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Neuropathy is a condition that generally describes any disturbance of the structure or function of nerves. Neuropathies are largely classified by the location and type of nerves that are affected, as well as by the underlying causes of the nerve damage. The most common type of neuropathy is peripheral neuropathy, which affects the nerves outside of the brain and spinal cord, but there are also cranial, autonomic, and focal neuropathies as well. Pain is the most common presenting symptom, but it is rarely present without other symptoms as well, including numbness, tingling, gait imbalance, and weakness.

Causes of Neuropathy

While the mechanisms that drive neuropathy are very complex, at a very high level the issue is that damaged or impaired nerves are not able to function properly, lowering their input to the central nervous system. This, in turn, causes a variety of issues with the nerves that can cause pain or paresthesia. Some of the most common causes of the nerve damage that drives neuropathy include:

Symptoms of Neuropathy

Peripheral neuropathies typically present with a gradual sensory loss in what is known as a stocking and glove distribution, meaning they affect the toes and fingers first. This makes sense when one considers that the longest nerve fibers are the easiest to be injured or damaged. As neuropathy progresses, it begins to affect the next longest fibers, leading to numbness, tingling, and pain in the arms, shoulders, and, finally, the chest. If motor neurons are affected, neuropathy can lead to issues with movement, including walking, extremity weakness, and loss of muscle tone and dexterity. 

The loss of sensory input can lead to the development of blisters or sores on the feet and hands, particularly in patients with diabetic neuropathy. In severe cases, these sores can deepen and lead to amputation if left untreated.

Diagnosing Neuropathy

The single most important test when diagnosing neuropathy is a comprehensive physical examination, as this will allow the practitioner to fully gauge the extent of the nerve damage. This exam should include a full neurological workup, to include testing of the reflexes and functioning of peripheral nerves. 

In addition to the physical exam, your provider may order additional tests, including but not limited to blood work, x-rays, CT scans, MRI scans, EMG/nerve conduction velocity tests, and nerve biopsies. They will then take all of the data points gleaned from these tests and synthesize them with the results of their physical examination to arrive at a cause for your neuropathy.

Treating Neuropathy

The treatment for neuropathy will vary based on the extent of the condition and the underlying causes of the nerve damage. In general, treatment will focus on managing the symptoms of neuropathy–the pain, numbness, and tingling–while working to address the underlying causes of the nerve damage. In some cases, treatment of the underlying causes–be it diabetes, medication/treatments, or autoimmune disorders–can greatly reduce the symptoms of neuropathy. However, other cases may require more intense interventions to attack the symptoms, including medication, minimally-invasive interventions, or surgery.