Peripheral neuropathy occurs when the nerves outside the spinal cord and the brain are damaged. It causes decreased sensation, pain, numbness, tingling, and sometimes weakness.
Treatments include rest, hot compresses, or taking a limited course of drugs to reduce inflammation.
This article examines peripheral neuropathy and its symptoms, types, causes, treatments, and more.
Peripheral neuropathy is a general term that describes many conditions caused by damage to the peripheral nervous system.
The peripheral nerves are any nerves located outside the spinal cord and brain. They send sensory messages to the central nervous system and receive messages from the spinal cord and brain to move muscles throughout the body.
Peripheral neuropathy can cause a loss of normal nerve signals or cause inappropriate or distorted signals. It affects
The condition can affect various nerves and impact the body in different ways. It can affect a single nerve or several nerves at the same time.
Examples of peripheral neuropathy include:
- postherpetic neuralgia, which can follow shingles and last for many months after the rash disappears
- ulnar nerve palsy, such as after an injury to the elbow.
- carpal tunnel syndrome, which occurs due to compression of the nerves in the wrist.
- peroneal nerve palsy, which is due to compression of the fibular nerve in the leg.
- Bell’s palsy, which is a single-nerve neuropathy that affects the face.
- diabetic or alcohol-related neuropathy, which can cause sensory loss and pain in the hands and feet.
Learn more about peripheral neuropathy.
General symptoms of peripheral neuropathy include:
- prickling or tingling sensations in certain body parts
- a feeling of pins and needles
- burning or sharp pain
- numbness
- weakness
- decreased sensitivity to pain
- reduced ability to feel changes in temperature
However, symptoms of peripheral neuropathy may vary according to the type of neuropathy.
Researchers have identified
Learn more about neuropathic itch.
Generally, experts classify the types into
Sensory neuropathy
This affects the sensory nerves, which impact the sensations of pain, touch, and temperature.
The person may have:
- decreased sensation of vibration and touch
- pins and needles and hypersensitivity
- increased pain or inability to feel pain
- inability to detect changes in heat and cold
- difficulty with coordination and balance
- burning, stabbing, lancing, or shooting pains, which may worsen at night
When sensory neuropathy is due to diabetes, it can also
Motor neuropathy
This affects the muscles that the brain controls consciously.
Symptoms include:
- muscle weakness, leading to instability and difficulty performing small movements, such as buttoning a shirt
- muscle twitching and cramps
- muscle shrinking
Autonomic neuropathy
This affects body processes that the brain controls involuntarily. Symptoms may include:
- abnormal sweat responses
- heat intolerance
- dysregulated body temperature
- problems with bowel or bladder control
- problems with blood pressure
- problems with swallowing
Treatment targets the underlying cause and aims to provide symptomatic pain relief and prevent further damage.
Treatments may
- Maintaining a healthy lifestyle: This can include exercising, eating a balanced, nutritious diet, maintaining a moderate weight, correcting any vitamin deficiencies, and not drinking alcohol or smoking.
- Managing blood sugar: This is particularly important for people with diabetic neuropathy.
- Taking immunosuppressive drugs: This applies when a person has an autoimmune disorder.
- Undergoing plasmapheresis: This procedure involves cleaning the blood to reduce inflammation.
- Avoiding exposure to toxins: Stopping a problematic drug can also help ease symptoms.
- Using mobility and support aids: Wearing hand and foot braces or orthopedic shoes can help people with physical disabilities due to motor symptoms.
Medications for neuropathic pain
Medications that may help relieve pain or discomfort but do not cure the underlying problem
- drugs typically prescribed for epilepsy, such as carbamazepine
- antidepressants, such as venlafaxine
- duloxetine, which may help people with chemotherapy-induced neuropathy.
- prescription skin patches, such as Lidoderm, for temporary, localized pain relief
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which may help control milder pain
- topical ointments and creams that may help ease pain
When choosing a treatment, a person should consider any medications they are taking for other conditions to avoid unwanted interactions. It is always a good idea to talk with a doctor before taking any new medications.
Learn more about remedies for chemotherapy-induced neuropathy.
Treatments for mononeuropathies
When a person’s neuropathy happens as a result of compression of a single nerve, treatment depends on whether the compression is fixed or transient.
A palsy of the ulnar, radial, or peroneal nerve may be temporary and reversible if a person avoids the cause of the nerve compression. For example, a person with ulnar nerve palsy might avoid leaning on the affected elbow.
