Neuropathy: Symptoms & Causes | NewYork-Presbyterian (2024)

Neuropathy, often called peripheral neuropathy, is not one condition but a group of conditions that result from damage to nerves in the peripheral nervous system. The peripheral nervous system is made up of nerve structures beyond the brain and spinal cord that communicate with the rest of the body. These nerves are responsible for sending out sensory information to your skin and muscles (the somatic nervous system) and involuntary functioning organs such as the heart and stomach (the autonomic nervous system).

An estimated 30 million people in the United States have peripheral neuropathy. Several health conditions can cause neuropathy, including diabetes, lupus, rheumatoid arthritis, lymphoma, Lyme disease, carpal tunnel syndrome, and more.

Injuries or diseases that affect the peripheral nerves often cause sensory and motor loss. This most commonly begins in the hands and feet, affecting one nerve or groups of nerves. Symptoms of neuropathy may include pain, numbness, tingling, painful cramps, burning, and muscle weakness. Managing symptoms with early diagnosis and treatment of peripheral neuropathy can help prevent future nerve damage.

Neuralgia vs. neuropathy

Some people use the terms neuropathy and neuralgia interchangeably, but they are different: Neuropathy refers to nerve damage while neuralgia is a type of nerve pain. Neuralgia can be a symptom of neuropathy.

Often described as a severe shooting, burning, or stabbing pain, neuralgia can result from damage, irritation, or dysfunction of a nerve. Possible causes include infection, pressure (from a blood vessel, tumor, ligament, or bone), some medications, injury, and certain conditions such as diabetes, multiple sclerosis, and chronic kidney disease.

Types of neuralgia include:

• Trigeminal neuralgia: This refers to pain from the trigeminal nerve, often caused by pressure from a blood vessel. This type of neuralgia usually occurs on one side of the face and is characterized by recurrent episodes or “attacks” of severe pain. Trigeminal neuralgia mostly affects people over 50 years old.
• Postherpetic neuralgia: Postherpetic neuralgia is caused by shingles — a viral infection involving rash and blisters. This type of neuralgia is usually concentrated on one side of the body and can range from mild to severe.
• Glossopharyngeal neuralgia: This rare type of neuralgia occurs in the glossopharyngeal nerve (in the throat) and causes pain in the neck area.

If you think you have pain from neuralgia or neuropathy, your doctor can provide you with the correct diagnosis and treatment for your condition.

Radiculopathy vs. neuropathy

When a nerve root in the spinal cord becomes pinched, it is referred to as radiculopathy. This affects the spinal vertebrae, tendons, and intervertebral discs. Radiculopathy is often mistaken for neuropathy because both conditions cause similar symptoms, such as pain, weakness, numbness, and tingling.

The difference between radiculopathy and neuropathy is that radiculopathy is caused by a pinched nerve in the spinal cord, while neuropathy is caused by nerve damage to the peripheral nervous system.

Radiculopathy can be caused by a herniated disc, thickening of the spinal ligaments, spinal infection, benign growths on the spine, and bone spurs in the spine. It is important to see your doctor to determine which condition you’re experiencing in order to receive the correct diagnosis and treatment.

There are more than 100 different types of neuropathy, which are generally categorized by the location of nerves affected or affected body parts.

If one type of nerve is affected and not functioning as it should, the condition is called mononeuropathy. Carpal tunnel syndrome is a common type of mononeuropathy that causes numbness, pain, and tingling, in the hand and forearm.If many nerves, or a group of nerves, are affected or malfunctioning, the condition is called polyneuropathy.

Types of neuropathy include:

• Diabetic neuropathy: Caused by either type 1 ortype 2 diabetes, diabetic neuropathy is one of the most common types of peripheral neuropathy and most often affects the hands and feet. It may also affect the autonomic nerve response (with symptoms such as excessive sweating or imbalance) and motor nerves (which control movement).
• Autonomic neuropathy: This type of neuropathy occurs when nerve damage affects the bodily organs. Autonomic neuropathy may affect various organs and related functioning, including:
  • Bladder
  • Blood pressure
  • Blood sugar
  • Eyes
  • Heart rate
  • Sex organs
  • Sweat glands
• Proximal neuropathy: If nerve damage affects the nerves in the hips, buttocks, thigh, legs, chest, or stomach, it may be considered proximal neuropathy. Pain may be concentrated on only one side of the body and rarely spreads to the other side. This type of neuropathy is found most often in adults over age 50.
• Motor neuropathy: This type of neuropathy affects the body’s motor nerves, which control muscle movement, and may lead to problems with walking and grasping objects, as well as general muscle weakness. If the condition affects the arms and legs, it may be diagnosed as multifocal motor neuropathy.
• Focal nerve: This type of nerve damage often affects a single nerve, causing pain, numbness, and tingling. This condition may also cause symptoms such as double vision, weakness on one side of the body or partial paralysis, and associated pain. Nerve damage is most likely in the legs, hand, head, and torso.
• Sensory neuropathy: Often experienced in the hands, feet, legs, and arms, sensory neuropathy — also called Fergus — occurs when the sensory nerves become damaged. This results in the inability to feel extreme temperature or pain, which may result in injury. Other symptoms include numbness, burning sensation, and acute pain.
• Combination neuropathy: This occurs when there is a combination of different kinds of neuropathy-related pain. The most common combination neuropathy involves the loss of both sensory and motor control. In these cases, your physician may treat your neuropathy with combination therapy (involving two or more methods of treatment).

