- Autoimmune diseases. In diseases such as Sjögren’s syndrome (best known for its symptoms of dry eyes and dry mouth), lupus and rheumatoid arthritis, the immune system attacks parts of the body, including nerves.
- Infections. Many infectious diseases, including COVID-19, hepatitis C, hepatitis B and Lyme disease, can cause neuropathy. Shingles, caused by the herpes zoster virus, sometimes causes nerve pain that lingers for months or years.
- Alcohol and other toxins. “Alcohol is a nerve toxin, so that if it’s consumed in excess, especially by those with poor nutritional status, it can damage the nerves,” Latov says. Mercury, lead and arsenic are among other nerve toxins.
- Genes. Some rare disorders, including Charcot-Marie-Tooth disease, are inherited forms of neuropathy.
In about one quarter of cases, no underlying cause is found. But many people in that group have the same risk factors — such as obesity, high cholesterol and high blood pressure — commonly found in people with type 2 diabetes, Smith says. So, he says, the underlying mechanisms could be similar.
Can neuropathy be treated?
There are treatments for neuropathy. However, they mostly aim at underlying causes and symptoms. “By and large, once you have an established neuropathy, it’s hard to reverse it,” Smith says, but the damage often can be slowed.
For people with diabetes, treatment includes blood sugar control, along with changes in diet and exercise to improve overall metabolic health, experts say. Anyone with neuropathy in their feet should see a podiatrist and establish a foot care routine to prevent injuries and infection, Feldman adds.
Some patients need pain medication, but “not all [medications] work for all patients,” Latov says. When one regimen doesn’t work, he says, “it’s important not to give up and to keep trying.”
Mental health care and physical therapy also can help, the doctors say.
It is possible to reduce your risks for many common forms of neuropathy. The Mayo Clinic recommends:
- Eating plenty of fruits, vegetables, whole grains and lean protein.
- Getting enough vitamin B-12. Some people, including vegetarians and vegans, may need fortified foods or supplements.
- Exercising regularly, aiming for at least 30 minutes to one hour at least three times a week.
- Avoiding toxic chemicals, smoking and heavy alcohol use, as well as repetitive motions and cramped positions that put pressure on nerves.
The Centers for Disease Control and Prevention also recommends that all adults over age 50 get vaccinated against shingles.