Causes of Neuropathy

This online resource describes different causes and specific self-management techniques that may help relieve symptoms or at least may slow your neuropathy progression. Our CNA 100 things for neuropathy relief blog posts are also a good resource if you are looking for tips on how to manage your neuropathy in general. Click on the links in the “List of Causes” table to learn more about the cause(s) of neuropathy.

List of Causes

Alcoholism	Hereditary Peripheral Neuropathy/Charcot-Marie-Tooth (CMT) Disease	Vasculitis
Amyloidosis
Anterior interosseous neuropathy (AIN)
Autoimmune Diseases	Idiopathic Neuropathy
Chemotherapy	Kidney Disease
Chronic Inflammation	Pinched Nerve/ Nerve Disease
Type 1 and Type 1 Diabetes	Shingles (Herpes Zoster)

Alcoholism

Alcohol is a toxic substance and will have a negative impact on your nerve health if used in excess. The US National Institute on Alcohol Abuse and Alcoholism provides the guideline of one drink per day for women and two for men. They also indicate older adults should limit their consumption to one per day.  If alcohol is used in excess over long periods of time it can lead to alcoholism, which is a pattern of alcohol use that involves problems controlling your consumption, being preoccupied with alcohol, or continuing to use alcohol even though it is causing you physical or emotional problems.¹ 

Long-term excessive drinking of alcohol can lead to alcoholic neuropathy. The British Journal of Clinical Pharmacology defines alcoholic neuropathy as “damage to nerves that results from long term excessive drinking of alcohol and is characterized by spontaneous burning pain, hyperalgesia (an enhanced sensitivity to pain), and allodynia (which is when you feel pain from the stimulation that shouldn’t hurt).”³ These symptoms usually appear gradually and worsen along with the continued excessive use of alcohol. In addition, drinking alcohol can result in vitamin B12 deficiency which is also a cause of neuropathy. 

Eliminating or limiting alcohol consumption will help alleviate these symptoms. Also, have your B12 levels checked by your doctor, and to start B12 supplements if your doctor finds them low. 

We understand that reducing your alcohol consumption can be a large and intimidating task. Know that you do not have to do it alone. Please see the government of Canada’s website on resources where you can get support: https://www.canada.ca/en/health-canada/services/substance-use/get-help/get-help-problematic-substance-use.html

References

1. Alcohol use disorder – Symptoms and causes. (2018, July 11). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
2. Allen, S. (2019, March 8). The Aftereffects of Alcoholism: Alcoholic Neuropathy. Healthline. https://www.healthline.com/health/alcoholism/alcoholic-neuropathy#outlook
3. Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British Journal of Clinical Pharmacology, 73(3), 348–362. https://doi.org/10.1111/j.1365-2125.2011.04111.x

Amyloidosis

Amyloidosis is a rare but serious condition characterized by the accumulation of abnormal proteins called amyloids in various organs and tissues throughout the body. These amyloids can damage the nerves and cause neuropathy.

The nerves are affected by amyloidosis because the amyloid proteins can build up around them, causing compression, inflammation, and ultimately damage. This damage can disrupt the normal functioning of the nerves, including their ability to transmit signals from the brain to the rest of the body. In some cases, the damage can be severe enough to cause irreversible nerve injury.

There are several types of amyloidosis, each with its own set of symptoms and complications. One of the most common types is AL amyloidosis, which is caused by the accumulation of abnormal immunoglobulin light chains. Another type is hereditary amyloidosis, which is caused by mutations in specific genes.

Treatment for neuropathy caused by amyloidosis depends on the underlying cause of the condition. In some cases, the underlying amyloidosis may need to be treated directly. This can be done through chemotherapy or stem cell transplantation, which can help to reduce the production of abnormal proteins and slow the progression of the disease.

In addition to treating the underlying amyloidosis, there are several other treatments that can help to manage neuropathy symptoms. These may include pain medication, physical therapy, and occupational therapy. In some cases, surgery may be necessary to relieve pressure on the nerves and reduce inflammation.

