What is peripheral neuropathy?
Your peripheral nervous system connects the nerves from your brain and spinal cord, or central nervous system, to the rest of your body. This includes your:
- internal organs
The job of these nerves is to deliver signals about physical sensations back to your brain.
Peripheral neuropathy is a disorder that occurs when these nerves malfunction because they’re damaged or destroyed. This disrupts the nerves’ normal functioning. They might send signals of pain when there’s nothing causing pain, or they might not send a pain signal even if something is harming you. This can be due to:
- an injury
- systemic illness
- an infection
- an inherited disorder
The disorder is uncomfortable, but treatments can be very helpful. The most important thing to determine is whether peripheral neuropathy is the result of a serious underlying condition.
What are the types of peripheral neuropathy?
More than 100 different types of peripheral neuropathy exist. Each type has unique symptoms and specific treatment options. Peripheral neuropathies are further classified by the type of nerve damage involved. Mononeuropathy occurs when only one nerve is damaged. Polyneuropathies, which are more common, occur when multiple nerves are damaged.
What are the symptoms of peripheral neuropathy?
The three types of peripheral nerves are:
- sensory nerves, which connect to your skin
- motor nerves, which connect to your muscles
- autonomic nerves, which connect to your internal organs
Peripheral neuropathy can affect one nerve group or all three.
The symptoms of peripheral neuropathy include:
- tingling in the hands or feet
- a feeling like you’re wearing a tight glove or sock
- sharp, stabbing pains
- numbness in the hands or feet
- a weak, heavy feeling in the arms and legs, which sometimes may feel like your legs or arms lock in place
- regularly dropping things from your hands
- a buzzing or shocking sensation
- thinning of the skin
- a drop in blood pressure
- sexual dysfunction, especially in men
- digestive difficulty
- excessive sweating
These symptoms can also indicate other conditions. Make sure you tell your doctor about all of your symptoms.
What are the causes of peripheral neuropathy?
People who have a family history of peripheral neuropathy are more likely to develop the disorder. However, a variety of factors and underlying conditions may also cause this condition.
Nerve damage caused by diabetes is one of the most common forms of neuropathy. This leads to numbness, pain, and a loss of sensation in the extremities. The risk of neuropathy increases for people who:
- are overweight
- have high blood pressure
- are over the age of 40
- have diabetes
According to the University of Chicago’s Center for Peripheral Neuropathy (UCCPN), nearly 60 percent of people with diabetes have some sort of nerve damage. This damage is often due to high blood sugar levels.
Other chronic diseases that may cause nerve damage include:
- kidney disorders in which high amount of toxins build up in the body and damage nerve tissue
- hypothyroidism, which occurs when the body doesn’t produce enough thyroid hormone, leading to fluid retention and pressure surrounding nerve tissues
- diseases that cause chronic inflammation and can spread to the nerves or damage connective tissue surrounding nerves
- deficiencies of vitamins E, B-1, B-6, and B-12, which are essential to nerve health and functioning
Physical trauma is the most common cause of injury to the nerves. This can include car accidents, falls, or fractures. Inactivity, or holding still too long in one position, can also cause neuropathy. Increased pressure on the median nerve, a nerve in the wrist that supplies feeling and movement to the hand, causes carpal tunnel syndrome. This is a common type of peripheral neuropathy.
Alcohol and toxins
Alcohol can have a toxic effect on nerve tissue, putting people with severe alcoholism at a higher risk of peripheral neuropathy.
Exposure to toxic chemicals like glue, solvents, or insecticides, either through chemical abuse or in the workplace, can also cause nerve damage. Additionally, exposure to heavy metals such as lead and mercury can also cause this condition.
Infections and autoimmune disorders
Certain viruses and bacteria directly attack nerve tissue.
Viruses such as herpes simplex, varicella-zoster virus, which causes chickenpox and shingles, and Epstein-Barr virus damage sensory nerves and cause intense episodes of shooting pain.
Bacterial infections such as Lyme disease can also cause nerve damage and pain if they aren’t treated. People with HIV or AIDS can also develop peripheral neuropathy.
Autoimmune diseases like rheumatoid arthritis and lupus affect the peripheral nervous system in various ways. Chronic inflammation and damage to tissues throughout the body, as well as pressure caused by inflammation, can all lead to severe nerve pain in the extremities.
Certain medications may also cause nerve damage. These include:
- anticonvulsants, which people take to treat seizures
- drugs to fight bacterial infections
- some blood pressure medications
- medications used to treat cancer
Recent research in The Journal of Family Practice also suggests that statins, a class of drugs used to lower cholesterol and prevent cardiovascular disease, may also cause nerve damage and increase the risk for neuropathy.
How is peripheral neuropathy diagnosed?
