What is peripheral neuropathy?
Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased.
The peripheral nerves make up an intricate network that connects the brain and spinal cord to the muscles, skin, and internal organs. Peripheral nerves come out of the spinal cord and are arranged along lines in the body called dermatomes. Typically, damage to a nerve will affect one or more dermatomes, which can be tracked to specific areas of the body. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain.
How common is peripheral neuropathy?
Please discuss with your doctor for further information.
What are the symptoms of peripheral neuropathy?
Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:
- Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin
- Motor nerves that control muscle movement
- Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder
Signs and symptoms of peripheral neuropathy might include:
- 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?
You should contact your doctor if you have any of the following:
- Unusual tingling, weakness or pain in your hands or feet.
What causes peripheral neuropathy?
There are many factors that can cause peripheral neuropathies, so it is often difficult to pinpoint the origin. Neuropathies occur by one of three methods:
- Acquired neuropathies are caused by environmental factors such as toxins, trauma, illness, or infection. Known causes of acquired neuropathies include:
- Several rare inherited diseases
- Poor nutrition or vitamin deficiency
- Certain kinds of cancer and chemotherapy used to treat them
- Conditions where nerves are mistakenly attacked by the body’s own immune system or damaged by an overaggressive response to injury
- Certain medications
- Kidney or thyroid disease
- Infections such as Lyme disease, shingles, or AIDS
- Hereditary neuropathies are not as common. Hereditary neuropathies are diseases of the peripheral nerves that are genetically passed from parent to child. The most common of these is Charcot-Marie-Tooth disease type 1. It is characterized by weakness in the legs and, to a lesser degree, the arms — symptoms that usually appear between mid-childhood and age 30. This disease is caused by degeneration of the insulation that normally surrounds the nerves and helps them conduct the electrical impulses needed for them to trigger muscle movement.
- Idiopathic neuropathies are from an unknown cause. As many as one-third of all neuropathies are classified in this way.
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?
Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:
- A full medical history. Your doctor will review your medical history, including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases.
- Neurological examination. Your doctor might check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.
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?
Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.
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.
- If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure.
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:
- 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.
- 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.
Review Date: November 28, 2017 | Last Modified: December 8, 2019
Peripheral neuropathy. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061. Accessed November 28, 2017.
Understanding Peripheral Neuropathy -- the Basics. https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3-7. Accessed November 28, 2017.