Saturday, 1 October 2016

Diabetes Is Not The Only Cause Of Neuropathy

Today's post from (see link below) is a sensible response from a doctor to a question as to why a patient suffers from neuropathy when they don't have diabetes. In the wider world, if people have heard of neuropathy at all, it's generally associated with diabetes but there are over 100 different causes of neuropathy and over 100 different forms of the disease too. So every bit of publicity highlighting the vast range of neuropathy causes is useful. I would say that 7 out of 10 internet articles also have 'diabetes' in the title when they talk about nerve damage because diabetes is unquestionably the most common cause. If you have neuropathy (and not diabetes) you can safely ignore the diabetes reference and trust the information will apply to you too. The one clear thing about neuropathy is that once it's diagnosed, the progress and treatment of the disease is pretty much the same for most people.

Dr. K: Peripheral neuropathy is not always caused by diabetes
Posted: Thursday, September 22, 2016 

Dear Doctor K: I have peripheral neuropathy. I know that people with diabetes often get neuropathy, but I’m not diabetic. What else can cause this condition? And what can I do about it?

Dear Reader: Neuropathy is a medical term that means nerve damage. The type of nerve damage that people with diabetes get involves specific nerve fibers in all nerves, particularly the nerves that travel to the legs and feet. (There are other conditions in which a single nerve leading to the legs and feet is pinched, causing pain. An example is what is often called a “slipped disk’’ or “herniated disk’’ in the lower part of the spine.)

The symptoms of peripheral neuropathy include numbness and tingling. Some cases cause burning, shooting or stabbing pain. When the doctor does a physical examination and touches your feet and lower legs with something as light as a feather (like some cotton), you may not feel it. However, you will feel it if the cotton touches your skin in the thigh or elsewhere on the body. You may also lose sensation to a pinprick in the lower legs and feet, but not the rest of you.

Diabetes is the most common cause of peripheral neuropathy. But neuropathy can result from other causes as well. These include:

• Excessive alcohol intake.

• Hypothyroidism. In this condition, the thyroid gland does not produce enough thyroid hormone.

• Amyloidosis, a disease in which an abnormal protein accumulates in the body.

• Vitamin deficiencies, particularly vitamin B1, B12 and folate deficiency.

• Infection with human immunodeficiency virus.

• Critical illness, particularly if you develop a severe inflammatory response to infection.

• Guillain-Barre syndrome. This uncommon autoimmune disorder damages the peripheral nerves.

• Chemotherapy.

Diagnosing peripheral neuropathy is best done by electromyography and nerve conduction studies. Such testing often is not necessary, as your symptoms, your medical history and your doctor’s physical examination make the diagnosis likely.

Treatment of peripheral neuropathy begins with treating the underlying cause of the condition. For example, let’s say your neuropathy is related to heavy drinking. You should severely restrict, or better yet abstain, from alcohol. If your neuropathy is caused by hypothyroidism, treatment with replacement doses of thyroid hormone should help.

The other goal of treatment is to relieve symptoms. In particular, treatment targets pain caused by peripheral neuropathy. Several medications can help. Gabapentin, an anticonvulsant medication, is usually effective. Tricyclic antidepressants can also effectively relieve pain.

Finally, while neuropathy itself causes pain, it (strangely enough) reduces sensitivity to pain caused by outside injuries. This makes you particularly vulnerable to foot damage. If you develop a cut or sore on your foot, without pain to alert you, you may not even notice the injury. Untreated, a simple wound may become severely infected. To prevent this, carefully check your feet every day and treat any foot injury immediately.

This column ran originally in October 2013.

Write to Dr. Komaroff at or Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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