What is Toxic Neuropathy

Toxic neuropathy is nerve damage that is caused by poisons or chemicals (toxins). These toxins may be in a medicine or drug, in the environment, or at the workplace.

Some examples include prescription medicines, industrial chemicals, poisons found in water or soil, insecticides, and cleaning solvents. These types of toxins can damage:

• Nerve cells.
• Nerve fibers.
• Covering of a nerve fiber.

The most common type of toxic neuropathy is damage to nerve cells that are farthest away from where the nerve leaves the spinal cord. In most cases, toxic neuropathy affects the nerves that go to the feet first. Toxic neuropathy can also damage nerve cells in the hands, arms, and legs. Damage from toxic neuropathy may improve slowly over time or it may be permanent.

What are the causes?

Many toxins can cause toxic neuropathy. Some common examples include:

• Drugs.
• Alcohol.
• Pesticides.
• Medicines for treating cancer (chemotherapy).
• Lead.
• Zinc.
• Mercury.
• Arsenic.
• Toxins found in fish or shellfish.
• Antifreeze.
• Industrial chemicals like toluene.

What are the signs or symptoms?

Symptoms of toxic neuropathy can occur in the legs, hands, and arms. They can include:

• Pain.
• Loss of feeling (numbness) in the legs, hands, or arms.
• Tingling in the legs, hands, or arms.
• Weakness.
• Trouble walking.

Symptoms in other parts of the body are less common and can include:

• Abnormal sweating or flushing.
• Diarrhea or constipation.
• Slow digestion, causing fullness or bloating.
• Trouble passing urine.
• Blurred vision.
• Feeling dizzy.
• Sexual function problems.
• Cramping.
• A strong urge to move the legs (restless legs).

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history. You will be asked about medicines or chemical exposure.
• A physical exam. Your health care provider will check for numbness and weakness.

You may need to see a nerve specialist (neurologist) and have other tests to find the cause of your condition. These tests may include:

• A neurological exam.
• Blood and urine tests.
• Electromyogram (EMG) and nerve conduction tests. These tests check nerve function.

How is this treated?

This condition may be treated by:

• Eliminating exposure to the toxin. You may need to stop taking certain medicines, or remove contact with toxins in the environment.
• Medicine to relieve pain, such as:
  • Medicines that treat seizures (antiseizure medicines).
  • Medicines that treat depression (antidepressants).
  • Patches that are applied to the skin.
• Physical therapy to help with movement, balance, and muscle strength.
• Occupational therapy to learn ways to function with the condition.
• Devices to help you move around (assistive devices).
• Cold or heat therapy on the affected area.
• Low-intensity transcutaneous electrical nerve stimulation (TENS).
• Acupuncture.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. Smoking keeps blood from reaching damaged nerves. If you need help quitting, ask your health care provider.
• Avoid or limit alcohol. Too much alcohol can cause a vitamin B deficiency, and vitamin B is needed for healthy nerves.
• Eat a healthy diet. This includes:
  • Eating foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limiting foods that are high in fat and processed sugars, such as fried or sweet foods.

Managing pain and discomfort

• If directed, work with a certified massage therapist to help relieve pain.
• If directed, apply heat to the affected area as often as told by your health care provider. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad. To do this:
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
• If directed, put ice on the painful area. To do this:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Safety

• Take care to avoid burning or damaging your skin if you have numbness.
• If you have numbness in your feet:
  • Check every day for signs of injury or infection. Watch for redness, warmth, and swelling.
  • Wear padded socks and supportive shoes. These help protect your feet.

General instructions

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Use assistive devices and attend physical therapy as told by your health care provider. This may include using a walker or a cane.
• Develop a good support system. Having toxic neuropathy can be stressful.
• Work with a pain specialist to find the best way to manage your pain. Ask about acupuncture, TENS therapy, or meditation techniques.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms do not improve or get worse.
• You have new symptoms of toxic neuropathy.
• You are struggling emotionally from dealing with toxic neuropathy.
• Your pain is not well-controlled.
• You have side effects from any of your medicines.

Get help right away if you:

• You have an injury or infection that is not healing normally.
• You have new weakness in an arm or leg.
• You fall frequently.

Summary

• Toxic neuropathy is nerve damage caused by poisons or chemicals.
• The most common symptoms are pain, numbness, and tingling in your feet, legs, hands, or arms.
• Eliminating exposure to the toxin is the most important part of treatment. Other treatments may be given to relieve the symptoms of neuropathy.
• Recovering from toxic neuropathy takes time. Damage may be permanent in some cases.