In conclusion, amyloidosis is a rare but serious condition that can cause neuropathy and damage to the nerves. It is important to seek medical attention if you experience symptoms of neuropathy or if you have a family history of amyloidosis. Treatment for neuropathy caused by amyloidosis depends on the underlying cause of the condition, and may involve a combination of therapies to manage symptoms and treat the underlying disease.

References:

1. Merlini, G., & Bellotti, V. (2003). Molecular mechanisms of amyloidosis. New England Journal of Medicine, 349(6), 583-596.
2. Koike, H., & Sobue, G. (2018). Amyloid neuropathies. Current opinion in neurology, 31(5), 546-554.
3. Adams, D., Suhr, O. B., & Hund, E. (2015). Neuropathy associated with systemic amyloidosis. New England Journal of Medicine, 372(18), 1754-1755.
4. Information is ChatGPT generated and edited to apply specifically to highlight Peripheral Neuropathy, references confirmed.

Anterior interosseous neuropathy (AIN)

Anterior interosseous (situated between bones) neuropathy (AIN) is a rare condition that affects the nerves in the forearm and hand. It occurs when the anterior interosseous nerve, a branch of the median nerve, becomes compressed or damaged. AIN can cause weakness and numbness in the forearm and hand muscles that it innervates. This condition typically affects adults aged 20-60 years old, with a slightly higher incidence in males than females [1].

The nerves that are affected by AIN are responsible for the motor function of certain forearm and hand muscles, including the ones to the index and middle fingers. When these nerves are compressed or damaged, it can result in weakness or paralysis of these muscles. Patients with AIN often report difficulty gripping objects or performing fine motor tasks [2].

The exact cause of AIN is not always known, but it is thought to be related to a combination of factors, including trauma, repetitive use, and anatomical abnormalities. For example, individuals who perform repetitive activities that involve pronation or supination of the forearm, such as playing a musical instrument or using power tools, may be at increased risk for developing AIN [3].

The treatment for AIN typically involves managing symptoms and addressing the underlying cause of the neuropathy. Non-surgical treatments may include rest, immobilization, physical therapy, and pain management. In more severe cases, surgery may be necessary to decompress the affected nerve. The prognosis for patients with AIN is generally good, with most patients experiencing a full recovery within several months to a year [4].

In conclusion, AIN is a rare condition that affects the nerves in the forearm and hand. It can cause weakness and numbness in the muscles it innervates, leading to difficulty with fine motor tasks and gripping objects. Contributing factors to the resulting neuropathy include trauma, repetitive use, and anatomical abnormalities. Treatment typically involves managing symptoms and addressing the underlying cause of the neuropathy, with a good prognosis for most patients.

References:

1. Mackinnon SE. Evaluation and management of peripheral nerve injury. Clinics in plastic surgery. 2003 Jul 1;30(3):247-68.
2. Mackinnon SE, Novak CB. Anterior interosseous nerve syndrome. Hand Clinics. 1992 Nov 1;8(4):685-91.
3. Bozentka DJ. Anterior interosseous nerve syndrome. The Journal of hand surgery. 1996 Jul 1;21(4):634-7.
4. Gabel GT, Amadio PC. Anterior interosseous nerve syndrome. The Journal of hand surgery. 1986 Nov 1;11(6):880-2.
5. https://neurochecklists.com/explore/checklists/anterior-interosseous-neuropathy-ain-causes
6. Information is ChatGPT generated and edited to apply specifically to highlight Peripheral Neuropathy, references are unconfirmed.

Autoimmune Diseases

Autoimmune Disease is a condition where your immune system is overactive, meaning that it attacks the healthy cells in your body rather than focusing just on the bad ones. Examples of these diseases include Lupus, celiac disease, rheumatoid arthritis, and Guillain-Barre syndrome.² Having an overactive immune system can wreak havoc on your nerves causing neuropathy. If you find you have severe or rapidly progressive muscle weaknesses and nerve pain and a autoimmune disease, then you might have autoimmune neuropathy³. 

