Department: Ask the Experts
B. Dyck, P. James. M.D.
P. James. B. Dyck, M.D., is co-director of the Peripheral Nerve Laboratory at the Mayo Clinic in Rochester, MN.
Q How can you tell if your neuropathy is getting worse? Is pain a reliable yardstick? My balance and speech continue to worsen, but I have no pain, just cramps.
A Peripheral neuropathy results from damage to nerves, which can result in pain but doesn't always. In fact, some types of neuropathy are not painful. People also define pain differently. I define pain as anything that is uncomfortable, whereas someone else might consider that same sensation simply “discomfort.” Pain also fluctuates naturally; some days it will be worse, other days it will be better, and this doesn't necessarily mean your neuropathy has improved or gotten worse.
Figure. DR. P. JAMES...Image Tools
In other words, just because the pain gets better, it doesn't mean your neuropathy has improved. In fact, sometimes a decrease in pain can mean your neuropathy is getting worse. Here's an example: It's not uncommon for people with peripheral neuropathy to have short-circuiting, backfiring neurons and axons that are ill and causing pain. Over time, those fibers may undergo degeneration and die, which means the neuropathy is worse because of the loss of more nerve fibers. This may cause increased numbness, but it usually causes the pain to get better. In this scenario, less pain means greater degeneration.
The most reliable symptom to measure whether you are getting better or worse is weakness. If your weakness is getting better, then your neuropathy is getting better. The second most reliable thing to follow is numbness. If you have increased numbness and loss of sensitivity, your neuropathy is probably getting worse.