Neuropathy 101: Identifying triggers, diagnosing and finding relief

Anyone who suffers from neuropathy knows it can be painful and can affect their quality of life.

The condition, which is caused by nerve damage, is common, according to neurologist Alba Coraini, MD, who practices at Neurologists of Cape Cod in Hyannis. It affects an estimated 20 to 30 million people in the United States.

The causes of neuropathy are varied, which means that treatment is dependent on discovering what is causing a patient’s symptoms.

There are different causes of neuropathy that include some metabolic disorders, certain kinds of infections, vitamin deficiencies, some autoimmune and inflammatory conditions and side effects of chemotherapy, explained Dr. Coraini. “In the U.S. the most common form of neuropathy is either caused by diabetes, number one, and alcohol, number two.”

She sees many patients with this condition, and they present differently depending on what kind of nerve fibers are affected, she said.

Neuropathy’s nerve damage can be sensory, motor or a combination of both. For example, if the sensory fibers are affected, the symptoms would most likely be tingling, numbness and possibly pain. If the motor fibers are affected, the main symptom would be weakness. If both types of fibers are affected, patients commonly present with gait instability and balance problems because the sensory fibers in the feet are not communicating properly with the brain.

Diagnosing the Issue

Whenever a patient comes to her presenting with symptoms of neuropathy, Dr. Coraini does a comprehensive workup.

“So, first of all, we do a neurological examination. That’s always very important because we test for different modalities of sensation and we test for strength. We also examine gait to see if there are any abnormalities,” she said.

The next step is to do an electromyography, or EMG study, which records the electrical activity of muscles. She will also do another test, called nerve conduction studies. Together with an EMG study, this is called electrodiagnostic testing.

“That’s the gold standard to assess for neuropathy,” she said.

Those tests confirm the diagnosis but also help the neurologist better characterize the neuropathy. They are also necessary to rule out any signs of demyelination, which is damage to the myelin sheath that surrounds the nerves. In addition to guiding treatment, the tests also help characterize the severity of the neuropathy as mild, moderate or severe.

The last part of the workup is blood work to help identify the cause of neuropathy, if any, (for example, diabetes, prediabetes, an infection or vitamin deficiencies).

Treatment

Treatment of neuropathy always depends on the underlying cause of the neuropathy, Dr. Coraini said.

“Let’s say we do the blood work, and we see the patient has evidence of diabetes or pre-diabetes, then it’s important to treat the underlying diabetes or pre-diabetes. If there is an underlying vitamin deficiency, like vitamin B12 or folate, which is very common, it’s important to treat that deficiency with a supplement,” she said.

Often times, neuropathy progresses despite treatment. Patient's might feel, for example, that their symptoms are moving upward from the feet into their legs and hands.

In addition to treatment of the underlying cause of neuropathy, she always recommends either exercise or physical therapy, which helps counteract the symptoms and progression of the neuropathy, she said.

“Especially if patients have imbalance or gait instability, physical therapy is super, super helpful and the mainstay of treatment.”

In the rare cases where there is evidence of demyelination, patients are treated with immunological therapies. Neuropathy treatment also includes nerve pain medications such as gabapentin, pregabalin or duloxetine.