Peripheral Neuropathy

What Is Peripheral Neuropathy?

Peripheral neuropathy occurs when nerves outside the brain and spinal cord are damaged, causing weakness, numbness, and pain—usually in the hands and feet. It affects an estimated 20 million Americans. Diabetes is the most common cause, but many conditions can damage peripheral nerves.¹

Common Causes²

Diabetes (most common)
Chemotherapy
Alcoholism
Vitamin deficiencies (B12, B1, B6)
Autoimmune diseases
Infections (HIV, Lyme, shingles)
Hereditary conditions
Kidney or liver disease
Toxin exposure
Idiopathic (unknown cause)

Symptoms

Sensory

Numbness and tingling
Burning or shooting pain
Sensitivity to touch
"Pins and needles" feeling
Loss of sensation

Motor

Muscle weakness
Cramping
Difficulty walking
Balance problems
Coordination difficulties

Autonomic

Blood pressure changes
Digestive problems
Sweating abnormalities
Bladder dysfunction

Diagnosis³

Physical and neurological examination
Blood tests (glucose, B12, thyroid)
Nerve conduction studies
Electromyography (EMG)
Skin biopsy (small fiber neuropathy)
Sometimes nerve biopsy

Treatment Approaches

Treating the Cause

Blood sugar control for diabetes
Vitamin supplementation
Treating underlying conditions
Stopping offending medications/toxins

Pain Management

Anticonvulsants (gabapentin, pregabalin)
Antidepressants (duloxetine, amitriptyline)
Topical treatments (capsaicin, lidocaine)
Pain specialists if severe

Other Treatments

Physical therapy
TENS therapy
Balance training
Foot care and protection

Living with Neuropathy

Check feet daily for injuries
Wear protective footwear
Use night lights (balance)
Remove tripping hazards
Manage underlying conditions

References

Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1997;62(4):310-318.
Callaghan BC, Price RS, Feldman EL. Distal symmetric polyneuropathy: a review. JAMA. 2015;314(20):2172-2181.
England JD, Gronseth GS, Franklin G, et al. Practice parameter: evaluation of distal symmetric polyneuropathy. Neurology. 2009;72(2):177-184.