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Neuropathy, also known as peripheral neuropathy, is a common medical problem caused by damage and dysfunction to one or more peripheral nerves, which are the nerves connecting the brain and spinal cord to the rest of the body. There are three different types of nerves: sensory, motor, and autonomic (controlling reflexive/automatic body processes like blood pressure, heart rate, temperature regulation, sweating, etc.).

It is a very common problem, seen in about 3-4% of people, and it’s particularly common in people over 55. About one third of cases are due to diabetes, and another third are termed idiopathic, a fancy sounding term just meaning that we can’t determine that cause of the problem (though a medical school professor of mine uncharitably suggested that it came from the idea that your doctor is an idiot, and that’s pathetic). The remaining third are from a range of identified causes such as chemotherapy or other medications, autoimmune diseases, infections, nutritional deficiencies, metabolic disorders, or genetic-mediated nerve damage.

Neuropathy is most colloquially noted to represent numbness and tingling, but it can range from a slight hint of numbness to debilitating neurologic problem that makes it difficult or impossible to ambulate and can be associated with chronic pain. Sensory neuropathy is often described as numbness and tingling that can lead to difficulty in walking, dropping things, inability to turn pages, pick up small objects, button a button, etc., and sometimes a general feeling like a person is wearing gloves or walking on hot sand or a shag carpet all the time. Autonomic neuropathy involving the internal organs can lead to constipation or diarrhea, low blood pressure and lightheadedness, or even difficulty with breathing.

In patients with cancer, the most common causes of neuropathy are:

• directly caused by chemo, radiation, or surgery
• cancer directly pressing on nerves (such as spinal cord compression from expansile vertebral metastases)
• metabolic disorders
• paraneoplastic (such as hormone- or antibody-mediated) neurologic disorders
• infections
• nutritional deficiencies

We’ll cover some details of chemotherapy-induced neuropathy next.