Four Types of Neuropathy

Nerves play an important role in controlling and regulating different body sensations.

When one or more nerves get damaged or impaired as a result of high levels of fats or sugar in the blood, patients develop an insufferable condition known as “neuropathy”.

According to the National Library of Medicine, 7-10% of the general population suffers from neuropathic pain conditions.

The most common problem related to neuropathy is diabetic neuropathy – a complication of diabetes that results in damage to the nervous system. It is a progressive disease with symptoms that get worse over time.

Neuropathy causes malfunctioning of the nerves, producing paresthesias (unusual sensations), agonizing pain, and utter discomfort.

It is divided into 4 main types – peripheral (affecting hands and feet), autonomic (abnormalities in involuntary functions of the body, like digestion, urination, heart rate, etc.), proximal (specific parts like chest wall or legs), and focal (affecting one nerve).

Common Causes of Neuropathy

There are numerous reasons that can contribute to nerve damage.

  • Diabetes: Diabetes is one of the main causes related to neuropathy, more precisely called diabetic neuropathy. This condition is more likely to occur in the elderly or those who have a long history of diabetes, obesity, high cholesterol, or high blood pressure.
  • Vitamin deficiencies: Deficiencies of B vitamins (like B12) and folate can cause damage to the nerves.
  • Autoimmune diseases: These include rheumatoid arthritis, systemic lupus, and Guillain-Barre syndrome which can potentially lead to neuropathy.
  • Infection: Certain infections like HIV/AIDS, Lyme disease, leprosy, and syphilis, may severely damage nerves.
  • Alcohol: Other deficiencies combined with alcoholism cause further damage to the nerves.
  • Heredity: In some cases, certain inherited disorders like Friedreich’s ataxia and Charcot-Marie-Tooth disease can seriously affect the nerves, causing neuropathy.
  • Drugs or Medication: Certain drugs and medications like vincristine (Oncovin, Vincasar), antibiotics such as metronidazole (Flagyl), and isoniazid (Nydrazid, Laniazid) can seriously harm the nerves in the body.
  • Injury & Tumors: An injury or a trauma may put unusual pressure directly on the nerves. In addition, Benign or malignant tumors of the nervous system may lead to different neuropathic conditions.

Symptoms of Neuropathy

The type of neuropathy you have would determine the characteristic symptoms and their severity. Yet, some common signs include:

  • Numbness, tingling, burning sensations, weakness, and pain in the skin, feet, arms, or legs
  • Loss of reflexes/dexterity.
  • Incontinence and other such urinary problems
  • Dizziness or Blurred vision
  • Trembling
  • Palpitation
  • Loss of muscle in the hands and feet
  • Insensitivity towards heat, cold, or physical injury
  • Loss of balance
  • Low sugar levels
  • Difficulties speaking or swallowing
  • Faster heart rates
  • Excessive sweating/inability to sweat
  • Sexual dysfunction

Four Types of Neuropathy that can Impact the Nervous System

Neuropathy can attack different nerves throughout the body, and patients may experience more than one type. pain specialists of Austin generally consider these 4 broad categories to define the various kinds of neuropathic variations:

  • Peripheral Neuropathy – It is quite common and occurs due to diabetes, usually affecting the limbs in the form of deformities and ulcers. In other words, peripheral neuropathy affects the nerves of extremities (the toes, feet, legs, fingers, hands, and arms) that are a part of the peripheral nervous system, outside those of the central nervous system (the brain and spinal cord). It comprises two types – peripheral diabetic neuropathy or distal polyneuropathy – which affect both sides of the body. Apart from diabetic disorders, other potential causes for this one include alcohol abuse, chemotherapy, and immune disorders.
  • Proximal Neuropathy – When the nerve damage radiates to the shoulders, thighs, hips, or buttocks, it is known as proximal neuropathy. Also called diabetic amyotrophy, it is recognized by severe muscle weakness and sharp pain. This neuropathy is less common than the other types and may occur with peripheral neuropathy. It is generally asymmetric and doesn’t affect both sides of the body equally. The most common causes of this one are cancer, Guillain-Barré syndrome (an inflammatory disease that causes respiratory problems ), and CIDP (chronic inflammatory demyelinating polyneuropathy).
  • Autonomic Neuropathy – This is another rare form of neuropathy that disrupts the functioning of the internal organs which are a part of the autonomic nervous system. This is a more serious kind of neuropathy interfering with involuntary nerves and causing problems relating to the movement of the intestines, heart rate, strength of heart contraction, digestion, bowel and bladder function, sexual functions, blood pressure, and urination, and so forth. It is generally associated with severe diabetes and systemic disorders, such as kidney failure and cancer.
  • Focal Neuropathy – This is a rather unique form of neuropathy, which affects only one nerve (or a group of nerves in one area) in the head, legs, or torso. It is quite common and relates to conditions like carpal tunnel syndrome and ulnar neuropathy, which occur due to compression of nerves in the hand and wrist. This can happen from prolonged positions or overuse of the limb. Bell’s palsy is a sub-type of focal neuropathy that affects the facial nerve and may occur as a result of a viral infection or inflammation. Then another type of focal neuropathy, trigeminal neuralgia, is triggered by the inflammation or irritation of the trigeminal nerve, which is responsible for controlling the sensations of the face.

