The Merriam Webster dictionary defines “Neuropathy” as:
Definition of NEUROPATHY
More simply put, “Nerve Dysfunction.” When for various reasons, a nerve or group of nerves doesn’t work, ‘symptoms’ arrive which can range from an annoyance to debilitating for the Neuropathy Patient. Symptoms of pain, numbness, burning, tingling/prickling and edema are found most common.
There are over 100 different types of neuropathy in the medical world; and, just as many reasons for developing them or the symptoms which accompany them.
Taken from Peripheral Neuropathy… Case Histories, Myths and Treatments which Work!
“What is neuropathy? Basically, it is, simply, nerve dysfunction! But, up for debate, there are many types and kinds. Breaking things down into just three groups, most doctors define different neuropathies as being either:
- Autonomic: nerves that control functions such as blood pressure, bladder or heart, hypoglycemia, constipation, gastroparesis or trouble swallowing, bladder infections, incontinence, erectile dysfunction, sweat gland malfunction, night blindness and pupils of the eyes becoming less responsive to light.
- Motor nerves (multifocal): nerves that are connected to your muscles.
- Sensory: nerves that can detect heat, cold, touch or vibration; mostly in the hands or feet, but can be in the face as well.
Broken down farther, doctors distill/diagnose neuropathy (especially, diabetic), to:
- Peripheral neuropathy; nerve damage which diabetics experience. Some doctors may call it sensorimotor or distal symmetric neuropathy. Most symptoms include: pain, numbness, burning, tingling, lack of sensitivity to pain or temperature, prickling sensations, cramps, balance and or coordination issues.
- Proximal, Radiculoplexus or diabetic Amyotrophy; nerve damage and pain, primarily only on one side of the body in the hips, thighs, legs, or buttocks; in addition, weakened and/or atrophied thigh muscles are common… as is trouble standing from a seated position, weight loss and possible abdominal edema.
- Focal or mononeuropathy; which generally affects nerves in the head, legs, or torso. Appearing suddenly, it can become painful. Generally, it can, possibly, have waning and waxing symptoms without treatment; although, without treatment improvement is slow. Symptoms can include: Bell’s palsy, sudden ADD or ‘focus’ issues, double vision, aching behind one eye, severe lower back or pelvic pain, front thigh pain, pain at the inside of a foot, pain on the outside of a shin, pain in the chest, stomach, or side, and intense chest or abdominal pain.”
- Third nerve neuropathy/palsy: when one cannot move their eye normally due to damage of a cranial nerve.”
With the long nerves, in this reference, the synoptic junctions of the nerve grow apart due to hypoxia (lack of oxygen). The farther apart the synoptic junctions grow in search of oxygen rich blood, the ‘less function’ they have. “Symptoms” arise; such as pain, burning, numbness and tingling. For a rather bad analogy, If you think of the junctions like a spark plugs in a car; if the plugs are ‘gaped’ properly (and providing there are no other engine issues with the car) it will run well, be able to effectively use all the horsepower available and get the best mileage. However, if one gaps the plugs a bit too wide… “symptoms” arise; smoking, sputtering, poor mileage, and etc. If they are gaped ‘too wide,” the car won’t run at all. These are just “symptoms” which a mechanic would recognize. A neuropathist, recognizes, through specialized testing, nerve symptoms to see what the problem might be with the long nerves.
Some times the problem may be “Symmetrical” (generally both sides of the body) and/or it could affect both the hands, arms, legs and/or feet.
With short nerves, the problem is still hypoxia, but each individual nerve in the hands/arms or feet/legs can be affected. This is why, nerve testing or biopsys are sometimes “inconclusive.” A nerve chosen at random, might test out as being fine; where as the next nerve my be in various stages from mildly to severely demyelinated. It is the demyelination of the nerve, (or the myelin sheath) which carries the signal to and from the brain. If the signal is ‘blocked’ somehow, due to damage (demyelination), symptoms, also, arise as with the long nerves. When a patient presents with symptoms and state that their doctor has told them: “You can’t have both pain and numbness at the same time,” the neuropathist will see this as a very good indicator that the patient has short nerve damage; as anyone WITH neuropathy will tell you, “Of course, you can have pain and numbness at the same time!” The reason is, as the nerves search for more oxygen themselves in the extremities, they can recede and even ‘curl over’ while moving downward into the tissue; this results with a ‘numb’ feeling at the surface of the ball of the foot, for example, but when stepping down on something… “OUCH!” The nerve, finally, gets the signal and sends it to the brain. In any event, lack of circulation is often one of the roots of the problem in either type of nerve.
Symmetrical (generally both sides of the body) peripheral neuropathy generally affects just the hands, arms, legs and/or feet. But, as stated before, there are over 100 different types of neuropathy and just as many reasons for it cause. The most common associated with ‘peripheral’ would most likely be:
- Autonomic neuropathy—which affects the internal organs such as the colon, heart and their functions, sweat glands, sexual organs, urinary function, the eyes and even the circulatory system.
- Cancer related neuropathy—caused by the cancer itself to the nerves or by treatment of radiation or chemotherapy.
- Cranial neuropathy—a result of when one of the twelve cranial nerves are damaged.
- Diabetic neuropathy—caused by too high or low (poorly managed) blood sugar.
- Focal neuropathy—affecting the head, torso and legs.
- Hereditary neuropathy—caused by inheriting genetic medical conditions such as Charcot-Marie-Tooth.
- Idiopathic neuropathy—meaning, of unknown origin; but in ‘doctor talk’… “I don’t know.” In other words, a neuropathy type they cannot explain.
- Infectious disease neuropathy—caused by infectious diseases such as Hepatitis C, HIV, Lyme disease or etc.
- Proximal neuropathy—affecting the hips, legs, thighs or buttocks.
- Sensorimotor neuropathy—which affects not only the nerves, but muscle control.
The list can go on and one; but the types listed above are by far, the most common. Many neuropathies are misdiagnosed; such as Irritable Bowel syndrome. Often, we find, when a patient presents with IBS, what they actually have is Autonomic neuropathy; generally, associated with an advanced case of peripheral neuropathy.
Some patients are told that they have Carpal Tunnel syndrome; which can actually be the case. However, few are told that Carpal or Tarsal Tunnel syndromes are another form of neuropathy; or the fact that, the problem may not be with the hands, but with the upper arm or shoulder. This is why, many neuropathists see patients whom say “I have had carpal tunnel surgery twice, but it didn’t work!” it didn’t work, because the pain in the wrist – presumed caused from repetitive action of the hand – is actually caused by a different issue in a different part of the arm!
It takes proper testing and Intake (learning a patients full, medical history) for the expert, doctor or neuropathist to determine exactly “what” form of neuropathy the patient might have; and only through learning this, can a proper judgement be made as to the modality (of which there are many) of treatment to use.
Will treatment ‘cure’ neuropathy? In general, the answer is no; however, if the cause of the neuropathy is something which can be corrected – such as, through surgery or eliminating self-medicating (illicit drugs, prescription drugs or alcohol) – often the neuropathy is resolved in time.