From the Guidelines
Neuropathy is a condition characterized by damage to the peripheral nerves, which are the nerves outside the brain and spinal cord, and its management should prioritize controlling the underlying cause, such as blood sugar levels in diabetic neuropathy, and relieving symptoms, especially pain, to improve quality of life 1.
Causes and Symptoms
Neuropathy can be caused by multiple factors including diabetes (the most common cause), autoimmune disorders, infections, vitamin deficiencies, alcoholism, certain medications, and exposure to toxins. Common symptoms include numbness, tingling, burning sensations, weakness, and pain, typically starting in the hands and feet.
- Diabetes is the most common cause of neuropathy, and controlling blood sugar levels is crucial in managing diabetic neuropathy 1.
- Other causes of neuropathy include autoimmune disorders, infections, vitamin deficiencies, alcoholism, certain medications, and exposure to toxins.
- Symptoms of neuropathy can vary depending on the underlying cause and the nerves affected.
Diagnosis and Treatment
Diagnosis of neuropathy involves a careful history and physical examination, including assessment of sensation, strength, and reflexes.
- Treatment depends on the underlying cause and may include managing the primary condition, medications for pain relief, physical therapy, and lifestyle modifications 1.
- Medications for pain relief, such as gabapentin, pregabalin, duloxetine, or amitriptyline, can be effective in managing neuropathic pain 1.
- Lifestyle changes, such as regular exercise, maintaining a healthy weight, limiting alcohol consumption, and avoiding tobacco use, can also help improve symptoms and quality of life.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of neuropathy are important to prevent further nerve damage and improve quality of life.
- Up to 50% of diabetic peripheral neuropathy may be asymptomatic, and if not recognized and managed, people with diabetes are at risk for injuries, diabetic foot ulcers, and amputations 1.
- Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life 1.
From the Research
Definition and Prevalence of Neuropathy
- Neuropathy is a common complication of diabetes, with 50% of adults with diabetes expected to develop neuropathy in their lifetime 2.
- Diabetic peripheral neuropathy (DPN) is the major form of neuropathy, accounting for 75% of diabetic neuropathy incidences 2.
- The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years 3.
Types and Symptoms of Neuropathy
- Peripheral neuropathy can be classified clinically by the anatomic pattern of presenting symptoms and by results of electrodiagnostic studies for axonal and demyelinating disease 3.
- Common symptoms of peripheral neuropathy include sensory alterations, such as sensory loss, numbness, pain, or burning sensations in a "stocking and glove" distribution of the extremities 3.
- Later stages of peripheral neuropathy may involve proximal numbness, distal weakness, or atrophy 3.
Causes and Risk Factors of Neuropathy
- Common identifiable causes of peripheral neuropathy include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies 3.
- Peripheral neuropathy is idiopathic in 25% to 46% of cases 3.
- Underlying risk factors for developing neuropathy include poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity 4.
Diagnosis and Evaluation of Neuropathy
- Diagnosis of peripheral neuropathy requires a comprehensive history, physical examination, and judicious laboratory testing 3.
- Initial laboratory evaluation includes a complete blood count, comprehensive metabolic profile, fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels, and serum protein electrophoresis with immunofixation 3.
- If the initial evaluation is inconclusive, referral to a neurologist for additional testing, such as electrodiagnostic studies, specific antibody assays, or nerve biopsy, should be considered 3.