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

Nerve pain medicines are sometimes called “neuropathic pain drugs.” These medicines are different from those used for regular pain. Strong painkillers like opioids usually don’t work well for nerve pain, but doctors may use them for very severe cases. Medicines like pregabalin and gabapentin, which are usually used for epilepsy, can help with nerve pain.

Some antidepressants, like tricyclic antidepressants (TCAs) such as imipramine, can also be useful for nerve pain. Other types of antidepressants, like serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, can help manage nerve pain, especially if it’s linked to fibromyalgia.

For nerve pain felt on the skin, creams like capsaicin can be helpful. Creams with steroids or lidocaine can also help. Eating foods rich in vitamins might make a difference too. For nerve pain that causes headaches or migraines, medicines like amitriptyline are often used.

Non-drug treatments include physical therapy and tools like walking aids.

First line treatments

The first steps to treat neuropathy usually involve lifestyle changes, such as cutting down or avoiding processed sugar, alcohol, and smoking. Doctors may also recommend exercise or physical therapy plans.

The most common medicines used first include non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve or Motrin for pain relief. Amitriptyline can help with pain, headaches, and depression. SNRIs like duloxetine can help with pain, bladder issues, and depression. Gabapentin and pregabalin can be used to manage pain and muscle spasms.

Other treatments

For people with peripheral neuropathy, doctors might recommend lidocaine or capsaicin patches. Lidocaine works by blocking pain signals, while capsaicin can reduce pain and swelling. In very serious cases, strong painkillers like tramadol or morphine might be used, though they are not ideal for long-term nerve pain.

Adjunctive therapy & alternative treatments

Low-impact activities like walking or swimming can help reduce nerve pain. Practices like Tai Chi, yoga, stretching, and meditation can lower stress and improve posture. Supplements, such as omega-3s, alpha-lipoic acid, CoQ10, and acetyl-l-carnitine, may help protect nerves and reduce pain. Acupuncture might also provide relief for some people.

Cannabis for neuropathy (nerve pain)

The endocannabinoid system (ECS) plays a role in controlling inflammation and pain signals in the body. CB1 receptors in the brain help manage pain signals, while CB2 receptors in the immune system help control inflammation. When nerves are damaged, they can become overly sensitive, causing more pain. Cannabinoids from cannabis can help reduce this pain by calming down these overactive nerves.

Medical cannabis contains compounds that may help nerve pain, including:

• THC: Reduces pain
• CBD: Lowers inflammation and may help with nerve pain by calming pain receptors
• CBG and CBC: Help protect and grow nerve cells
• CBN: Supports sleep
• THCV: May help with diabetic nerve pain by improving insulin sensitivity

Certain terpenes (plant compounds) in cannabis can also help:

• Beta-caryophyllene: Reduces stress and inflammation
• Myrcene: Helps reduce pain
• Linalool: Can ease pain from non-painful triggers
• Humulene: May help with sleep and reduce pain
• Pinene: May prevent nerve pain
• Limonene: Helps with mood, nerve repair, and pain
• Camphene: Reduces inflammation and nerve pain

These natural compounds work together to provide relief from nerve pain and related symptoms.

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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