The wide variety of symptoms resulting from neuropathy (also known as peripheral neuropathy) reflect the fact that it can be caused by an equally wide range of conditions involving disease and damage to peripheral nerves.
Depending on the cause and varying by patient, symptoms of neuropathy can include: temporary or permanent numbness; tingling; pricking or burning sensations; increased sensitivity to touch; pain; muscle weakness or wasting; paralysis; dysfunction in organs or glands; or impairment to urination and sexual function. (1,2)
Such symptoms depend on whether autonomic, sensory, or motor nerves — or a combination of them — are involved. Autonomic nerve damage can affect bodily functions or blood pressure, or create gastrointestinal symptoms. Damage to sensory nerves can affect sensations and sense of balance, while damage to motor nerves can affect movement and reflexes. When both sensory and motor nerves are involved, the condition is known as sensorimotor polyneuropathy. (3)
Diabetic peripheral neuropathy, which affects between 12 and 50 percent of people with diabetes, is the most common form of neuropathy. Often, symptoms involve a progressive change in sensation, as well as pain and weakness in the feet (and less commonly the hands). As the neuropathy progresses, it can lead to a loss of sensation in the affected areas.
This lack of feeling increases the likelihood of injury to the affected areas, explains Matthew Villani, doctor of podiatric medicine at Central Florida Regional Hospital in Sanford, Florida. Without the pain to signal when there’s a problem, people with diabetic neuropathy can allow small abrasions or blisters on their feet, for example, to fester as sores or ulcers. “The ulcers can become infected because there are open wounds, which can also progress into bone infection. Unfortunately, commonly it requires amputations if it does progress to that point.” (4)
Cancer patients can suffer from neuropathy induced by chemotherapy and other drugs used to treat the disease. Symptoms can include severe pain, impaired movement, changes in heart rate and blood pressure, problems with balance, trouble breathing, paralysis, and even organ failure. After chemotherapy is done, the symptoms often abate swiftly, but sometimes they last longer, or don’t go away at all. (5)
People being treated for HIV or AIDS may develop neuropathy from effects of the virus and the drugs used to treat it. Common symptoms include burning, stiffness, prickling, tingling, and loss of feeling in the toes and soles of the feet. Sometimes the nerves in the fingers, hands, and wrists are also affected. The drugs Videx (didanosine), Hivid (zalcitabine), and Zerit (stavudine) are most frequently associated with neuropathic symptoms. (6)
Inflammation caused by infections, such as herpes zoster (also known as shingles), Lyme disease, or hepatitis B and hepatitis C can lead to neuropathy, as can inflammation resulting from autoimmune disorders, such as vasculitis, sarcoidosis, or celiac disease. In such cases, the symptoms tend to be burning, tingling, or numbness. (7)
Additional causes of neuropathy and associated symptoms include metabolic disorders, such as hypoglycemia or kidney failure; autoimmune disorders, such as rheumatoid arthritis, lupus, Sjogren’s syndrome, and Guillain-Barré syndrome; toxicity; hereditary disorders, such as Charcot-Marie-Tooth disease; hormonal disorders; alcoholism; vitamin deficiencies; physical trauma; compression; and repetitive stress. Additionally, many people have idiopathic neuropathy, meaning doctors don’t know the cause. (8,9,10)
Although there’s a wide range of symptoms related to neuropathy, there are commonalities to the pain that people experience, notes says Vernon Williams, MD, a sports neurologist who is director of the Center for Sports Neurology and Pain Medicine at Cedars-Sini Kerlan-Jobe Institute in Los Angeles. “The character and quality of neuropathic pain tends to be pain that’s burning or electric in character.” Additionally, he says, the pain will often be associated with other symptoms, such as paresthesia (a lack of normal sensation associated with pain); allodynia (a painful response to a stimulus that wouldn’t normally trigger pain signals); and hyperalgesia (a dramatic or severe pain in response to a stimulus that normally causes mild pain).
If you think you’re having these symptoms, consult a physician. A variety of tests can be done to diagnose neuropathy. “There are certain patterns of complaints that suggest neuropathy,” says Dr. Williams, so taking down a patient history that includes a description of the complaints is an important first step.
After that, your doctor can do a physical examination, “checking motor and sensory function, checking deep tendon reflexes, as well as looking for symptoms such as allodynia and hyperalgesia,” Williams says. “Then we can also perform electrodiagnostic testing; the most common being electromyography and nerve conduction testing, where we can stimulate nerves and record responses, calculate the speed at which signals are being transmitted and see if there are any areas where nerves are not transmitting signals normally,” Williams continues.
With needle examinations, Williams says, “We can put small needles into individual muscles, and, based on what we see and hear with the needle in the muscle, get information about how the nerves supplying that muscle are functioning. So there are a number of different tests that could be helpful to identifying neuropathy, as well as localizing where the abnormality is most likely to be coming from.”
Frequently, blood tests can check for elevated blood sugar (to see if your symptoms may be related to type 2 diabetes), vitamin deficiencies, toxic elements, hereditary disorders, and evidence of an abnormal immune response. (11)
Your doctor may also do a nerve biopsy, which usually entails removing a small portion of a sensory nerve to look for abnormalities, or a skin biopsy to see if there is a reduction in nerve endings. (12)
To give yourself the best chance of an accurate diagnosis — and relief of your symptoms — be prepared to describe your symptoms in detail, when you experience them, how long an episode lasts, and the amount of discomfort, pain or loss of sensation or movement you experience. The more specific you can be about the symptoms you are experiencing, the easier it will be for your doctor to understand what is going on.