Pain, Numbness, Tingling, Weakness: What's Causing It?

Nerve conditions in the body

There are two likely culprits--and it's important to know the difference.

Neuropathy and radiculopathy are nerve conditions that share similar symptoms—pain, numbness, tingling—but have very different causes. Telling the difference between the two isn’t just tricky for ordinary patients. Even healthcare professionals have been known to get them mixed up. In rare cases, patients have even had unnecessary surgery. "It’s so important to distinguish these two causes," says Paul Abend, DO, FAAPMR, Medical Director, Inpatient and Outpatient Rehabilitation Services, at Robert Wood Johnson University Hospital (RWJUH) Rahway. "The treatments are completely different."

Neuropathy

The more common of the two conditions, it is also often called peripheral neuropathy. That’s because it is the result of damage to nerves outside of, or peripheral to, the central nervous system, which consists of the brain and spinal cord. Symptoms: Weakness, pain, numbness, tingling or a "pins and needles" sensation are common signs. They can appear almost anywhere but often begin in hands or feet.

Causes: Dabetes is the most common, but injuries, infections, autoimmune disease, hereditary factors and even chemotherapy can also cause it.

Diagnosis: “You have to do a detailed medical history—85 percent of the diagnosis is in the history" says Dr. Abend. "Then you need a good physical exam. "Only then" Dr. Abend says, "should the physician proceed with tests EMG [electromyography], which measures muscle response, and nerve conduction studies are the gold standard, he says. If necessary Dr. Abend may use CT (computed tomography) or MRI (magnetic resonance imaging) scans to get more information.

Treatment: Different types of neuropathy may call for different treatments. Dr. Abend has had success with one called MicroVas, in which electrical stimulation boosts blood flow and helps heal damaged nerves. Physical therapists at RWJUH Rahway administer MicroVas along with gait and balance retraining. Topical treatments or pain relievers may also be used.

Radiculopathy

This pain begins at the root of nerves near the spinal column, and can originate at various locations along the spine.

Symptoms: Similar to neuropathy, radiculopathy can manifest as numbness and tingling, weakness or sharp pain.

Cause: A nerve root gets pinched in the spinal column, a result of spinal stenosis (a narrowing of the spaces within the spine) a herniated (slipped or ruptured) disk or a bone spur (an outgrowth of a bone that occurs along its edges).


Diagnosis: An extensive medical history and exam should be done, followed by the same tests as those done for neuropathy.

Treatment: Medications or steroid injections can help manage the pain. So can physical therapy to strengthen muscles, and weight loss to reduce pressure on the area. In some cases, surgery to relieve compression on nerves is recommended.

Some patients may have both radiculopathy and neuropathy, with overlapping symptoms. "No matter what the condition, the goal is to have it treated it appropriately in order to increase functionality, to be pain-free and to maintain balance," says Dr. Abend. "When your physician does a thorough exam and takes the time to really listen, it’s usually pretty obvious what’s going on."

To learn about peripheral neuropathy treatment at RWJUH Rahway, call the Rehabilitation Department at 732.499.6012