• Falls. Muscle weakness and reduced sensation in the feet can increase the risk of falls and balance disorders.

Prevention

Some habits that can help maintain nerve health include:

• Manage your medical conditions. Prevent neuropathy by controlling blood sugar if you have diabetes, avoiding alcohol consumption, and taking medications regularly if you have autoimmune conditions like rheumatoid arthritis.
• Live a healthy life by including fruits, vegetables, whole grains, and protein sources (eggs, fish, meat, low-fat dairy) to maintain nerve health. Exercise regularly for at least 30 minutes a day, three times a week. Avoid activities that can cause nerve damage, such as repetitive motions, poor posture, exposure to harmful chemicals, smoking, and excessive alcohol consumption.

When to see a doctor?

See a healthcare provider immediately if you experience weakness or pain in your hands or feet. Early diagnosis and treatment can help control the underlying disease causing neuropathy, preventing further worsening of the condition.

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