What is neuropathy?
Neuropathy refers to damage to the peripheral nerves that carry information between the brain and spinal cord and the rest of the body. Peripheral neuropathy often affects the hands and feet first, causing symptoms like tingling, numbness, burning pain, and weakness. There are over 100 different types of peripheral neuropathy, each with its own causes and symptoms. Some common forms include:
Diabetic neuropathy
Diabetic neuropathy is a complication of diabetes that causes nerve damage over time. High blood sugar levels associated with diabetes can damage and irritate nerves, reducing sensation and sometimes leading to pain or numbness. If left uncontrolled, diabetic neuropathy can impair sensation in the feet, increasing the risk of foot injuries and amputations. Diabetic neuropathy may also affect digestion, urination, sexual function, and cardiac function. Managing blood sugar levels is crucial for preventing and slowing the progression of diabetic neuropathy.
Chemotherapy-induced neuropathy
Some chemotherapy drugs used to treat cancer can damage peripheral nerves, causing neuropathy symptoms. Symptoms usually start in the hands and feet with tingling or numbness. Chemotherapy-induced neuropathy may resolve after treatment ends, but can sometimes persist and become disabling. There are treatments to help reduce discomfort, but no way to reverse nerve damage caused by chemotherapy.
Idiopathic peripheral neuropathy
Idiopathic peripheral neuropathy has no known cause. It may related to autoimmune diseases, viral infections, or toxic exposures. Symptoms are usually mild at first but get worse over time. Managing symptoms is the main treatment approach.
Neuropathy from trauma/injury
Injuries, repetitive stress, compression, or physical trauma to nerves can all cause acute and chronic neuropathic pain and numbness. Carpal tunnel syndrome is one of the most common trauma-induced neuropathies, caused by compression of the median nerve in the wrist. Prompt treatment of any new neuropathies is important to try to prevent permanent nerve damage.
How can neuropathy lead to injury or death?
While neuropathy itself is not fatal, it can increase the risk of severe injuries and health complications that may indirectly lead to death in some cases. Here are some of the ways neuropathy can have fatal consequences:
Falls and fractures
Numbness and loss of sensation in the feet due to neuropathy removes an important protective mechanism – the ability to feel injuries and irritation. This lack of sensation increases the risk of foot ulcers, open sores and infections going unnoticed. Neuropathy can also lead to muscle weakness and loss of reflexes and proprioception, which maintains balance. All of these factors significantly increase the risk of falls, especially in the elderly. Falls cause millions of fractures every year, with hundreds of thousands being hip fractures. Broken hips have a high mortality rate in the elderly, with studies showing up to 10% dying within one month of their fracture. Preventing falls through exercise, assistive devices and by treating neuropathy can help reduce fracture-related deaths.
Cardiovascular disease
Autonomic neuropathy affects the nerves that control involuntary functions like heart rate, blood pressure and digestion. Damage to these nerves can disrupt cardiovascular function, making the heart prone to arrhythmias, slowed heart rate variability and hypotension. This cardiac instability can lead to heart attacks and sudden death. Treating the underlying causes of autonomic neuropathy may help stabilize cardiovascular health.
Infections
As mentioned above, people with neuropathy often develop foot ulcers that they do not feel due to numbness. These ulcers can become infected, leading to cellulitis or potentially limb-threatening infections. Neuropathy-related foot infections are the leading cause of hospitalizations for people with diabetes. Severe foot infections may spread to the bone (osteomyelitis) and require intravenous antibiotics or amputation. In rare cases, severe infections that go untreated can become life-threatening. Daily foot inspections, prompt treatment of any wounds, use of diabetic footwear and keeping blood sugar under control can help prevent infections.
Heat illness
Autonomic neuropathy can disrupt sweating, body temperature regulation and thirst perception. This makes people with neuropathy prone to overheating and heat stroke in hot weather. Cases of people with diabetic neuropathy dying from heat stroke have been reported during heat waves. Air conditioning, hydration,frequent cooling breaks and monitoring body temperature can help prevent hyperthermia.
