What is peripheral neuropathy?
Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body.
How common is peripheral neuropathy?
Peripheral neuropathy is common. It can occur at any age, but is more common among older adults. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of peripheral neuropathy?
The common symptoms of peripheral neuropathy are:
- Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
- Sharp, jabbing, throbbing, freezing or burning pain
- Extreme sensitivity to touch
- Lack of coordination and falling
- Muscle weakness or paralysis if motor nerves are affected
If autonomic nerves are affected, signs and symptoms might include:
- Heat intolerance and altered sweating
- Bowel, bladder or digestive problems
- Changes in blood pressure, causing dizziness or lightheadedness
Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet.
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes peripheral neuropathy?
Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Causes of neuropathies include:
- Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
- Autoimmune diseases. These include Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and necrotizing vasculitis.
- More than half the people with diabetes develop some type of neuropathy.
- Exposure to poisons. Toxic substances include heavy metals or chemicals.
- Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
- These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis C, leprosy, diphtheria and HIV.
- Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
- Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
- Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body’s immune response. These are a form of paraneoplastic syndrome.
- Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.
- Bone marrow disorders. These include abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (osteosclerotic myeloma), lymphoma and amyloidosis.
- Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).
In a number of cases, no cause can be identified (idiopathic).
What increases my risk for peripheral neuropathy?
There are many risk factors for peripheral neuropathy, such as:
- Diabetes mellitus, especially if your sugar levels are poorly controlled
- Alcohol abuse
- Vitamin deficiencies, particularly B vitamins
- Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis C and HIV
- Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues
- Kidney, liver or thyroid disorders
- Exposure to toxins
- Repetitive motion, such as those performed for certain jobs
- Family history of neuropathy
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is peripheral neuropathy diagnosed?
Besides a physical exam, which may include blood tests, diagnosis usually requires:
- A full medical history.
- Neurological examination.
Your doctor may order tests, including:
- Blood tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy.
- Imaging tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities.
- Nerve function tests. Electromyography records electrical activity in your muscles to detect nerve damage. A probe sends electrical signals to a nerve, and an electrode placed along the nerve’s pathway records the nerve’s response to the signals (nerve conduction studies).
- Other nerve function tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test, and sensory tests that record how you feel touch, vibration, cooling and heat.
- Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities.
- Skin biopsy.Your doctor removes a small portion of skin to look for a reduction in nerve endings.
How is peripheral neuropathy treated?
Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include:
- Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.
- Medications containing opioids, such as tramadol (Conzip, Ultram) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are prescribed only when other treatments fail.
- Anti-seizure medications.Medications such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.
- Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can’t tolerate it.
- Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch.
- Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
- The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also might ease the pain of peripheral neuropathy caused by diabetes. Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation.
Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.
- Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.
- Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).
- Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair.
Surgery. If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure.
Some people with peripheral neuropathy try complementary treatments for relief. Although researchers haven’t studied these techniques as thoroughly as they have most medications, the following therapies have shown some promise:
- Acupuncture. Inserting thin needles into various points on your body might reduce peripheral neuropathy symptoms. You might need multiple sessions before you notice improvement. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
- Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years. Discuss using alpha-lipoic acid with your doctor because it can affect blood sugar levels. Other side effects can include stomach upset and skin rash.
- Herbs. Certain herbs, such as evening primrose oil, might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so discuss herbs you’re considering with your doctor.
- Amino acids. Amino acids, such as acetyl-L-carnitine, might benefit people who have undergone chemotherapy and people with diabetes. Side effects might include nausea and vomiting.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage peripheral neuropathy?
The following lifestyles and home remedies might help you cope with peripheral neuropathy:
To help you manage peripheral neuropathy:
- Take care of your feet,especially if you have diabetes. Check daily for blisters, cuts or calluses. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet.
- Exercise. Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help.
- Quit smoking.Cigarette smoking can affect circulation, increasing the risk of foot problems and other neuropathy complications.
- Eat healthy meals.Good nutrition is especially important to ensure that you get essential vitamins and minerals. Include fruits, vegetables, whole grains and lean protein in your diet.
- Avoid excessive alcohol. Alcohol can worsen peripheral neuropathy.
- Monitor your blood glucose levels. If you have diabetes, this will help keep your blood glucose under control and might help improve your neuropathy.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Understanding Peripheral Neuropathy — the Basics. http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#1. Accessed June 28, 2017.
Peripheral neuropathy. http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/home/ovc-20204944. Accessed June 28, 2017.
Neuropathy: Causes, Symptoms and Treatments. http://www.medicalnewstoday.com/articles/147963.php. Accessed June 28, 2017.
Neuropathy: Causes, Symptoms and Treatments.
Review Date: June 28, 2017 | Last Modified: June 28, 2017