Peripheral neuropathy not always caused by diabetes

Dear Doctor K: I have peripheral neuropathy. I know that people with diabetes often get neuropathy, but I’m not diabetic. What else can cause this condition? And what can I do about it?

Critical illness, particularly if you develop a severe inflammatory response to infection.

Guillain-Barre syndrome. This uncommon autoimmune disorder damages the peripheral nerves.

Chemotherapy cancer treatment. Diagnosing peripheral neuropathy is best done by electromyography (EMG) and nerve conduction studies (NCS). Such testing often is not necessary, as your symptoms, your medical history and your doctor’s physical examination make the diagnosis likely.

Treatment of peripheral neuropathy begins with treating the underlying cause of the condition. For example, let’s say your neuropathy is related to heavy drinking. You should severely restrict, or better yet abstain, from alcohol. If your neuropathy is caused by hypothyroidism, treatment with replacement doses of thyroid hormone should help.

The other goal of treatment is to relieve symptoms. In particular, treatment targets pain caused by peripheral neuropathy. Several medications can help. Gabapentin, an anticonvulsant medication, is usually effective. Tricyclic antidepressants can also effectively relieve pain.

Finally, while neuropathy itself causes pain, it (strangely enough) reduces sensitivity to pain caused by outside injuries. This makes you particularly vulnerable to foot damage. If you develop a cut or sore on your foot, without pain to alert you, you may not even notice the injury. Untreated, a simple wound may become severely infected. To prevent this, carefully check your feet every day and treat any foot injury immediately.

(This column ran originally in October 2013.)