The 4 Neuropathy Types and How to Treat Them

There are four types of neuropathy: peripheral, autonomic, proximal, and focal. There are many causes of neuropathy and you can also have more than one type. Neuropathy can cause paresthesias (unusual sensations), discomfort, or pain. Usually, the unpleasant sensations can be treated with medication. Sometimes, treating the underlying condition can stop the progression of neuropathy.

This article will discuss the types of neuropathy, their symptoms, and treatment. 

Neuropathy Types 

Neuropathy can affect different nerves throughout the body, usually with a specific pattern of involvement. Sometimes you can have more than one type of neuropathy.

Peripheral Neuropathy

This type of neuropathy affects the nerves that control the movement and sensation of your limbs. Peripheral neuropathy is often described as having a “stocking-glove” pattern because it usually affects the hands and feet more severely than other areas of the body.

Peripheral neuropathy stems from problems that affect the entire body. It also often affects nerves on both sides of the body symmetrically. Common causes include diabetes (especially if blood sugar levels are not well controlled), high amounts of alcohol use, medications such as chemotherapy, and immune disorders.

Autonomic Neuropathy

This type of neuropathy affects the involuntary nerves that control the organs of your body. These nerves control movement of the intestines, heart rate, strength of heart contraction, blood pressure, urination, and more.

Autonomic neuropathy is associated with severe diabetes and systemic illnesses, such as kidney failure and cancer.

Proximal Neuropathy 

Proximal neuropathy is neuropathy that affects nerves of the limbs closer to your torso, such as nerves of the upper arm, shoulder, or thighs. It is less common than other types of neuropathy and can occur on its own or with peripheral neuropathy. Sometimes severe peripheral neuropathy can involve proximal nerves as it progresses.

This type of neuropathy is usually asymmetric (not affecting both sides of the body equally). Causes can include cancer and inflammatory diseases such as Guillain-Barré syndrome (acute demyelinating polyneuropathy), Miller Fisher syndrome, and chronic inflammatory demyelinating polyneuropathy.

Guillain-Barré is also known to involve the muscles that control breathing, which can cause a respiratory emergency.

Focal Neuropathy 

Focal neuropathy is common. It includes conditions like carpal tunnel syndrome and ulnar neuropathy, which are caused by compression of different specific nerves (both affect the hand and wrist). Compression can occur due to pressure, often from prolonged positions, or from overusing the limb in a way that causes inflammation.

Bell’s palsy, which is neuropathy of the motor portion of the facial nerve, can occur due to a viral infection or inflammation, and it is also described as a focal neuropathy.

Trigeminal neuralgia, another type of focal neuropathy, is a painful condition caused by inflammation or irritation of the trigeminal nerve, which controls sensation of the face.

Neuropathy Symptoms 

The symptoms of peripheral neuropathy, proximal neuropathy, and focal neuropathy can include paresthesias, diminished sensation, and weakness. Often, paresthesias are the first noticeable symptoms. Symptoms can come and go, but without treatment, the symptoms will continue to progress over time.

Autonomic neuropathy causes different symptoms that may include diarrhea, constipation, urinary incontinence, lightheadedness, flushing, and more.

Prognosis

Some neuropathies are not expected to improve. Diabetic neuropathy and alcoholic neuropathy, for example, can stabilize with treatment, but the damage is not likely to heal.

Focal neuropathy can improve with treatment, often with complete resolution of symptoms.

Neuropathy Treatment 

Neuropathy can occur due to damage of the myelin, which is a fatty layer of protection surrounding the nerves, or in severe cases, nerve damage may occur. The body naturally can renew myelin, so sometimes demyelination (loss of myelin) can heal if the damage stops occurring.

Usually, treatment of neuropathy is focused on preventing nerve and myelin damage by controlling the underlying cause. Symptomatic treatment is usually necessary to relieve discomfort or pain.

Treatments for neuropathy may include: 

• Optimal blood sugar control to prevent progression of diabetic neuropathy 
• Discontinuing alcohol to prevent progression of alcohol-associated neuropathy 
• Using anti-inflammatory medication to reduce nerve and myelin damage when neuropathy is caused by a systemic inflammatory condition
• Resting, wearing splints, and going to physical therapy for neuropathy that is caused by pressure (such as carpal tunnel syndrome)
• Having surgery to treat compression, such as with carpal tunnel syndrome or ulnar neuropathy 

There are no treatments that can specifically heal a nerve, but sometimes you can use physical therapy to improve your motor function and avoid injuries by learning to adapt and maximize your abilities. 

Symptomatic and Supportive Treatment

The pain of neuropathy can be distressing, and it can interfere with your quality of life and with your ability to be active. Symptomatic treatment is important, but it does not heal the myelin or the nerve and it does not prevent neuropathy from worsening.

Medications that are often used to control neuropathic pain include antidepressants and antiepileptic drugs (AEDs, which typically are used to treat nerve cell activity causing seizures). These medications affect nerve activity in a way that can subdue the pain. Generally, the medications must be taken several times per day for pain relief.

Standard pain medications are not typically effective for controlling neuropathic pain.

Usually, with Guillain Barré, supportive treatment, particularly respiratory support with mechanical ventilation, is needed while anti-inflammatory treatment is used to resolve the condition.

Summary 

Neuropathy is damage or dysfunction of a nerve. This condition can affect any nerve in the body, and the type of nerves and pattern of involvement depend on the cause. Peripheral neuropathy, a common type, is usually caused by diabetes, alcohol overuse, or chemotherapy—and there are many other potential causes.

Autonomic neuropathy and proximal neuropathy affect larger nerves and can cause substantial symptoms. Inflammatory disease is a common culprit. Focal neuropathy is often caused by nerve compression. Treatment of neuropathy is very important for preventing permanent and severe nerve damage.

If you have been diagnosed with neuropathy, it may be concerning. It’s important to get the right treatment for your condition. It can take weeks or longer before you notice the effects of treatment, but do not be discouraged. Some neuropathies can completely resolve, and those that cannot be reversed can often be managed to prevent progression.