From the Guidelines
Neuropathy can be caused by various factors, including medical conditions, medications, toxins, and physical trauma, with diabetes being a major cause due to high blood sugar levels damaging nerves, as noted in the most recent study 1. When considering the causes of neuropathy, it's essential to look at the most recent and highest quality evidence. The study from 2022 1 highlights that in all patients with diabetes and diabetic peripheral neuropathy (DPN), causes of neuropathy other than diabetes should be considered, including toxins, neurotoxic medications, vitamin B12 deficiency, hypothyroidism, renal disease, malignancies, infections, chronic inflammatory demyelinating neuropathy, inherited neuropathies, and vasculitis.
Some key points to consider include:
- Diabetes damages nerves through high blood sugar levels, and improved glycemic control can prevent or slow the progression of diabetic peripheral neuropathy (DPN) and cardiac autonomic neuropathy (CAN) 1.
- Certain medications, such as chemotherapy drugs (vincristine, paclitaxel, cisplatin), antibiotics (metronidazole, fluoroquinolones), anticonvulsants (phenytoin), and cardiovascular medications (amiodarone, statins), can induce neuropathy 1.
- Excessive alcohol consumption is a significant cause of neuropathy through both direct toxicity and nutritional deficiencies.
- Heavy metal exposure (lead, mercury, arsenic) and industrial chemicals can damage nerves.
- Physical injuries from accidents, repetitive stress, or compression (carpal tunnel syndrome) may also cause neuropathy.
It is crucial to identify the underlying cause of neuropathy, as addressing it can sometimes halt or reverse nerve damage, particularly when identified early, emphasizing the importance of annual assessments for DPN in patients with diabetes, as recommended in the 2022 study 1. Recognizing these causes is vital for prevention and treatment, and supportive care such as physiotherapy, physical activity, referral to podiatrists, patient education, and vitamin B supplementation can be helpful in managing neuropathy, as discussed in the 2022 study on long-term survivorship in gynecologic cancer 1.
From the Research
Causes of Neuropathy
- Diabetes mellitus is a common cause of peripheral neuropathy, affecting up to 50% of patients with diabetes mellitus 2, 3, 4
- Other causes include nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies 5
- Poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity are underlying risk factors that can increase the likelihood of developing neuropathy 2
- In some cases, the cause of peripheral neuropathy is idiopathic, accounting for 25% to 46% of cases 5
Symptoms of Neuropathy
- Neuropathic pain is a common symptom, characterized by pain, numbness, tingling, and loss of sensation in the extremities 6, 3, 4
- Sensory alterations, such as sensory loss, numbness, pain, or burning sensations, can present in a "stocking and glove" distribution of the extremities 5
- Later stages of neuropathy may involve proximal numbness, distal weakness, or atrophy 5
Diagnosis and Treatment of Neuropathy
- Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing 5
- Treatment focuses on managing the underlying etiology, and several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain 2, 3, 4, 5
- Nonpharmacological treatments, such as spinal cord stimulation and transcutaneous electrical nerve stimulation, can also be effective in reducing pain 3, 4