Neuropathy (Disorders of the Peripheral Nerve)

What is peripheral neuropathy?

Peripheral neuropathy is the medical term for damage to the nerves outside your brain and spinal cord. It's not a single condition but a broad term for many different types of nerve damage, which can cause pain, numbness, tingling or muscle weakness, most often in your hands and feet.

What are the symptoms of peripheral neuropathy?

Symptoms depend on which nerves are affected, and can develop gradually or suddenly. You might notice:

• Tingling, numbness or pins and needles, often starting in your hands or feet
• Burning, stabbing, shooting or electric shock like pain
• Muscle weakness, cramps or wasting
• Reduced ability to feel pain or changes in temperature
• Balance problems or difficulty walking
• Difficulty with fine movements, such as doing up buttons or picking up small objects
• A foot that drags or drops, unusually high arches, or curled toes

If the nerves controlling your automatic body functions are affected, you may also have:

• Digestive problems, such as nausea, bloating, diarrhoea or constipation
• Bladder or bowel problems
• Changes in sweating
• Dizziness or fainting from blood pressure changes
• Sexual difficulties

What are the causes of peripheral neuropathy and who is at risk?

The most common cause by far is diabetes, where long-term high blood sugar damages the small blood vessels that supply your nerves. Other causes include:

• Drinking too much alcohol over a long period
• Vitamin deficiencies, particularly B12 and other B vitamins
• Autoimmune and inflammatory conditions, such as Guillain-Barré syndrome, lupus and rheumatoid arthritis
• Infections, including shingles, HIV and Lyme disease
• An underactive thyroid, or kidney or liver disease
• Certain medications, including some chemotherapy drugs
• Exposure to toxins, such as heavy metals, solvents and insecticides
• An injury, or pressure on a nerve from swelling, a tumour or a slipped disc
• An inherited condition, such as Charcot-Marie-Tooth disease
• Some cancers, including lymphoma and multiple myeloma

Sometimes no cause is found, which doctors call idiopathic neuropathy. You may be more likely to develop neuropathy if you're over 50, have a family history of nerve problems, have an underlying condition such as diabetes, or do a job involving the same repetitive movements over a long period.

Are there different types of peripheral neuropathy?

Peripheral neuropathy is usually classified in a few different ways.

• By the nerves involved: sensory neuropathy affects feeling, motor neuropathy affects muscle movement, and autonomic neuropathy affects automatic body functions such as digestion and blood pressure. Most people have a mix of all three.
• By how many nerves are affected: mononeuropathy affects a single nerve, while polyneuropathy, the most common type, affects several nerves at once.
• By the underlying cause: for example, diabetic neuropathy (the most common type overall), Charcot-Marie-Tooth disease (the most common inherited type) and Guillain-Barré syndrome (a rare type that develops suddenly, often after an infection)

How is peripheral neuropathy diagnosed?

Your doctor will start by asking about your symptoms, medical history, and any conditions, medications or family history that might be relevant. They'll examine you, checking things like your strength, reflexes, balance and your ability to feel light touch, pinprick or temperature changes. They may then arrange:

• Blood tests, to check for conditions such as diabetes, vitamin deficiencies or thyroid problems
• Nerve conduction studies and electromyography (EMG), which measure the electrical activity in your nerves and muscles
• An MRI, CT or ultrasound scan
• A nerve biopsy, taking a small sample of nerve tissue
• Genetic testing, if an inherited cause is suspected

How is peripheral neuropathy treated?

Non-surgical treatment

Treatment usually starts with managing the underlying cause, for example controlling blood sugar if you have diabetes, correcting a vitamin deficiency, treating an infection, or stopping a medication that's causing the problem. Alongside this, your doctor may offer:

• Medication for nerve pain, such as certain anti-epilepsy drugs, antidepressants, or topical creams and patches
• Anti-inflammatory painkillers for milder pain
• Immunosuppressant medication or plasmapheresis (a blood-cleaning procedure), if an autoimmune condition is the cause
• Physiotherapy and occupational therapy
• Splints, braces or supportive footwear
• Complementary approaches such as acupuncture or a TENS machine, though there's limited evidence for how well these work

You can also support your nerve health by eating a balanced diet, staying physically active, keeping to a healthy weight, avoiding excess alcohol, and wearing protective equipment if your job exposes you to toxins.

Surgical treatment

Surgery isn't a typical first treatment for peripheral neuropathy and is used only in specific situations. If a single nerve is compressed by something fixed, such as a tumour, or a condition like carpal tunnel syndrome doesn't improve with splinting or other conservative treatment, surgery to relieve the pressure on the nerve may be recommended, though this is uncommon.

When should I see a doctor?

Contact your doctor if you notice tingling, numbness, weakness, unusual sensitivity to touch, poor coordination, or burning or shooting pain. It's important not to wait, as some types of neuropathy can be stopped or even reversed if you're diagnosed and treated early.

Seek urgent medical help if these symptoms come on suddenly and get worse quickly. Call 999 or go to your nearest A&E (emergency department) if you have trouble breathing, speaking or swallowing.