Peripheral Neuropathy

“Peripheral neuropathy” is the term for any type of nerve damage outside of your brain and spinal cord. It can lead to a range of symptoms, like numbness, pain and movement issues. It’s a common condition that has several possible causes.

When your peripheral nerves are damaged, it disrupts the way your brain “talks” to your body and/or vice versa. The communication issues may include:

• Nerve signals that don’t reach their target
• Signals that send when they shouldn’t
• Errors that change the message of the signal

Peripheral neuropathy can happen for minor reasons that aren’t serious, like a slightly compressed nerve. But it can also develop due to dangerous conditions, like Guillain-Barré syndrome. Diabetes is the most common cause overall, often affecting the nerves in your feet first. Regardless of the cause, the symptoms can disrupt your life.

It’s possible to stop or reverse certain types of neuropathies if you get diagnosed and treated quickly. Because of this, you should see a provider at the first signs of peripheral neuropathy. Treatment may include medication, physical therapy and other therapies.

Types

Providers may also classify it as:

• Mononeuropathy: It affects one nerve.
• Polyneuropathy: It affects more than one nerve.

Symptoms of peripheral neuropathy

Peripheral neuropathy can lead to many different symptoms. You may notice changes in one area of your body or in several areas. Depending on the underlying cause, these symptoms can develop slowly or suddenly, ranging from hours to years.

Healthcare providers classify peripheral neuropathy based on the type of nerve it affects. The three types include:

• Sensory: Sensory nerves detect touch, temperature, pain and positioning. They carry information to your brain and spinal cord.
• Motor: Motor nerves send muscle movement commands from your brain to various parts of your body.
• Autonomic: Autonomic nerves control the automatic functions of your body systems, like your heart rate and digestion. They send signals to and from your brain.

Sensory and movement symptoms are the most common. They may include:

• Tingling and numbness (paresthesia)
• Pain that feels like burning, tingling, stabbing or an electric shock (neuropathic pain)
• Inability to sense temperature changes
• Loss of reflexes
• Muscle weakness and/or paralysis
• Muscle loss (atrophy)
• Muscle cramps
• Balance issues

Peripheral neuropathy can also affect your body’s automatic functions. It can lead to signs and symptoms of dysautonomia, like:

• Blood pressure changes, which may lead to fainting
• Digestion issues, like nausea, vomiting and bloating
• Irregular heart rate
• Peeing or pooping issues
• Sexual dysfunction
• Sweating too much or not enough

Peripheral neuropathy causes

Damage to your peripheral nerves causes peripheral neuropathy. But damage can happen in many ways.

The most common cause of peripheral neuropathy is diabetes. Long-term high blood sugar damages small blood vessels that provide oxygen and nutrients to your nerves. Over time, nerve cells can die.

Other causes include:

• Alcohol use disorder, due to direct nerve damage from long-term alcohol use and/or vitamin deficiencies associated with it
• Vitamin and nutrient deficiencies, like copper and vitamins B1, B6, B9, B12, folic acid (B9) and E
• Paraproteinemias, like multiple myeloma
• Exposure to toxins, like heavy metals and industrial chemicals
• Medications, like chemotherapy and certain antibiotics
• Autoimmune and inflammatory conditions, like Guillain-Barré syndrome, lupus and vasculitis
• Infections, like HIV, shingles and leprosy (Hansen’s disease)
• Chronic kidney or liver disease, due to a buildup of toxins
• Pinched or compressed nerves due to issues like swelling, herniated disks or tumors
• Direct trauma from injuries or surgery
• Genetic conditions, like amyloidosis, Fabry disease and Charcot-Marie-Tooth disease

When there’s an unknown cause, healthcare providers call it idiopathic neuropathy.

Risk factors

Age is an overarching risk factor for peripheral neuropathy. The older you are, the more likely you’ll develop it. You’re also at risk if you have any of the underlying causes, like diabetes and alcohol use disorder.

Complications of this condition

Peripheral neuropathy complications are more likely to develop if the condition is severe. They may include:

• Chronic pain
• Difficulty with movement
• Slow-healing sores, especially in your legs or feet
• Burns (due to not feeling pain)
• Amputation (due to issues with infection and healing)

Neuropathy that affects your autonomic nerves tends to have the most severe complications. They may include:

• Bowel obstruction from constipation
• Cardiovascular complications, like blood clots, stroke and heart failure
• Dehydration and malnutrition from diarrhea and/or vomiting
• Injuries related to fainting
• Trouble breathing
• Urinary retention or frequent urinary tract infections

How doctors diagnose peripheral neuropathy

A healthcare provider will ask about your symptoms and medical history. They’ll do physical and neurological exams.

Your provider may suggest certain tests to help diagnose it and the cause, like:

• Blood tests
• Electromyogram
• Nerve ultrasound
• MRI
• Nerve biopsy
• Genetic testing

How is it treated?

Treatment for peripheral neuropathy largely depends on the cause and its severity. Your healthcare provider will tailor a plan to fit your needs.

In general, treatments may include:

• Medication for pain and/or the underlying cause
• Physical and occupational therapy
• Devices and wearable equipment, like walkers and braces
• Surgery to relieve compressed nerves

What can I expect if I have this condition?

Peripheral neuropathy can be a temporary concern, or it can be permanent. How long it lasts depends on many factors, including the cause and your overall health. The more severe and the longer lasting it is, the less likely it’ll be reversible.

Peripheral neuropathy usually isn’t life-threatening. But it can disrupt your life. Pain is often the most bothersome symptom. But medications or other treatments may help. Autonomic symptoms are among the most serious because they involve your body’s vital functions.

Lean on your healthcare provider for guidance. They can let you know what to expect based on your unique situation.

Can peripheral neuropathy be prevented?

Some of the causes of peripheral neuropathy are preventable. In general, preventive steps you can take include:

• Eating nutritious foods
• Staying physically active and maintaining a healthy weight
• Wearing safety gear to prevent injuries and exposure to toxins
• Managing chronic conditions
• Avoiding alcohol in excess