Spine & Orthopedic Pain Centers


Neuropathy means nerve disorder or progressive loss of nerve function. It is common in people with poorly controlled diabetes. Two classification systems for diabetic neuropathy are the Thomas system and the symmetrical-versus-asymmetrical system.

The Thomas system (modified) is as follows:

  • Hyperglycemic neuropathy
  • Generalized symmetrical polyneuropathies
  • Sensory neuropathy
  • Sensorimotor neuropathy
  • Autonomic neuropathy—affecting internal organs like the GI tract
  • Focal and multifocal neuropathies
  • Superimposed chronic inflammatory demyelinating polyneuropathy


Distal symmetrical sensorimotor polyneuropathy is commonly defined according to the following 3 key criteria:

  • The patient must have diabetes mellitus consistent with a widely accepted definition
  • Severity of polyneuropathy should be consistent with the duration and severity of diabetes
  • Other causes of sensorimotor polyneuropathy must be excluded

Pure autonomic diabetic neuropathy is rare.



Asymmetrical neuropathies include the following:

  • Median neuropathy of the wrist (carpal tunnel syndrome)
  • Other single or multiple limb mononeuropathies
  • Thoracic radiculoneuropathy (affecting the nerves from the thoracic spine)
  • Lumbosacral radiculoplexus neuropathy (affecting the nerves from the lumbar and sacral spine)
  • Cervical radiculoplexus neuropathy (affecting nerves from the cervical or neck region of the spine)


  • Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking-and-glove distribution in the distal extremities
  • Motor – Distal, proximal, or more focal weakness, sometimes occurring along with sensory neuropathy (sensorimotor neuropathy)
  • Autonomic – Neuropathy that may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands

Consult with a pain management doctor if you are experiencing any of these symptoms.

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