Neuropathy can have many underlying causes
by CLINT O. HOXIE, OD - Bitterroot Valley Eye Associates
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Neuropathy is a condition where the nerves, usually furthest from the center of the body, do not work properly. It usually involves the feet first. Neuropathy is not a disease per se, but rather it is a set of symptoms and findings that are caused by something. It would be comparable to a rash. Certainly something abnormal, and not desirable, but not a diagnosis in and of itself. The treatment for neuropathy is ideally treating the underlying cause.
There are many causes for neuropathy. In this country diabetes mellitus is the most common one. An interesting feature of diabetic neuropathy is that it can precede the diagnosis of diabetes itself by several years. There are actually several forms of diabetic neuropathy. It most typically causes pain, numbness, and tingling in the toes, which gradually works its way up the foot and leg. The progression is usually over a period of months to years. The pain is often described as a burning, prickly, cold or swollen feeling. It is often least noticeable during the day, and much more so at night when lying quietly in bed, trying to fall asleep. The lack of feeling in the feet can be quite a problem. A minor cut, abrasion, stone, or splinter can go undetected and lead to serious infection. Keeping close attention to the skin health and integrity of the feet can literally save life and limb. The better one has control of their diabetes the slower the progression of neuropathy.
Other causes of neuropathy include alcohol abuse, vitamin B12 deficiency, auto immune diseases, infections and hereditary causes. I’m often asked if taking vitamins, in particular vitamin B12, will help neuropathy. The answer is; usually not, unless the cause is vitamin B 12 deficiency itself. This can be discovered with a simple blood test.
The most distressing symptom is often the pain, but other problems can occur, such as muscle weakness, and decreased balance. Certain types of neuropathy, and most types that last for a long time, can cause weakness in the feet and legs. Even without any weakness people with neuropathy can have difficulties with balance. The reason is that we must have normal sensation in our feet to feel the ground securely in order to maintain proper balance. With lack of feeling in the feet, we rely more on our other senses, in particular our vision, to maintain normal balance. This is why people with neuropathy often feel especially unsteady in the dark or with their eyes closed.
If a cause can be found, that is the most important part of treatment. If no cause is found, which can occur 10 to 30 percent of the time, or if treatment is already being done (e.g. diabetes is under good control) and symptoms are still present, treatment is often indicated for those symptoms per se. If there is pain in the feet for example that keeps a person from sleeping at night, medication is often used. There are many medicines used for this. Typically they are in the group of medications that are either antidepressants or anti-seizure medicines. This does not mean a person has to have depression or seizures to use these medicines, but these types of medications seem to help for “nerve pain.” Commonly used medications include Lyrica, Cymbalta, amitriptyline, and gabapentin. Many more have been used, and the medication must be customized to the patient’s particular needs.
Hereditary and post-infectious states (that is, after somebody has an infection) can cause neuropathies. The hereditary neuropathies are usually very chronic in character and the post-infectious states such as Guillain-Barre’ syndrome are the opposite i.e. sudden onset and rapid in progression. Both of these carry quite different prognoses and are much rarer than the more common type of neuropathy such as we see with diabetes. This brings us full circle to the beginning of this discussion… finding the cause of neuropathy; if possible is the most important step in evaluation and treatment.
Questions or comments can be addressed to Clint O. Hoxie, OD, c/o Bitterroot Valley Eye Associates, 300 N. 10th Street, Ste A, Hamilton, MT 59840 or Bitterroot Valley Eye Associates 401 Main Street, Ste A Stevensville, MT 59870.
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