First, your doctor will perform a physical exam and ask about your medical history. If they still can’t tell whether your symptoms are due to peripheral neuropathy, other tests to perform include:
- Blood tests can measure vitamin and blood sugar levels and determine whether your thyroid is functioning correctly.
- Your doctor may also order a CT scan or MRI to see if anything is pressing on a nerve, such as a herniated disk or a tumor.
- Sometimes your doctor will order a nerve biopsy. This is a minor surgery that involves removing a small amount of nerve tissue that they can then examine under a microscope.
Electromyography can show problems with how your body’s nerve signals move to your muscles. For this test, your doctor will place a small needle into your muscle. Your doctor will then ask you to move your muscle gently. Probes in the needle will measure the amount of electricity moving through your muscle. This test may feel like you’re receiving a shot. Sometimes the area becomes sore for a few days afterward.
Nerve conduction study
In a nerve conduction study, your doctor places electrodes on your skin. They then pulse tiny amounts of electricity through your nerves to see if the nerves are transmitting signals properly. This procedure is slightly uncomfortable while it’s happening, but it shouldn’t hurt afterward.
What are the treatment options for peripheral neuropathy?
The treatment is based on treating the underlying disorder. If diabetes is the cause, making certain that the blood glucose is controlled is important. If a vitamin deficiency is causing the problem, then correcting the deficiency is the treatment. Many treatments can bring relief and help you return to your regular activities. Sometimes a combination of treatments works best.
Over-the-counter (OTC) pain medications like acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, can be very helpful in controlling moderate pain. If you take them in excess, these drugs can affect your liver or stomach function. It’s important to avoid using them for an extended period, especially if you drink alcohol regularly.
Many prescription pain medications can also help to control the pain of this condition. These include narcotics, some antiepileptic medicines, and some antidepressants. Other helpful prescription medicines include:
- cyclooxygenase-2 inhibitors
- corticosteroid injections
- seizure medications, such as gabapentin or pregabalin
- antidepressants, such as amitriptyline
- Cymbalta, which is a serotonin norepinephrine reuptake inhibitor
Prescription drugs for sexual dysfunction in men include:
- sildenafil (Viagra)
- vardenafil (Levitra, Staxyn)
- tadalafil (Cialis)
- avanafil (Stendra)
Your doctor can use several medical treatments to control the symptoms of this condition. Plasmapheresis is a blood transfusion that removes potentially irritating antibodies from your bloodstream. If you get a nerve block, your doctor will inject an anesthetic directly into your nerves.
Transcutaneous electronic nerve stimulation (TENS)
Transcutaneous electronic nerve stimulation (TENS) doesn’t work for everyone, but many people like it because it’s a drug-free therapy. During TENS, electrodes placed on the skin send small amounts of electricity into the skin. The goal of this treatment is to disrupt nerves from transmitting pain signals to the brain.
Ergonomic casts or splints
Ergonomic casts or splints can help you if your neuropathy affects your:
These casts provide support for the part of your body that’s uncomfortable. This can relieve pain. For example, a cast or splint that holds your wrists in a proper position while you sleep can relieve the discomfort of carpal tunnel syndrome.
In addition to OTC pain relievers, many people have found relief for peripheral neuropathy through:
- chiropractic care
Moderate, regular exercise can also help lessen discomfort.
If you drink alcohol or smoke, consider cutting back or stopping. Both alcohol and tobacco aggravate nerve pain and can cause nerve damage when used for long periods.
Take precautions at home
If you have peripheral neuropathy, you’re potentially at greater risk for accidents in the home. You can do the following to improve your safety:
- Always wear shoes to protect your feet.
- Keep your floor clear of things that you could trip on.
- Check the temperature of your bath or dishwater with your elbow, not your hand or foot.
- Install handrails in your bathtub or shower.
- Use bath mats that can prevent slipping.
- Don’t stay in one position for too long. Get up and move around a couple of times each hour. This is especially important for those whose work involves sitting for long periods at a desk.
What is the long-term outlook?
If your neuropathy is due to an underlying, treatable condition, you may be able to stop your peripheral neuropathy by treating the larger problem. However, if this isn’t the case for you, you can successfully manage the symptoms of your peripheral neuropathy. Speak with your doctor to determine the best medical treatment for you, and explore alternative and self-care options that can supplement your medical care.
How can I prevent peripheral neuropathy?
Even if you have a family history of this disorder, you can help prevent its onset by doing the following:
- avoiding alcohol or drinking it only in moderation
- avoiding smoking or quitting smoking if you smoke
- eating a healthy diet
- getting regular, moderate exercise
You can lower your risk of peripheral neuropathy by:
- knowing what toxins you might be exposed to at work or school
- protecting your feet during sports, especially those that involve kicking
- never inhaling toxins like glue to get high
If you have diabetes, take special care of your feet. Wash and inspect your feet daily, and keep the skin moist with lotion.