Neuropathy: causes, symptoms and treatment

Verified 21/06/2022 by PasseportSanté

Polyneuropathies are diseases of the peripheral nervous system. Motor skills, sensitivity, and mobility are rarely affected.

The most common cause of neuropathy is diabetes. Elimination of the causative agent as well as pain control allows for a better quality of life. We are evaluating.

What is neuropathy?

Polyneuropathies, also called polyneuritis, refer to diseases of the peripheral nerves (that is, the nerves between the spinal cord and the muscles of the extremities). In most cases, polyneuropathies are chronic and slow to develop. It is rarely acute, meaning a sudden onset.

The causes of nerve damage are very diverse:

  • infection;
  • toxins;
  • Drugs ;
  • cancer;
  • nutritional deficiency;
  • diabetic ;
  • Autoimmune diseases.

lower extremity neuropathy

Weak sensitivity and strength. Motor skills are rarely reduced. The disease usually first affects the extremities, extremities (feet, hands, arms, and legs), and sometimes the trunk.

Most often, the first signs that lead to a consultation are tingling, or even pain in the form of electric shocks. A decrease in muscle size (atrophy) can be added to the clinical picture.

Electromyography, nerve conduction studies, and blood and urine tests are required for diagnosis. Physical therapy, occupational therapy, medication, and other measures may be necessary to relieve pain and restore a better quality of life.

What causes neuropathy?

Symptoms of polyneuropathies are explained by lesions of different locations. A large number of diseases, infections or poisonings can lead to the development of polyneuropathy.

Peripheral nerve damage

Polyneuropathy can affect one or more peripheral nerves in the body (we are also talking about peripheral neuropathy).

As a reminder, peripheral nerves connect the body’s organs (including muscles) to the central nervous system (spinal cord, brain, etc.). It can work on any nerves:

  • motor nerves (motor neuropathy);
  • sensory nerves (sensory neuropathy);
  • cranial nerves (facial neuropathy);
  • Autonomic nerves (which control involuntary functions such as blood pressure, breathing, heart rate), etc.

Polyneuropathy can result from lesions of different sites. Lesions may be located in the myelin sheath of nerves (demyelinating polyneuropathy), as occurs in Guillain-Barré syndrome.

Neuropathic Neuropathy

The lesion sometimes affects the blood vessels that supply the nerves, as occurs in vasculitis. Finally, sometimes the axon of the nerves (axial neuropathy) is damaged, as seen in diabetes or kidney failure.

Several risk factors for neuropathy

Neuropathy can have many causes:

  • Diabetes mellitus: is the most common form of chronic neuropathy. It is usually caused by poor control of blood sugar levels in diabetics. We are talking about diabetic neuropathy.
  • An infection associated with a toxin caused by bacteria (as in diphtheria).
  • autoimmune reaction, as in Guillain-Barré syndrome;
  • poisoning with certain toxins or metals (triphosphate, thallium, arsenic, mercury, etc.);
  • Excessive consumption of alcohol (alcoholic neuropathy);
  • some infections (hepatitis C, HIV, Lyme disease, shingles, etc.);
  • certain hereditary neuropathies (eg Charcot-Marie-Tooth disease);
  • certain autoimmune diseases (eg, chronic inflammatory demyelinating polyneuropathy, vasculitis or systemic lupus erythematosus);
  • nutritional deficiency including vitamin B12 (deficiency of vitamin B12 also causes spinal cord degeneration and often pernicious anemia) or thiamine (vitamin B1);
  • alcoholism (especially when it leads to nutritional deficiencies);
  • hypothyroidism;
  • Renal failure;
  • Cancer (eg, multiple myeloma that damages nerves by invading them directly or pressing on them);
  • taking certain medications (the anticonvulsant phenytoin, some antibiotics (chloramphenicol, nitrofurantoin, sulfonamides and some chemotherapy drugs such as vinblastine and vincristine);
  • Excessive intake of vitamin B6 or pyridoxine (a rare cause).

What are the symptoms of neuropathy?

The onset of symptoms in case of polyneuropathy can be sudden or, conversely, slow and progressive.

The extremities and extremities are usually the first affected areas. We talk especially about distal neuropathy when the disease affects the nerves of the feet. It is the most common complication of diabetes. Clinical features that are commonly found are:

  • muscle weakness
  • tingling sensation
  • numbness;
  • loss of sensitivity
  • pain with a burning sensation or electric shock;
  • loss of sense of vibration and position;
  • loss of thermal sensitivity (the patient no longer feels hot and cold);
  • Loss of sensation of pain, which is common in diabetic neuropathy. It results in injuries, burns, and open sores from prolonged pressure and other trauma. It also causes many complex skin disorders without the patient feeling them. Loss of pain sensation can also lead to joint damage called neuroarthropathy (Charcot joints);
  • Walking and standing instability.
  • inability to locate arms and legs in space;
  • etc.

Eventually, the muscles are no longer tense enough, which leads to:

  • muscle wasting (atrophy);
  • muscle stiffness;
  • muscle cramps;

Polyneuropathy can affect the nerves of the autonomic nervous system, which controls involuntary body functions (such as blood pressure, breathing, heart rate, digestion, saliva, and urination).

Characteristic symptoms are:

  • Constipation;
  • sexual dysfunctions
  • dry mouth and bad breath (halitosis);
  • fluctuations in blood pressure (particularly responsible for orthostatic hypotension);
  • Paleness and dry skin due to lack of sweating.
  • loss of sphincter or bladder control resulting in fecal or urinary incontinence;
  • respiratory failure;
  • etc.

People with hereditary neuropathy often have physical abnormalities such as:

  • hammer fingers;
  • hollow feet
  • curved back (scoliosis);
  • etc.

What are the treatments for neuropathy?

Treatment for polyneuropathy begins with its underlying cause, such as diabetes, autoimmune disease, or ingestion of toxins or medication.

Management also consists of reducing pain and improving mobility and patients’ quality of life through medication, physical therapy, and occupational therapy.

Treating the cause

The specific treatment of polyneuropathy depends on the cause:


The patient should take care of his lifestyle and take the prescribed treatments (hypoglycemic drugs, other oral antidiabetics, insulin, etc.). Blood sugar should be controlled and stabilized to reduce the risk of exacerbation of neuropathy.

Multiple myeloma, kidney or liver failure

Treating these disorders can slow recovery.


Surgical removal of the tumor and chemotherapy/radiotherapy can reduce neuropathy.


The patient must ensure a healthy lifestyle and an adequate intake of iodine. Thyroid hormone is given.

autoimmune diseases

Treatments may include corticosteroids, immunosuppressants, plasmapheresis, and intravenous immunoglobulin.

In case of drug or toxic

The disease-causing drug should be stopped as soon as possible or exposure to toxins should be avoided. For some drugs and poisons, an antidote is available that can reverse some of the toxic effects.

pain reliever

For pain relief, the doctor may prescribe:

  • analgesics (paracetamol);
  • opioids (codeine, morphine);
  • Anti-inflammatories (NSAIDs, corticosteroids).

Some medications that aren’t usually considered pain relievers can reduce pain from nerve damage.

They include the antidepressant amitriptyline and the anticonvulsants gabapentin, pregabalin, and mexiletine (used to treat irregular heartbeats).

Lidocaine (a numbing lotion, ointment, or skin patch) may also be prescribed.

Maintain mobility and quality of life

Physical therapy sometimes reduces muscle stiffness and can prevent muscle shortening and stiffness. Consultation with a physical therapist and/or occupational therapist may be recommended in order to improve the patient’s mobility and quality of life.

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