The best way to manage your neuropathy is to manage your autoimmune disease.¹ Talk to a doctor about appropriate treatments and medications that you can take to manage your symptoms. 

References:

1. Autoimmune Disease. (2021, May 13). The Foundation For Peripheral Neuropathy. https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/autoimmune-disease/
2. Autonomic neuropathy – Symptoms and causes. (2020, August 21). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/symptoms-causes/syc-20369829
3. Klonoski, J. M., & Peterson, L. K. (2020, August 1). Autoimmune Neuropathies – Neuropathic Disease | Choose the Right Test. ARUP Consult. https://arupconsult.com/content/autoimmune-neuropathies

Chemotherapy

Chemotherapy works by using drugs to destroy cancerous cells. It prevents them from replicating, growing, and making more cancer cells¹. Since cancer cells grow faster than normal cells in the body, chemotherapy generally affects the cancer cells more than normal ones¹. That being said, chemotherapy can also affect your healthy cells, so nerve cells can and often do become damaged too.

The stress chemotherapy puts on neurons often leads to inflammation and functional impairment of nerves. This impairment affects about 30-40% of patients who undergo chemotherapy, causing them to develop chemotherapy-induced neuropathy (aka CIPN).² It is difficult to pinpoint exactly which chemotherapy drug causes neuropathy, as each drug is different and affects patients differently. 

If you experience any of the tell-tale signs of neuropathy (like tingling, sharp stabbing pain, loss of sensation, or trouble with motor skills) while undergoing chemotherapy, talk to your oncologist³. If they determine your neuropathy is caused by chemotherapy, they may consider altering your chemotherapy treatment by changing the drug, lowering the dose, or stopping chemotherapy altogether³.  However, the doctor has chosen your treatment plan based on what they considered to be the best option so keep in mind there may not be any alternatives and their priority is managing cancer. They may also recommend painkillers or other methods of managing your neuropathy throughout your treatment.

Chemotherapy-induced neuropathy may only last as long as your treatment, but for some, it becomes a life-long struggle. It is very important to keep your oncologist in the loop about how you’re feeling and if you’re experiencing any neuropathy symptoms. The earlier they know, the sooner they can help find options and help you feel better.

References:

1. Areti, A., Yerra, V. G., Naidu, V., & Kumar, A. (2014). Oxidative stress and nerve damage: Role in chemotherapy induced peripheral neuropathy. Redox Biology, 2, 289–295. https://doi.org/10.1016/j.redox.2014.01.006
2. Pietrangelo, A. (2019, January 24). Does Neuropathy from Chemo Go Away? Healthline. https://www.healthline.com/health/cancer/neuropathy-from-chemo#outlook-and-prevention
3. Understanding Chemotherapy. (2021, May 3). Cancer.Net. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/understanding-chemotherapy

Chronic Inflammation

Chronic inflammation is slow, long-term inflammation lasting several months or even years². Inflammation is one of the ways your body fights off infections and toxins and begins to heal itself³. However, in the case of chronic inflammation, this immune response stays in the body for a prolonged period of time, which has adverse effects on your body tissues and nerves. 

There is a specific type of neuropathy specifically caused by chronic inflammation called Chronic Inflammatory Demyelinating Polyneuropathy (or CIDP for short)¹. CIDP is caused by damage to the myelin sheath (the fatty tissue that coats and protects nerves) of peripheral nerves, causing tingling, weakness, and pain to the arms and legs¹. The National Institute of Neurological Disorders and Stroke says that CIDP is more common in men than in women¹. The institute also adds that “CIDP is closely related to Guillain-Barre syndrome and is considered the chronic counterpart of that acute disease”¹.

The best way to treat neuropathy caused by chronic inflammation is to treat the inflammation itself. Your doctor may decide to prescribe immunosuppressant drugs to minimize the immune response or use corticosteroids like prednisone¹. Your doctor may also recommend physiotherapy to help improve muscle function and mobility.

