Peripheral Neuropathy

What is Peripheral Neuropathy?

Peripheral neuropathy refers to conditions resulting from damage to the peripheral nerves. The peripheral nerves are the network of nerves outside the brain and spinal cord (the central nervous system), and they work to send information from the central nervous system to other parts of the body. 

These peripheral nerves, found in extremities like hands and feet, can be likened to the wires that connect different parts of a computer together. When these malfunction, important functions of the body can be affected. 

Peripheral neuropathy can be a result of traumatic injuries, infections, metabolic issues and exposure to toxins. It can be inherited too. In many cases, other conditions such as a kidney condition, hormone imbalance or diabetes could lead to peripheral neuropathy.

How will having peripheral neuropathy affect me?

If you have peripheral neuropathy, you could experience differing symptoms, based on what kind of nerves are damaged. The nerves can be classified into sensory nerves, motor nerves and autonomic nerves.

Motor nerves control muscle movement, and sensory nerves receive feelings such as temperature and pain from the skin surface. When they are damaged, patients could experience:

  • Numbness
  • Tingling sensation in the feet or hands, which can spread to the legs and arms
  • Hypersensitivity to touch
  • Sharp, stabbing or burning pain
  • Lack of coordination, dizziness and falling
  • Loss of reflexes
  • Muscle weakness
  • Paralysis

Autonomic nerves control bodily functions such as blood pressure, heart rate, digestion and bladder functions. When they are damaged, patients could experience:

  • Intolerance to heat
  • Excessive sweating, or inability to sweat
  • Digestive issues
  • Fluctuations in blood pressure, causing dizziness

What are the causes and risk factors of peripheral neuropathy?

Peripheral neuropathy is most commonly caused by physical injury or trauma, such as from car accidents, sports injuries and medical procedures that have damaged nerves or detached them from the spinal cord. 

Ulnar neuropathy and carpal tunnel syndrome are common types of neuropathy that arise from trapped nerves at the elbow or wrists. In some cases, underlying medical causes such as diabetes can cause damage to your nerves. About 60% to 70% of people with diabetes have mild to severe forms of damage to their nerves [1]. People with vascular conditions that decrease oxygen supply to the peripheral nerves can also have damaged nerve tissue.

Smoking and narrowing of arteries from high blood pressure, scarring from vasculitis, or  atherosclerosis can also have neuropathy. People with autoimmune diseases, and those with viral infections like Shingles that affect the whole body can also have nerve damage.

How is peripheral neuropathy diagnosed?

If you are experiencing unusual tingling, weakness or pain in your hands and feet, you should seek medical care immediately. Early diagnosis and early treatment of peripheral neuropathy would definitely help you to control your symptoms and prevent the worsening of the damage to your nerves.

Medical examination. Your doctor will likely perform a thorough medical examination before definitively diagnosing you with peripheral neuropathy. Your doctor may also ask about your symptoms, lifestyle habits, any underlying health conditions and medical history. 

Blood tests. Your doctor may conduct a blood test to detect any abnormal activity in your immune system. 

Imaging. Imaging tests such as CT and MRI scan may also be used by your doctor when diagnosing your peripheral neuropathy. CT and MRI scans can help to reveal tumours, bone and vascular irregularities that may be affecting the nerves.

Electromyogram (EMG). In some cases, your doctor may conduct an electromyogram (EMG), which measures the electrical activity of your nerves and muscles. There are two parts to an EMG. 

The first part comprises of nerve conduction studies (NCS), which measures the rate at which electrical impulses move through your nerves. During this test, small patches which deliver electrical pulses will be attached to your skin. This process may cause you some discomfort depending on the strength of the electrical pulse but is generally painless. 

The second part is known as a needle electrode examination, which measures the electrical activities in your muscles. During this test, five or more thin needles will be inserted into your muscle. You may experience a slight pain during the insertion of the needles. However, this test is otherwise painless as well.

Neuropathology tests. Lastly, your doctor may conduct several neuropathology tests, such as a nerve biopsy to remove a sample of nerve tissue for observation. Another test which may be performed by your doctor is a neurodiagnostic skin biopsy, whereby a tiny piece of skin will be removed. This will allow your doctor to examine your nerve fibre endings.

In certain cases, you may also be referred to see a neurologist to better diagnose your symptoms.

How do I prevent myself from getting peripheral neuropathy?

It is recommended that people with the highest risk of developing peripheral neuropathy, such as people with diabetes, have regular health screenings. 

The best treatment for peripheral neuropathy would be preventing it, and unnecessary operations should be avoided where possible. Diabetes and some other diseases are common causes of neuropathy that can be prevented. Some families with a history of very severe genetic neuropathies use in vitro fertilisation in conceiving in order to prevent transmission to their children.

Lifestyle choices such as not drinking too much alcohol, not exposing yourself to toxic chemical substances such as industrial chemicals, and trying your best to avoid trauma and pressure on your nerves from injury. Vitamin B is crucial to your nerve health and development, so ensure you get enough of it from leafy vegetables, eggs and whole grains.

How is peripheral neuropathy treated?

Not all symptoms of peripheral neuropathy can be treated, so prevention is better than treatment. 

Medications can be used to treat the typical symptoms of peripheral neuropathy. Drugs that are normally used for epilepsy might work, a well as opioid painkillers and antidepressants. Nerve pain may be treated with medicines called neuropathic pain agents, as standard painkillers might not work. Doctors are also able to prescribe skin patches for temporary and localised pain relief. 

Other symptoms associated with peripheral neuropathy might need to be treated individually, for example, muscle weakness might be treated with physiotherapy.

Remember never to self-medicate and always consult your doctor about which course of medication or treatment is best for you.

  1. NHS Choices. (2019). Overview – Peripheral neuropathy. NHS.
  2. Peripheral neuropathy. (n.d.). NHS Scotland.
  3. Peripheral Neuropathy. (2019). Johns Hopkins Medicine.
  4. Peripheral Neuropathy Fact Sheet. (2018, August 11). National Institute of Neurological Disorders and Stroke.