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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.  Please note, this is not an extensive list.

Causes of Neuropathy

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.

References

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

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

Celiac Disease

Celiac disease is an immune-triggered inflammatory disorder of the small intestine that causes chronic inflammation and malabsorption of nutrients. When a genetically susceptible (HLA DQ2 and HLA DQ8) person is exposed to gluten, there is a triggered response in which the gluten protein binds to antigens (substances that trigger an antibody immune response) (1). This triggers a cascade of inflammatory events that leads to chronic inflammation. Gluten can be found in foods like wheat, barley, and rye and when ingested a person’s immune system mistakes gluten as a threat and launches an immune response. This causes inflammation of the small intestine, which is responsible for nutrient absorption.

People can present with a wide array of symptoms. It can manifest as minimal, unusual, or even absent intestinal complaints to extra-intestinal manifestations such as diarrhea, weight loss, flatulence, pallor, easy bruising, skin issues, ulcers, reproductive abnormalities and more. Amongst these symptoms is peripheral neuropathy, which includes pain, pins and needles or a burning sensation in the extremities (2). The exact mechanisms are still unknown; however, it has been suggested that there is a cross reaction between nerve cells and gluten protein, in addition to vitamin deficiencies due to malabsorption (3). Testing for celiac disease involves specific blood work for celiac disease markers, as well as an endoscopy.

Although there is no cure for celiac disease and its symptoms, it has been shown that a strict gluten free diet may be a cornerstone therapy, promoting healing in the intestine and preventing long term complications associated with the condition. A person with celiac disease may benefit from seeing a gastroenterologist for help with dietary changes and medications; and a registered dietitian/nutritionist to help them learn how to implement such a diet and maintain adequate nutritional requirements.

  1. Chin, R. L., & Latov, N. (2005). Peripheral Neuropathy and Celiac Disease. Current treatment options in neurology, 7(1), 43–48. https://doi.org/10.1007/s11940-005-0005-3
  2. David Shen, T.-C., Lebwohl, B., Verma, H., Kumta, N., Tennyson, C., Lewis, S., Scherl, E., Swaminath, A., Capiak, K. M., DiGiacomo, D., Bosworth, B. P., Thomas, H. B., & Green, P. H. R. (2012). Peripheral Neuropathic Symptoms in Celiac Disease and Inflammatory Bowel Disease. Journal of Clinical Neuromuscular Disease, 13(3), 137–145. https://doi.org/10.1097/CND.0b013e31821c55a1
  3. Spagnoli, C., Pisani, F., Di Mario, F., Leandro, G., Gaiani, F., De’ Angelis, G. L., & Fusco, C. (2018). Peripheral neuropathy and gastroenterologic disorders: an overview on an underrecognized association. Acta bio-medica : Atenei Parmensis, 89(9-S), 22–32. https://doi-org.ezproxy.lib.ucalgary.ca/10.23750/abm.v89i9-S.7956

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 Biology2, 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

COVID-19 & Peripheral Neuropathy

As we continue to navigate the challenges posed by COVID-19, emerging research has highlighted a concerning issue – nerve damage, known as neuropathy, as a potential consequence of the virus. Neuropathy involves damage to the nerves in the peripheral nervous system and can lead to symptoms like pain, tingling, and numbness. Understanding how COVID-19 can trigger neuropathy and exploring ways to manage it is crucial for individuals recovering from the virus.

COVID-19, caused by the SARS-CoV-2 virus, can affect various parts of the body, including the nervous system. One way it may impact our nerves is by triggering an immune response that goes into overdrive. This hyperactive immune response can lead to inflammation throughout our body, including our nerves. This inflammation can potentially result in conditions like peripheral neuropathy, where the nerves in our limbs are affected, causing symptoms like pain, tingling, or muscle weakness. Additionally, the virus may also interact with receptors found in the lining of our blood vessels. This interaction could affect how our blood vessels function, potentially contributing to nerve-related complications, impacting the quality of life of individuals recovering from COVID-19.

One potential approach to managing COVID-19-related neuropathy is through the use of nutrients and dietary supplements, also known as nutraceuticals. These substances, such as vitamins and minerals, have properties that may support nerve function, reduce inflammation, and aid in the recovery process. Among these nutraceuticals are vitamins B1, B6, B12, and D. These nutrients can complement traditional treatments and support the body’s natural healing processes to help manage neuropathic symptoms post-infection.