The person may need to rest, use heat, or take a limited course of drugs to reduce inflammation.
In carpal tunnel syndrome, conservative therapy includes splinting the wrist and taking oral or injected corticosteroid drugs.
If a single-nerve neuropathy does not respond to these treatments, a person may require surgery, although this is rare. A person may also need surgery if the nerve compression is fixed due to a tumor, for example.
A doctor should consider referring a person to a pain specialist or a relevant clinical specialty if:
- their pain is severe
- their pain significantly limits daily activities and quality of life
- an underlying health condition is getting worse
Learn more about neuropathic pain.
Natural treatments
Non-drug treatments for peripheral neuropathy can include using warm or cold packs unless heat or cold worsens the symptoms.
Stress relief and other complementary therapies include meditation, relaxation techniques, massage, and acupuncture. These may help a person cope with pain from the condition.
Some people find that using a transcutaneous electrical nerve stimulation (TENS) machine helps. This device interrupts nerve messages by delivering a small electric current. Research has not confirmed the effectiveness of this treatment.
Learn more about treating peripheral neuropathy naturally.
Many types of neuropathy are “idiopathic” or of unknown cause, but several conditions can trigger the problem. These
- Chronic kidney disease: If the kidneys are not functioning normally, an imbalance of salts and chemicals can cause peripheral neuropathy.
- Injuries: Broken bones and tight plaster casts can put pressure directly on the nerves.
- Infections: Shingles, HIV, Lyme disease, and viral illnesses can lead to nerve damage.
- Guillain-Barré syndrome: This is a specific type of peripheral neuropathy triggered by infection.
- Some autoimmune disorders: These include rheumatoid arthritis and systemic lupus erythematosus (SLE).
- Some kinds of cancer: These include lymphoma and multiple myeloma
- Chronic liver disease: Chronic liver disease can cause peripheral neuropathy.
Other causes can include:
- excessive alcohol intake
- some medications, such as chemotherapy and HIV treatment drugs
- B12 or folate vitamin deficiencies
- exposure to toxins, such as insecticides and solvents
Disorders of the small blood vessels can reduce blood supply to the nerves, damaging nerve tissue. Certain benign tumors can also affect nerve tissue and lead to neuropathic pain.
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Diabetic neuropathy
Diabetes is the
Metabolic changes caused by uncontrolled diabetes can damage the walls of the tiny blood vessels that supply oxygen and nutrients to the nerves at the ends of the hands and feet and the essential organs in the body, such as the eyes, kidneys, and heart.
The loss of sensation increases the risk of damage whenever skin becomes damaged.
Learn more about diabetic neuropathy.
Peripheral neuropathy causes a variety of symptoms with many possible causes.
A doctor will usually begin by taking a person’s medical history. This includes gathering information about all the symptoms and details about a person’s life, potential environmental exposures, and any risks of infectious or neurological diseases.
The next step will likely be a physical and neurological exam to help the doctor identify any nerve damage. A doctor may perform further tests, including nerve conduction velocity (NCV) and electromyography (EMG). These tests measure nerve signal strength and electrical activity.
A doctor may also do a nerve biopsy. If a doctor suspects a person had autonomic neuropathy, they will likely do a QSART test, which measures the person’s ability to sweat.
For some types of neuropathies, such as nerve compression, a person can also get a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan. Another option is a muscle and nerve ultrasound, but this is uncommon.
If the doctor confirms that neuropathy is present, the doctor will look for the cause. The doctor may then send the person to get blood tests to check for diabetes and other potential underlying conditions.
The doctor may check for vitamin deficiencies, liver or kidney dysfunction, infections, metabolic disorders, or any immune cells that may indicate an immune disorder. Sometimes, the doctor may order a test to rule out a genetic disorder.
A doctor may conduct additional tests if none of these tests can point to a cause.
The outlook for peripheral neuropathy varies depending on the underlying cause and which nerves have been damaged.
Some cases may improve with time after treatment of the underlying cause, but in others, the damage may be permanent or gradually worsen.
Learn more about the outlook and life expectancy.
Peripheral neuropathy describes many different conditions that damage the peripheral nervous system. Many underlying conditions can cause neuropathies, which result in impairments to a person’s nerve signals.
A person’s symptoms will vary depending on the affected nerves and the type of neuropathy.