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Neuropathy

  • Nerve damage outside the brain and spinal cord that causes pain or numbness
  • Symptoms include muscle weakness, twitching or cramps, numbness, or lightheadedness
  • Treatments address the underlying cause, which could range from diabetes to an infection
  • Involves neurology and neuromuscular medicine

Overview

Neuropathy is a form of nerve damage that is estimated to affect more than 20 million Americans. It often accompanies other health problems including diabetes, cancer, shingles, autoimmune disease or injury.

“Neuropathy presents a spectrum of symptoms,” says Daniel DiCapua, MD, a Yale Medicine neurologist. Those symptoms may include a burning sensation, shooting pain, numbness or muscle weakness. For some patients, Dr. DiCapua says, the symptoms are just an annoyance. But for others, the effects of neuropathy can be debilitating.

The team at Yale Medicine has both the comprehensive expertise and advanced equipment to diagnose neuropathy successfully, and to provide treatments that both minimize the discomfort and offer the best opportunity to reverse the condition.

What causes neuropathy?

Patients with neuropathy experience “misfiring” of the peripheral nerve cells (nerves that carry signals between the brain and other parts of the body). The result can range from pain to complete loss of sensation.

Up to half of patients with diabetes experience some kind of neuropathic pain.

Other health problems associated with neuropathy include shingles, cancer, autoimmune disease, and certain kinds of injury. It is not clear to researchers exactly why nerve damage results from those conditions. 

What are the different types of neuropathy?

There are four major categories of neuropathy.

  • Motor neuropathy: Caused by damage to nerve cells that control muscles and movement. Patients with motor neuropathy will often experience loss of control and coordination of their limbs, or trouble speaking.
  • Sensory neuropathy: Sensory feelings such as a light touch to the skin or pain are controlled by sensory nerves. When this group of nerves becomes damaged, patients often lose those important “feeling” senses.
  • Autonomic nerve neuropathy: Autonomic nerve damage can be dangerous, because the nerve cells control unconscious bodily functions such as breathing and heartbeat. Damage to those nerve cells could lead to serious respiratory and heart problems.
  • Combination neuropathies: The most common combination of neuropathies is motor and sensory, with many patients suffering from a loss of sensation and motor control. Other combinations of neuropathic pain are also possible.

What are the symptoms of neuropathy?

Early signs of neuropathy can include muscle weakness, twitching or cramps, as well as feelings of numbness or loss of sensation, or lightheadedness. 

As the condition progresses, patients might also experience imbalance, emotional distress or trouble sleeping. 

Some patients complain of losing sensation in their feet or have problems with motor control. Others feel neuropathic pain in their feet, plus legs, back and hands, which can make the simple act of sitting at a desk—or lying in bed—very difficult. 

How is neuropathy diagnosed?

A definitive diagnosis of neuropathy can be difficult because there are so many different types. Electrodiagnostic techniques such as electromyography (EMG), which evaluates nerve and muscle function, help Yale Medicine neurologists pinpoint the exact source and type of nerve damage. This test, and others such as magnetic resonance imaging (MRI) and computerized 
tomography (CT) scans also help.

If the cause of neuropathy is still not obvious, physicians will perform skin biopsies that can detect damage in nerve cells called small unmyelinated peripheral nerve fibers. The results of this test should reveal if the symptoms are caused by neuropathy or another condition.

How is neuropathy treated?

The most effective way to treat neuropathy is to address the underlying cause, such as diabetes, vitamin deficiencies, infection, an autoimmune condition, or cancer. If the nerve cell damage is modest, patients may regain function and experience less pain once their condition is under control.

But for most patients, neuropathy will become a chronic condition that requires lifelong management. While general painkillers can be used to treat neuropathy, frequent and prolonged use of opioids can lead to unwanted side effects and addiction, so physicians at Yale Medicine prefer to offer patients care for their specific neuropathy-related symptoms.

How is Yale Medicine's approach to treating neuropathy unique?

Patients treated at Yale Medicine Neuromuscular Program receive personalized care, based on the severity of their symptoms and their underlying medical conditions—and also benefit from a multidisciplinary team of experts who specialize in nervous system disorders and pain management.

“Because there are so many underlying causes of neuropathy, treatment requires a multi-pronged approach,” Dr. DiCapua says. “Our division meets twice a month to go over our patients' cases and bounce ideas off each other, so patients are benefiting from many doctors’ minds for the price of one.”

Neurologists focus on diagnosis and nerve-related issues, while pain specialists can address different reactions as they arise. Movement specialists are on hand to help patients stay active.

The Neuromuscular Program works closely with Yale researchers who are exploring the underlying cause of neuropathy and hunting for new treatments.