References:

1. National Institute of Neurological Disorders and Stroke. (n.d.). Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Information Page | National Institute of Neurological Disorders and Stroke. Retrieved July 6, 2021, from https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Inflammatory-Demyelinating-Polyneuropathy-CIDP-Information-Page
2. Pahwa;, R., Goyal, A., Bansal, P., & Jialal, I. (2020). Chronic Inflammation. StatPearls [Internet]. Published. https://www.ncbi.nlm.nih.gov/books/NBK493173/#:~:text=Chronic%20Inflammation-,Chronic%20 inflammation%20is%20also%20 referred%20to%20as%20 slow%2C%20long%2 Dterm,repair%20and%20 overcome%20the%20 damage.

Santos-Longhurst, A. (2018, July 28). Understanding and Managing Chronic Inflammation. Healthline. https://www.healthline.com/health/chronic-inflammation

Type 1 and Type 2 Diabetes

Diabetes, according to Diabetes Canada, is a disease in which your body either cannot produce insulin or cannot properly use the insulin it produces². Type 1 diabetes is an autoimmune disease where the body cannot produce its own insulin because the body is attacking the pancreas. Type 2 diabetes, on the other hand, occurs because the body either cannot use the insulin made or the body cannot produce enough insulin². This inefficient production or usage of insulin makes it difficult to regulate blood sugar, which in turn can result in nerve damage.

One of the complications from having consistently high blood sugar is diabetic neuropathy. Diabetic neuropathy is a specific type of neuropathy that affects as many as 50% of people with diabetes and often presents itself as pain in their legs and feet¹. Other warning signs you may have diabetic neuropathy are a cut or sore on your foot that is infected/won’t heal, weakness and pain in your hands and feet, changes in bodily functions, dizziness, and fainting. Both type 1 and type 2 diabetes can cause diabetic neuropathy.

If you have any of the symptoms described and think you may have diabetic neuropathy talk to your doctor. As is the case with many disease-related neuropathies, the best way to manage your symptoms is to manage underlying conditions, in this case, your blood sugar and insulin levels¹. Your doctor may be able to prescribe treatments to relieve the pain, manage the progression of the disease, and restore some nerve function where possible.

References:

1. Diabetic neuropathy – Symptoms and causes. (2020, March 3). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
2. What is diabetes? (n.d.). DiabetesCanada Website. Retrieved June 22, 2021, from https://www.diabetes.ca/about-diabetes/what-is-diabetes

Hereditary Peripheral Neuropathy/Charcot-Marie-Tooth (CMT) Disease

Hereditary neuropathy means that your neuropathy is caused by your genetic makeup, and implies that you have family members that also have neuropathy. There are many different types of hereditary neuropathy. Some hereditary neuropathies only affect sensory nerves, some only affect motor nerves, and some affect a combination of sensory, autonomic, and motor nerves¹. 

One of the most common types of hereditary peripheral neuropathy is Charcot-Marie-Tooth (CMT) disease, which is why hereditary neuropathy and CMT disease are often used interchangeably². CMT symptoms include numbness, tingling, muscle weakness/loss in the legs and feet, and pain in the hands and feet³. It often first shows signs of appearing in early adulthood or mid-childhood, but it can make itself apparent at any time². Some signs you have CMT disease include having high arches or flexed toes and poor balance/coordination in your hands and feet³. 

There are tests your doctor may choose to perform if you believe you have hereditary neuropathy/CMT. They can perform a physical and neurological evaluation, as well as potentially do a muscle/nerve biopsy to confirm the diagnosis³. Your doctor may decide to do genetic testing to determine if your neuropathy is hereditary.