Hypoglycemia unawareness
In people with diabetes, neuropathy can cause hypoglycemia unawareness. This means they no longer experience the warning signs of low blood sugar like shakiness, anxiety, sweating and rapid heartbeat. Without awareness of hypoglycemia, severe low blood sugar can progress to loss of consciousness, seizures and even death. Wearing a continuous glucose monitor allows people with hypoglycemia unawareness to track their blood sugar trends and alert them to drops before they become dangerously low.
Who is most at risk of fatal neuropathy complications?
While anyone with peripheral neuropathy is at increased risk of injuries and health issues, certain groups have even higher odds of suffering fatal consequences:
The elderly
Older adults with neuropathy are more likely to fall and less likely to recover well from resulting injuries like hip fractures. Age-related conditions like osteoporosis also contribute to the high mortality rate from falls and fractures. Autonomic neuropathy can be especially dangerous for seniors too, increasing their cardiovascular risk.
People with diabetes
At least 50% of people with diabetes eventually develop neuropathy, putting them at very high risk for infections, hypoglycemia unawareness, heat illness, cardiovascular disease and falls. Good diabetes management can prevent or delay neuropathy and its complications.
Cancer patients undergoing chemotherapy
Chemotherapy-induced neuropathy affects over 68% of cancer patients, peaking in severity 3-5 months after treatment. The acute numbness in the hands and feet increases fall risk during this time. Lingering neuropathy symptoms combined with general chemotherapy side effects like fatigue and weakness leave patients vulnerable to injuries.
People with HIV/AIDS
Over 35% of people living with HIV experience peripheral neuropathy, either from the virus itself or as a side effect of antiviral medications. Autonomic neuropathy is also common, increasing cardiovascular risks. People with HIV are already at higher risk of infections, so any neuropathy-related wounds or ulcers raise concerns.
People with chronic alcoholism
Alcoholism is one of the most common causes of peripheral neuropathy. Chronic heavy drinking can damage nerves in multiple ways, including direct toxicity, vitamin deficiencies and organ damage. Alcoholic neuropathy combined with intoxication, alcohol withdrawal, seizures, liver disease and poor health make for potentially deadly outcomes.
How can fatal risks be reduced?
While neuropathy can indirectly lead to grave outcomes, there are ways to lower risks:
- Treat any underlying cause of neuropathy, such as diabetes, vitamin deficiencies, autoimmune disorders, etc.
- Keep blood sugar tightly controlled if diabetic
- Maintain a healthy weight and nutrition
- Take neuropathy medications as prescribed to manage pain and discomfort
- Wear properly fitted footwear and avoid going barefoot
- Inspect feet daily and treat any wounds immediately
- Exercise to build strength and improve balance
- Have vision and hearing checked and use recommended aids
- Remove tripping hazards and install grab bars in the home
- Stay hydrated and avoid extreme heat
- Monitor body temperature with autonomic neuropathy
- Use air conditioning as needed
- Wear a medical alert bracelet about neuropathy
- Use a continuous glucose monitor if diabetic
- Receive all recommended vaccines
- Seek emergency care for any suspected infections
- Follow up regularly with a podiatrist, primary doctor, neurologist
Treatment
While neuropathy cannot be reversed, early treatment provides the best chance of managing or slowing progression of nerve damage. Lifestyle modifications, pain medications, physical therapy, surgery and other therapies may improve neuropathy symptoms and prevent complications. Close monitoring and follow up care are key, especially for people at high risk of dangerous neuropathy complications.
Conclusion
Peripheral neuropathy affects nerves that relay sensations and movements between the brain and extremities. Damage to these nerves increases risks of falls, changes in cardiovascular function, infections, heat illness, hypoglycemia unawareness and more. While neuropathy alone is rarely fatal, it can set off a cascade of events leading to death in vulnerable people. However, preventing complications through medical treatment, lifestyle changes, awareness of risks and vigilant monitoring can help reduce chances of severe outcomes. Patients with neuropathy should educate themselves on risks, while healthcare providers need to assess risks and provide preventative care. With proper management, most people with neuropathy can enjoy health, function and quality of life despite nerve discomfort and associated challenges.