In addition to nutraceutical interventions, individuals recovering from COVID-19-related neuropathy can benefit from a multidisciplinary approach to their care. This may include physical therapy, pain management techniques, and lifestyle modifications to support nerve health and overall recovery. Working closely with a team of allied-health care providers (e.g., dieticians, physiotherapists, psychologists, physicians) to develop a personalized care plan can help individuals effectively manage neuropathic symptoms and improve their quality of life. It is important to consult your doctor for guidance tailored to your individual health needs before making any changes to your diet or health regime.

While COVID-19 can have lasting effects on the nervous system, there are ways to address neuropathic symptoms and support recovery. By exploring the ways in which COVID-19 interacts with our nerves, researchers aim to shed light on the complexities of the virus’s impact on our bodies and pave the way for targeted therapies to address neurological issues in individuals affected by the pandemic. Through a comprehensive approach that includes nutraceutical support and personalized care, individuals can navigate the challenges of COVID-19-related neuropathy with resilience and hope.

References:

Andalib, S., Biller, J., Di Napoli, M., Moghimi, N., McCullough, L. D., Rubinos, C. A., … & Divani, A. A. (2021). Peripheral nervous system manifestations associated with COVID-19. Current neurology and neuroscience reports21, 1-14.

Córdova-Martínez, A., Caballero-García, A., Pérez-Valdecantos, D., Roche, E., & Noriega-González, D. C. (2022). Peripheral neuropathies derived from COVID-19: New perspectives for treatment. Biomedicines10(5), 1051.

Oaklander, A. L., Mills, A. J., Kelley, M., Toran, L. S., Smith, B., Dalakas, M. C., & Nath, A. (2022). Peripheral neuropathy evaluations of patients with prolonged long COVID. Neurology: Neuroimmunology & Neuroinflammation9(3), e1146.

 

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.

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

Chronic Inflammatory Demyelinating Polyneuropathy (CIPD)

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the arms and legs. It is caused by an inflammatory response that damages the myelin sheath of peripheral nerves. The specific triggers for CIPD can vary. Some studies have shown that certain conditions, like chronic hepatitis, diabetes, bacterial infections, inflammatory bowel disease, lupus or HIV/AIDS can cause the onset of CIPD in many people (1). Because of the unspecified cause, people may experience a variety of symptoms, which include, but are not limited to gradual onset of symmetrical weakness in the legs and arms, tingling or numbness, impaired balance and coordination, fatigue, difficulty walking or climbing stairs and loss of sensation. In addition, symptoms may worsen over time and may relapse.

 

Diagnosing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) typically involves a combination of medical history review, physical examination, nerve conduction studies, electromyography (EMG), blood tests, and sometimes a lumbar puncture (spinal tap) to analyze cerebrospinal fluid (2). Additionally, imaging tests like MRI may be used to rule out other conditions. A neurologist is usually involved in the diagnosis and management of CIDP.

 

Several studies have focused on treating Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), including the use of various immunosuppressive medications, intravenous immunoglobulin (IVIG) therapy, corticosteroids, plasma exchange (plasmapheresis), and newer agents such as rituximab and subcutaneous immunoglobulin (1). These treatments aim to reduce inflammation, modulate the immune response, and improve nerve function in individuals with CIDP. It’s essential to consult with a healthcare provider to determine the most appropriate treatment plan based on individual needs and circumstances.

  1. Querol, L., Crabtree, M., Herepath, M., Priedane, E., Viejo Viejo, I., Agush, S., & Sommerer, P. (2021). Systematic literature review of burden of illness in chronic inflammatory demyelinating polyneuropathy (CIDP). Journal of Neurology, 268(10), 3706–3716. https://doi.org/10.1007/s00415-020-09998-8
 
  1. Vedeler, C. A., Farbu, E., & Mellgren, S. I. (2013). Chronic inflammatory demyelinating polyneuropathy (CIDP). Acta Neurologica Scandinavica, 127(s196), 48–51. https://doi.org/10.1111/ane.12049

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

Fluoroquinolones

Fluoroquinolones are one of the most widely used antibiotics to treat a wide range of bacterial infections. They are most used for upper and lower respiratory tract infections such as tuberculosis, mycobacterial infections, sinusitis, bronchitis and pneumonia, and urinary tract infections. Although these drugs are quite effective in treatment, researchers have extensively studied the link between fluoroquinolones and central nervous system side effects, such as dizziness, headaches and seizures(3). However, it has also been self-reported that some people have also experienced peripheral neuropathy after using the antibiotic. People describe these side effects as numbness, tingling, weakness, and pain in the hands or feet (4). In some cases, this condition can be severe and long-lasting, affecting everyday activities.