Once diagnosed, the treatment for CMT is very similar to the treatment prescribed for most forms of peripheral neuropathy. Your doctor may recommend over-the-counter medications to help with the pain or prescribe specific pain medications that can help you manage your symptoms. You can also look into physical therapy (if recommended by your doctor) and using equipment like leg braces or special shoes to help you prevent injuring your legs and feet³. In some cases, your doctor might recommend surgery on your feet. It all depends on the severity and condition that your feet are in.

References:

1. Merck Manuals. (n.d.). Hereditary Neuropathies. Merck Manuals Consumer Version. Retrieved June 30, 2021, from https://www.merckmanuals.com/en-ca/home/brain,-spinal-cord,-and-nerve-disorders/peripheral-nerve-and-related-disorders/hereditary-neuropathies
2. National Institute of Neurological Disorders and Stroke. (n.d.). Hereditary Neuropathies Information Page | National Institute of Neurological Disorders and Stroke. Retrieved June 30, 2021, from https://www.ninds.nih.gov/Disorders/All-Disorders/Hereditary-Neuropathies-Information-Page
3. The Foundation for Peripheral Neuropathy. (2020, June 9). Hereditary Neuropathy Disorders | CMT & HNPP | The Foundation For PN. https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/heredity-disorders/

Idiopathic Neuropathy

Idiopathic neuropathy refers to neuropathy that occurs without any apparent cause. While idiopathic neuropathy can affect people of all ages, it is typically found in patients over the age of 60 and typically progresses slowly rather than appearing all at once³. The symptoms of idiopathic neuropathy are very similar to diabetic neuropathy and can include anything from numbness and tingling to muscle weakness and cramping¹. 

Since there is no clear underlying condition that doctors can treat, the best way to help with your neuropathy is to have a thorough talk with your doctor about your symptoms. Your doctor may choose to perform a variety of tests to see if an underlying cause can be identified². Otherwise, your doctor may prescribe pain medications or recommend over-the-counter pain medications that can help you manage pain caused by neuropathy. 

References:

1. McNamara, L. (2015, October 6). Idiopathic Polyneuropathy. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/conditions/idiopathic_polyneuropathy.html
2. The Foundation for Peripheral Neuropathy. (2020, June 9). Idiopathic Peripheral Neuropathy | Symptoms & Treatment | FPN. https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/idiopathic-neuropathy/
3. University of Chicago. (2010, April 16). Types of Peripheral Neuropathy – Idiopathic. Center for Peripheral Neuropathy. http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/idiopathic/

Kidney Disease

Chronic kidney disease refers to the gradual loss of kidney function, which causes excess wastes and fluids to build up in the body because the kidneys can no longer flush them out². This fluid retention can lead to swelling in your limbs putting pressure on your nerves, causing a type of peripheral neuropathy called uremic neuropathy. Uremic neuropathy can affect twenty to fifty percent of people who have kidney disease¹. Uremic neuropathy symptoms can include pain and numbness in legs and feet, cramping in those areas, and muscle weakness¹. People with diabetes and high blood pressure are more at risk for kidney failure, and therefore more at risk for uremic neuropathy.

The best way to treat uremic neuropathy is to treat kidney failure itself. This can include going on dialysis, getting a kidney transplant, and generally taking precautions to compensate for the loss of sensation in the feet and legs¹. Talk to your doctor about which treatment plan works best for your specific health requirements.

References:

1. Kidney Failure | Symptoms & Treatment | The Foundation For PN. (2021, April 19). The Foundation For Peripheral Neuropathy. https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/kidney-failure/
2. Mayo Clinic Staff. (2019, August 15). Chronic kidney disease – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

Pinched Nerve/ Nerve Injury

Pinched nerves happen when too much pressure is applied to a nerve by the tissues surrounding them, like bones or muscles². This pressure can be caused by injuries, aging, obesity, and forms of arthritis or even repetitive motions¹. The pressure inhibits nerve function and can cause peripheral neuropathy symptoms like numbness and tingling. Usually pinched nerves resolve themselves with time, but those that stick around after several days may cause permanent nerve damage and lead to a form of peripheral neuropathy.