What is diabetic neuropathy?

Nerve damage caused by diabetes or prediabetes is called diabetic neuropathy. This may affect the sensory nerves, motor nerves, and other functions. An estimated nine million people with diabetes experience diabetic neuropathy symptoms, which may include pain, weakness, tingling, skin ulcerations, changes in pulse or blood pressure rates, and more. Neuropathy in the feet (foot neuropathy) is common with diabetic neuropathy.

Diabetic neuropathy may go undiagnosed for years or develop early with associated conditions such as prediabetes and metabolic syndrome. Early diagnosis and treatment of diabetic neuropathy can help manage symptoms and prevent diabetic complications.

As neuropathy develops, there are several stages of progression, ranging from early-onset to late-stage neuropathy.

• Early stage: Symptoms are very mild and can be self-managed. This is the best time to seek medical treatment to protect and preserve your peripheral nerve health.
• Middle stages: Symptoms are more pronounced and painful. Some individuals may have trouble sleeping.
• Later stages: Symptoms have progressed and may include muscle weakness, pain, and numbness. There is also a higher risk of injury and related complications due to increased nerve damage.

There are many signs and symptoms of neuropathy, which affects the peripheral nerves and their function. In the early stages of neuropathy, some people experience little to no symptoms or mild symptoms, while in the late stages, symptoms are more debilitating and may result in nerve injury and, in some cases, loss of mobility.

Neuropathy can cause acute symptoms, such as a stabbing pain or a burning sensation that may come and go, or, as nerve damage progresses, chronic symptoms such as muscle weakness or lack of sensation in the nerve-affected area.

Symptoms of peripheral neuropathy include:

• Hypersensitivity
• Numbness
• Tingling
• Burning
• Prickling, stinging, or stabbing sensations
• Muscle weakness
• Unsteadiness
• Cold skin to the touch on affected limb
• Discolored, thinning skin and hair loss on affected limb

Autonomic neuropathy symptoms may include:

• Blood pressure changes
• Heart rate changes
• Sweating
• Bowel and urinary incontinence
• Sexual dysfunction
• Dizziness and fainting
• Dry mouth and eyes

There are several causes of neuropathy, with diabetes being the most well-known. Some individuals may have certain genetic conditions that cause neuropathy while others may have an underlying medical condition that acts as the direct cause. In some cases, neuropathy may have no known cause.

Causes of neuropathy may include:

• Diabetes and prediabetes: About half of those with diabetes develop neuropathy, which may be caused by high blood sugar, triglycerides, and cholesterol levels.
• Nerve compression: Ulnar neuropathy (the result of damage to the ulnar nerve, which travels from the arm to the wrist, hand, and ring and little fingers) and carpal tunnel syndrome are examples of neuropathy caused by nerve compression in the hand and wrist.
• Certain hereditary conditions: Genetic mutations may cause mild neuropathy while certain genetic diseases present at birth, such as Charcot-Marie-Tooth disease, may be the cause of nerve damage.
• Rheumatologic and autoimmune diseases: Certain conditions, such as lupus and rheumatoid arthritis, may cause neuropathic pain.
• Trauma: Sports injuries, accidents, falls, and bone fractures may cause damage to nerves, in turn leading to neuropathic symptoms.
• HIV/AIDS, Lyme disease, and other infections: HIV/AIDS and Lyme disease significantly impact the nervous system, which can result in neuropathic symptoms. Other infections, such as herpes simplex and West Nile virus, can also cause symptoms.
• Kidney disease: Nerve function may be impacted by high concentrations of toxins in the blood caused by kidney disease.
• Medications: Certain cancer medications, such as chemotherapy and radiation, may trigger symptoms of neuropathy in some individuals.
• Toxins: Exposure to certain toxins such as mercury, copper, lead, and arsenic may cause peripheral neuropathy.
• Nutritional deficiencies: Neuropathy symptoms may result from a lack of vitamin B12, niacin, vitamin E, or thiamine in your system.
• Critical illnesses: Severe trauma or infection resulting from conditions or procedures in intensive care, such as ventilator use and prolonged immobility, may lead to neuropathy.
• Tumors: Brain and spinal tumors may cause neuropathy symptoms when a mass grows too close to a nerve or presses against it.
• Guillain-Barré syndrome: A neurological disorder that occurs from an immune attack on the peripheral nervous system. This syndrome can cause limb weakness, a tingling sensation, and neuropathic pain.

There are several risk factors for neuropathy, with the most common being diabetes and its associated conditions. Awareness of the risk factors can help prevent the condition or slow its progression. Some neuropathy risk factors are genetic, while others are environmental or behavioral (meaning they may be preventable with lifestyle modifications).

Risk factors include:

• Alcohol use
• Diabetes (taking into account duration and age)
• Diabetic retinopathy
• Family history
• High body mass index (BMI)
• Hyperglycemia
• Hypertension
• Insulin resistance
• Low physical activity
• Obesity
• Prediabetes
• Repetitive movements or motions
• Smoking
• Vitamin deficiencies

There are many ways to reduce your risk of developing neuropathy in order to help prevent or slow nerve damage:

• Following a healthy lifestyle
• Not smoking
• Reducing alcohol use
• Diabetes monitoring and management
• Foot care
• Using protective footwear
• Exercising with caution
• Reporting any early symptoms to your physician