One study published in JAMA Internal Medicine in 2014 identified a significant increase in the risk of peripheral neuropathy with current or recent fluoroquinolone use compared to other antibiotics (1). Another study published in the Journal of Neurology in 2019 highlighted the potential risk of long-term peripheral neuropathy following fluoroquinolone exposure (2). These findings emphasize the importance of monitoring and addressing symptoms of peripheral neuropathy in individuals who have taken fluoroquinolone antibiotics. By exploring a range of studies and clinical data, we can gain a comprehensive understanding of the impact of fluoroquinolone antibiotics on peripheral neuropathy and the broader implications for patient care. When being prescribed fluoroquinolones it’s important for people to ask their doctor about the risks and complications that may occur in taking the medications as well as alternative antibiotics.

  1. Su, V. Y., et al. (2014). Use of fluoroquinolone and risk of peripheral neuropathy: a population-based study. JAMA Internal Medicine, 174(7), 1200-1208.
  1. Tang, H. L., et al. (2019). Risk of peripheral neuropathy following systemic fluoroquinolone exposure: a first step towards earlier diagnosis. Neurology, 92(15), e174-e182.
  1. Staff, N. P., & Dyck, P. J. B. (2019). On the Association Between Fluoroquinolones and Neuropathy. JAMA Neurology, 76(7), 753–754. https://doi.org/10.1001/jamaneurol.2019.0886
  1. Jay S. Cohen. (2001). Peripheral Neuropathy Associated with Fluoroquinolones. The Annals of Pharmacotherapy, 35, 1540–1547. https://doi.org/10.1345/aph.1z429

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 PNhttps://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/heredity-disorders

Guillain-Barré syndrome (GBS)

Guillain-Barré syndrome (GBS) is a rare condition that occurs when a person’s immune system attacks part of the peripheral nervous system, the nervous system that affects sensation of the arms and legs. People of all ages can be affected, and those who are infected with a bacteria, namely  campylobacter jejuni and other viral infections including cytomegalovirus, Epstein-Barr virus, and the Zika virus have a higher risk of developing GBS. Because the syndrome affects the nerves that control muscle movement, as well as pain, temperature, and touch sensation, this can result in muscles weakness and loss of sensation in the arms and/or legs, usually on both sides of the body. As the condition progresses, individuals may experience difficulty walking, standing, or performing daily activities. In severe cases, muscle paralysis can occur, affecting breathing and potentially leading to life threatening complications (1). Early recognition of these symptoms is crucial for prompt diagnosis and treatment of GBS.

 

People with suspected GBS should be referred to a neurologist who will aid in the  diagnoses based on history, neurological assessment, electrophysiological examination, and cerebral spinal fluid testing. Once confirmed, a variety of treatments can be used to decrease severity of symptoms. This includes intravenous immunoglobulin and plasma exchange, analgesics, NSAIDS, gabapentin for neuropathic pain relief (2).

 

 The prognosis of GBS varies depending on several factors, including the severity of initial symptoms, progression, an individual’s age, and overall health. The majority of people do recover, with some fully regaining their strength and function. However, in more severe cases, some may experience long term disability and may require ongoing rehabilitation and support (3). With advancements in medical care and early intervention, prognosis for GBS has significantly improved and many individuals can achieve a good recovery with appropriate treatment and care (4). A multidisciplinary approach to care is essential for optimizing outcomes for those affected by GBS.

1.Asbury, A. K., & Cornblath, D. R. (1990). Assessment of current diagnostic criteria for Guillain-Barré syndrome. Annals of neurology, 27 Suppl, S21–S24. https://doi.org/10.1002/ana.410270707

2.Yao, J., Zhou, R., Liu, Y., & Lu, Z. (2023). Progress in Guillain-Barré syndrome immunotherapy-A narrative review of new strategies in recent years. Human vaccines & immunotherapeutics, 19(2), 2215153. https://doi.org/10.1080/21645515.2023.2215153

3.Guyen TP, Taylor RS. Guillain-Barre Syndrome. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532254/

4. Swami, T., Khanna, M., Gupta, A., & Prakash, N. B. (2021). Neuropathic Pain in Guillain-Barre Syndrome: Association with Rehabilitation Outcomes and Quality of Life. Annals of Indian Academy of Neurology, 24(5), 708–714. https://doi.org/10.4103/aian.AIAN_602_20

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/
  2. The Foundation for Peripheral Neuropathy. (2020, June 9). Idiopathic Peripheral Neuropathy | Symptoms & Treatment | FPNhttps://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

 

Lupus

Living with Lupus can present a myriad of challenges, one of which is peripheral neuropathy – a condition that causes pain, weakness, and discomfort in the nerves of the extremities. But how does Lupus contribute to this nerve damage? Let’s delve into the reasons behind this connection.