How pinched nerves are treated depends on their severity. Your doctor may recommend anti-inflammatory medication, physical therapy, or even surgery to correct it¹. Neuropathy caused by pinched nerves has similar treatments, but there are self-management tools that you can use on your own. Avoiding repetitive motions (if you can) can help prevent pinched nerves or slow your neuropathy progression. Stretching exercises and taking breaks from repetitive motions can help, as well as using items like a wrist rest when you’re typing¹. Even avoiding crossing your legs for an extended period of time can prevent you from compressing a nerve in your leg. Make sure you check with your doctor before you try any new exercises or medications to make sure they are right for your specific health needs. 

References:

1. Cleveland Clinic. (2020, July 4). Pinched Nerves: Causes, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/6481-pinched-nerves
2. Mayo Clinic Staff.(2019, September 26). Pinched nerve – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pinched-nerve/symptoms-causes/syc-20354746

Shingles (Herpes Zoster)

According to the Center for Disease Control and Prevention, shingles are painful rashes that occur either on one side of the face or the body¹. Shingles occur when you’ve had chickenpox at some point in your life, and the virus reactivates itself in the form of a nasty rash, a fever, a headache, or a combination of all these symptoms. Shingles outbreaks can be triggered by autoimmune diseases or by stress, as studies have shown a correlation between stressful life events and shingles outbreaks in peoples’ lives.³ A shingles outbreak can also damage nerve fibers and cause a type of neuropathy called postherpetic neuralgia². You are more at risk for developing postherpetic neuralgia if you’re over 50 years of age, had a severe shingles outbreak, delayed your shingles treatment, or if you have a chronic disease like diabetes². 

The best thing to do to prevent the development of postherpetic neuralgia is to get a shingles vaccine before an outbreak occurs². Your family doctor should recommend which brand of vaccine is most appropriate for you. If you’ve already developed postherpetic neuralgia and experienced neuropathy symptoms, talk to your doctor about what your next steps should be.

References:

1. Postherpetic neuralgia – Symptoms and causes. (2020, November 6). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588
2. Signs and Symptoms of Shingles (Herpes Zoster) | CDC. (2019, July 1). Centers for Disease Control and Prevention. https://www.cdc.gov/shingles/about/symptoms.html
3. Whelan, C. (2017, March 18). Can Stress Trigger Shingles? Healthline. https://www.healthline.com/health/shingles-and-stress#connection

Vasculitis

Vasculitis is a term for a group of illnesses that cause inflammation of the blood vessels². These illnesses can include anything from autoimmune diseases to viral infections¹. This inflammation leads to blockages in the blood vessels and may cut off the blood supplying peripheral nerves. If nerves are not receiving sufficient blood flow, this can cause a type of neuropathy called vasculitic neuropathy³. 

Symptoms of vasculitic neuropathy present themselves almost identically to most types of peripheral neuropathy, but one difference is that vasculitic neuropathy can be very asymmetric in that it can affect one limb more than the rest³. Treating vasculitic neuropathy starts with treating the underlying blood vessel inflammation. Johns Hopkins Medicine says that vasculitic neuropathy often responds to treatments targeting the immune system, or in extreme cases, a plasma exchange³. 

That said, it is up to your healthcare provider to determine which treatment is best, and know that your treatment may not include either of those things. Your unique medical history will undoubtedly influence which direction your doctor decides to take your treatment, so their advice is your best option. 

References:

1. Blaes, F. (2015). Diagnosis and therapeutic options for peripheral vasculitic neuropathy. Therapeutic Advances in Musculoskeletal Disease, 7(2), 45–55. https://doi.org/10.1177/1759720×14566617
2. Diseases and Conditions Vasculitis. (n.d.). American College of Rheumatology. Retrieved June 22, 2021, from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Vasculitis
3. McNamara, L. (2015, October 6). Vasculitic Neuropathy. Hopkins Medicine. https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/conditions/vasculitic_neuropathy.html