Neuropathy (nerve pain)

Neuropathy is a condition where nerves in the nervous system are damaged, leading to pain, numbness, and weakness. When this happens to the nerves in the peripheral nervous system (PNS), it’s called “peripheral neuropathy (PN).”

Symptoms include numbness and tingling in the hands and feet, burning or stabbing pain, weakness, fatigue, and loss of balance.

The most common cause is diabetes, known as “diabetic neuropathy.” Other conditions linked to neuropathy include:

• Multiple sclerosis (MS)
• Cancer
• Trigeminal neuralgia (TN)
• HIV/AIDS
• Parkinson’s disease (PD)
• Stroke
• Shingles
• Complex regional pain syndrome (CRPS)
• Traumatic brain injuries (TBIs)

Neuropathy causes

Neuropathy can result from many health issues, with diabetes being the most common cause. High blood sugar levels can damage nerves and small blood vessels over time.

Other causes include injuries, toxins, MS, strokes, cancer treatments, kidney disease, vitamin B12 deficiency, autoimmune diseases, and infections like shingles, Lyme disease, and HIV/AIDS. Alcoholism and certain inherited conditions like Charcot-Marie-Tooth disease (CMT) can also lead to neuropathy.

Neuropathy symptoms and health effects

There are four main types of neuropathy:

• Sensory neuropathy
• Motor neuropathy
• Autonomic neuropathy
• Mononeuropathy

While they share symptoms like chronic pain, numbness, and weakness, each type has unique characteristics.

Sensory neuropathy

Symptoms include:

• Pins and needles
• Numbness, especially in the feet
• Burning or sharp pain
• Pain from light touches
• Loss of balance

Motor neuropathy

Symptoms include:

• Muscle twitching and cramps
• Muscle weakness or paralysis
• Muscle thinning
• Difficulty lifting the front of your foot (foot drop)

Autonomic neuropathy

Symptoms include:

• Digestive issues like constipation or diarrhea
• Nausea and bloating
• Low blood pressure, causing dizziness
• Rapid heartbeat
• Excessive or lack of sweating
• Sexual dysfunction
• Bladder control problems

Mononeuropathy

Mononeuropathy affects only one nerve. Symptoms depend on the nerve affected but may include:

• Altered sensation in fingers
• Double vision
• Weakness on one side of the face (Bell’s palsy)
• Foot or shin pain

Carpal tunnel syndrome is a common type of mononeuropathy.

Neuropathy diagnosis

Neuropathy is diagnosed by a general practitioner and/or a neurologist. Common tests include blood tests, nerve conduction tests (NCT), electromyography (EMG), and scans like X-rays, MRIs, and CT scans.

There are three patterns of nerve degeneration in neuropathy:

• Segmental demyelination: Damage to the myelin sheath (the insulating layer formed around the nerve)
• Wallerian degeneration: Damage to the nerve axon due to lack of nutrients
• Axonal degeneration: The far end of a nerve fiber deteriorates, spreading closer to the neuron over time

Neuropathy prognosis

Neuropathy doesn’t usually reduce life expectancy, but this can depend on its cause. It can significantly impact quality of life (QoL). Some symptoms may improve if the underlying cause is treated, but in other cases, the damage may worsen or be permanent. Left untreated, neuropathy can develop into severe complications, such as foot ulcers or heart problems. This can lead to gangrene and amputation, which can impact life expectancy.

Neuropathy treatments

Treatment often involves lifestyle changes like controlling blood sugar and reducing alcohol or tobacco use.

Medications for nerve pain, known as “neuropathic pain agents,” differ from those used for other chronic pain. Opioids are rarely effective for neuropathic pain. Anticonvulsants like gabapentin and pregabalin, as well as certain antidepressants, are more commonly used. In some cases, opioids may be prescribed, but these can have side effects like drowsiness and addiction.

Non-drug treatments include physiotherapy, exercise, and high-vitamin diets. Medical cannabis is also an option for some.

First line treatments

First-line treatments include lifestyle changes like reducing sugar, alcohol, and tobacco, along with physiotherapy and exercise. Common first-line medications include NSAIDs, amitriptyline, SNRIs, and anticonvulsants.

Other treatments

Second-line treatments for peripheral neuropathy may include lidocaine or capsaicin topicals. In severe cases, opioids may be prescribed, though they are not usually recommended for chronic pain.

Adjunctive therapy & alternative treatments

Low-impact exercises like walking and swimming, along with practices like Tai Chi and Yoga, can help with neuropathic pain. Supplements, antioxidants, and acupuncture are other options.

Cannabis for neuropathy (nerve pain)

The endocannabinoid system (ECS) helps regulate pain and inflammation. Cannabinoids like THC and CBD can reduce nerve pain by altering how pain signals are processed. Medical cannabis contains various cannabinoids and terpenes that may help manage different types of nerve pain. Cannabinoids and terpenes of particular interest include THC, CBD, CBG, THCV, beta-caryophyllene, humulene, geraniol, and myrcene.

Additional information for patients

There are many charities and organizations that provide support for people with neuropathy, such as The Foundation for Peripheral Neuropathy and the U.S. Pain Foundation.

Insurance may cover treatments like acupuncture, medications, physical therapy, and mental health services, although some may require out-of-pocket payments.

Neuropathy FAQs

What causes neuropathy?

Neuropathy is caused by damage to the myelin sheath around nerves. It can result from conditions like cancer, diabetes, HIV/AIDS, MS, Parkinson’s disease, and more.

Can neuropathy go away?

Neuropathy isn’t curable, but it can be managed to prevent worsening. This includes lifestyle changes, supplements, exercise, and medication.

What is the life expectancy of a person with neuropathy?

Neuropathy itself doesn’t reduce life expectancy, but the underlying cause may. It can, however, greatly affect quality of life.

What condition can be mistaken for neuropathy?

Radiculopathy, which has similar symptoms, can often be mistaken for neuropathy.

Resources

• Diabetic Peripheral Neuropathy: https://www.ncbi.nlm.nih.gov/books/NBK442009/
• Charcot-Marie-Tooth Disease: https://emedicine.medscape.com/article/1232386-overview?form=fpf
• Neuropathy: https://www.ncbi.nlm.nih.gov/books/NBK542220/
• Cannabinoid Therapeutics in Chronic Neuropathic Pain: From Animal Research to Human Treatment: https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.785176/full
• Terpenes from Cannabis sativa Induce Antinociception in Mouse Chronic Neuropathic Pain via Activation of Spinal Cord Adenosine A2A Receptors: https://pmc.ncbi.nlm.nih.gov/articles/PMC10081257/

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