Firstly, Lupus triggers an autoimmune response in the body, where the immune system mistakenly attacks healthy tissues, including the peripheral nerves. This attack can lead to inflammation and damage to the nerves, disrupting their normal function and causing symptoms like pain and tingling sensations.

Another way Lupus can impact the nerves is through Vasculitis, a condition characterized by inflammation of blood vessels. In individuals with Lupus, Vasculitis can affect the blood supply to the peripheral nerves, compromising their health and leading to nerve damage and Neuropathy.

Finally, a lesser-known aspect is the presence of Small-fiber Neuropathy in Lupus patients. This type of neuropathy targets specific nerve fibers, causing intense burning pain and discomfort. Small-fiber Neuropathy may be more common in Lupus than previously recognized, highlighting the diverse ways in which the disease can affect the nervous system.

Additionally, certain medications used to manage lupus, such as corticosteroids, may have side effects that can worsen nerve damage or contribute to neuropathy development. It’s essential for healthcare providers to carefully monitor and manage these potential side effects to ensure optimal treatment outcomes for Lupus patients.

By understanding how Lupus can cause Peripheral Neuropathy, individuals living with the disease can work closely with their healthcare team to monitor and manage their nerve health effectively. Early recognition and appropriate treatment of neuropathic symptoms are key to improving quality of life and overall well-being for those navigating the complexities of Lupus.

References

  1. Fukami, Y., Koike, H., Iijima, M., Mouri, N., Nishi, R., & Katsuno, M. (2022). Role of complement components in vasculitic neuropathy associated with systemic lupus erythematosus and rheumatoid arthritis. Muscle & Nerve, 66(2), 175–182. https://doi.org/10.1002/mus.27636
  2. Oomatia, A., Fang, H., Petri, M., & Birnbaum, J. (2014). Peripheral neuropathies in systemic lupus erythematosus: clinical features, disease associations, and immunologic characteristics evaluated over a twenty‐five–year study period. Arthritis & Rheumatology, 66(4), 1000-1009.

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/
  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 Disease7(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

Vitamin B12 Deficiency

Vitamin B12 plays a crucial role in maintaining the health of our nerves. When we don’t get enough of this vitamin, it can lead to a condition known as vitamin B12 deficiency. This deficiency can cause a range of problems, including nerve damage that manifests as peripheral neuropathy.

Imagine your nerves as messengers that send signals between your brain and the rest of your body. When there isn’t enough vitamin B12 to support these messengers, they can start to malfunction. This can result in the tingling, numbness, and pain characteristic of peripheral neuropathy.

But why does vitamin B12 deficiency occur in the first place? Several factors can contribute, such as poor diet, certain medical conditions, or even age-related changes in our bodies. For example, individuals with conditions like diabetes, alcoholism, or certain medications may be at a higher risk of developing both vitamin B12 deficiency and peripheral neuropathy.

Remember the image of your nerves as messengers that relay signals between your brain and the rest of your body? Vitamin B12 deficiency can disrupt this communication system in several ways:

  • Myelin Maintenance: Vitamin B12 helps create a protective shield called myelin around nerves, aiding in signal transmission. Without enough B12, this shield may weaken, causing nerve damage.
  • Cell Repair: B12 is crucial for repairing nerve cells. When B12 is low, nerve cells may struggle to heal and function properly, contributing to nerve-related symptoms.
  • Inflammation: Low B12 can lead to high levels of a compound called homocysteine, which can harm nerves. This stress can cause inflammation and damage, worsening nerve health.
  • Signal Support: B12 is essential for nerve signaling. When B12 is lacking, nerve communication may be disrupted, affecting how your body responds to sensations.
  • Toxic Effects: Elevated homocysteine levels due to B12 deficiency can be harmful to nerve cells, affecting blood flow and oxygen supply to nerves, worsening nerve damage.
 

The good news is vitamin B12 deficiency is often treatable. By incorporating B12-rich foods into your diet or taking supplements as recommended by your healthcare provider, you can help support your nerve health and potentially alleviate symptoms of peripheral neuropathy. Remember, our bodies are complex systems that rely on essential nutrients like vitamin B12 to function properly. Taking care of your vitamin intake could be a key step in maintaining healthy nerves and overall well-being.

References

Stein, J., Geisel, J., & Obeid, R. (2021). Association between neuropathy and B‐vitamins: A systematic review and meta‐analysis. European Journal of Neurology28(6), 2054-2064

Causes of Neuropathy: Need more?

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Want more information on where to find more causes of neuropathy information. View the following CNA Video: Essential Websites for Neuropathy for more ideas on where to look.

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