Neuropathy Diagnosis & Treatment

The neurologists at Advanced Pain Care, offering neuropathy treatment recommend monitoring blood pressure and cholesterol levels along with fluctuations in heart rate to diagnose neuropathy.

In certain situations, blood tests might also be recommended to check for any deficiencies, and imaging tests like X-rays, CT scans, and MRI scans can also be used to locate the nerve compression.

Other diagnostic practices are:

Physical Assessment – A thorough physical examination will be conducted by the physician to check for:

  • Ankle reflexes
  • Loss of sensation
  • Changes in skin texture/color

Diagnostic Tests

  • Electromyogram (EMG) – A thin needle, containing an electrode, is inserted into the muscle through the skin to monitor the electrical activity in the muscles.
  • Nerve Conduction Velocity Test (NCV) – Here, surface electrodes are placed on the skin at different body parts to observe and evaluate the pace at which induced signals pass through the nerves.
  • Nerve Biopsy – This includes taking a small piece of tissue from the sural nerve (in the ankle), or the superficial radial nerve (wrist) for a microscopic examination.

Treatment -If your blood pressure, cholesterol, or sugar level is responsible for your disorder, your doctor will focus on different treatment options to bring them down to ideal levels. Other ways of managing neuropathy include:


Medicines like anticonvulsant drugs, tricyclic antidepressants/serotonin-norepinephrine inhibitors, opioids, nonopioid pain relief medication, topical lotions or compound creams, etc. are very commonly prescribed for neuropathic pain treatment.

Physical Therapy

Certain physical therapies (like electrical nerve stimulation, therapeutic ultrasound, exercises, massage, etc.) when used together with medications can help relieve:

  • Pain
  • Burning and tingling sensations in the legs and feet
  • Muscle cramps
  • Muscle weakness
  • Sexual dysfunction

In case of reduced mobility or injury to one or more parts, some patients can be recommended to wear splints.

Also, when alcohol is identified as the main cause of neuropathy, specialists help patients by restricting or discontinuing its consumption. 

Complications Related to Neuropathy: Some risk factors and complications associated with neuropathy are: 

Gangrene and Amputations

As neuropathy may result in loss of pain sensations, some wounds may go unnoticed, being susceptible to bone infections. This can give birth to fatal tissue problems like Gangrene.

When this disease is diagnosed in the initial stages, it can be treated with antibiotics and surgery. But in other cases, amputations i.e the surgical removal of limbs may be considered to stop the worsening of the condition.

Digestive Issues Due to Autonomic Nerve Damage 

Damage to the autonomic nervous system can lead to gastroparesis, a disorder of the digestive system which slows down the digestion of food causing acidity/heartburn, feeling of fullness, nausea/vomiting, bloating, lack of appetite, unexplained weight loss, etc.

Heart and Blood Circulation Complications

Patients may experience issues with heart and blood circulation that can cause cardiovascular autonomic neuropathy. This condition leads to low blood pressure and makes the individuals feel dizzy and easily tired after a brief period of physical activities. 

Loss of Bladder Control

This is a common problem caused by nerve damage that makes the bladder overactive or underactive.

To prevent or treat such complications, doctors may prescribe bladder relaxation medicines like tolterodine, oxybutynin, and propantheline.

Now that you have a fair knowledge of neuropathic pain, you must consult a neuropathy clinic if you see signs of neuropathy, to get an accurate diagnosis and receive timely medical assistance.

About The Author:

Stacey Smith is a freelance health writer. She is passionate to write about women’s health, dental health, diabetes, endocrinology, and nutrition and provides in-depth features on the latest in health news for medical clinics and health magazines.

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