Living with
Peripheral Neuropathy
Understanding Peripheral Neuropathy
What is peripheral neuropathy?
Peripheral neuropathy is caused by damage to the peripheral nerves (the nerves outside of the central nervous system/ spinal cord and brain).
Peripheral neuropathy often causes weakness, numbness and pain, usually in your peripheries (the hands and feet), but may also affect other parts of your body.
While long-term, unmanaged diabetes is the most common cause of peripheral neuropathy (diabetic neuropathy), it can also result from traumatic injuries, infections and exposure to toxins.
People with peripheral neuropathy generally describe the associated pain as stabbing, burning or tingling. Medications can be used to reduce the pain of peripheral neuropathy if the cause is non-reversible.
What is the peripheral nervous system?
Your peripheral nervous system is responsible for sending information from your central nervous system (the spinal cord and brain) to the rest of your body. The peripheral nerves also send sensory information to the central nervous system for processing.
Symptoms of peripheral neuropathy depend on the type of nerves affected, as every nerve in your peripheral nervous system has a specific function.
Peripheral nerves are classified into:
- Sensory: These nerves receive sensations, such as touch, temperature, pain or vibration, from the skin.
- Motor: These nerves mainly bring about muscle movement.
- Autonomic: These nerves control involuntary functions such as bladder tone, blood pressure, heart rate and digestion.
How do you know you have peripheral neuropathy?
Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome, for example, is an example of mononeuropathy.
However, most people with peripheral neuropathy have polyneuropathy.
Symptoms of peripheral neuropathy may include:
- Gradual onset of numbness, prickling or tingling sensations in your feet or hands, which can spread upward into your legs and arms with time.
- Sharp, jabbing, throbbing or burning pain.
- Extreme sensitivity to touch.
- Pain during activities that shouldn’t cause pain, such as pain when your feet touch the mattress.
- Muscle weakness and wasting.
- Lack of coordination and falling
- A “gloving sensation” – a feeling as if you are wearing gloves or socks when you are not.
- Partial or complete paralysis if motor nerves are affected.
If autonomic nerves are affected, symptoms may include:
- Heat intolerance and excessive sweating or not being able to sweat.
- Bowel, bladder or digestive problems.
- Sudden changes in blood pressure, causing dizziness.
What causes peripheral neuropathy?
Health conditions that can cause peripheral neuropathy include:
- Diabetes: More than 60 % of people with diabetes will develop some type of neuropathy.
- Autoimmune diseases: This include systemic lupus erythematosus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
- Infections: These include certain viral or bacterial infections, including Lyme disease, shingles (Herpes zoster virus) or Epstein-Barr virus and HIV.
- Genetic/inherited disorders: Certain disorders such as Charcot-Marie-Tooth disease, also known as Motor and Sensory Neuropathy, are hereditary and cause peripheral neuropathy.
- Tumours: Growths, whether cancerous (malignant) or non-cancerous (benign), can develop in the nervous system, pressing on surrounding nerves.
- Other diseases: These can include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).
Other causes of peripheral neuropathy can include:
- Alcoholism: Alcoholism can lead to vitamin deficiencies, especially deficiencies in vitamin B12 that is essential for healthy nervous function.
- Toxic substances: These can include industrial chemicals and heavy metals such as lead and mercury.
- Medications: Certain chemotherapeutics (medications used to treat cancer) can cause peripheral neuropathy.
- Trauma or pressure on a nerve: Traumas, such as from motor vehicle crashes, or falls, can damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or doing high-frequency repetitive actions, like excessive typing on a keyboard.
- Vitamin deficiencies: B vitamins (particularly vitamin B1, B6 and B12) are important to maintain good nerve health.
In a number of cases, no cause for peripheral neuropathy can be identified (the condition is
then said to be idiopathic).
Living and managing
To help manage your peripheral neuropathy there are a number of lifestyle changes you can make, such as the following:
- Manage underlying conditions: The best way to prevent peripheral neuropathy and stop it worsening is to manage medical conditions that can cause the condition, such as diabetes or rheumatoid arthritis.
- If you have diabetes, take care of your feet: Check your feet daily for blisters or cuts. Try to wear soft, loose, cotton socks and padded shoes. Avoid walking barefoot or putting your feet near heat sources, like near a fireplace or on electric blankets.
- Exercise regularly: Regular moderate exercise, such as walking three times a week, can reduce neuropathic pain, improve muscle strength and help control blood sugar levels if you have diabetes.
Gentle routines such as yoga and tai chi might also help to relieve pain. - Quit smoking: Cigarette smoke can affect circulation, increasing the risk of foot problems and other neuropathy complications. Talk to your doctor about ways to quit smoking.
- Eat a healthy diet: Good nutrition is especially important to ensure that you get essential vitamins and minerals for good nervous system health. Include plenty of fruits, vegetables, whole grains and lean protein in your diet.
You can protect against vitamin B12 deficiency by eating meats, fish, eggs, low-fat dairy products and fortified cereals. If you are vegetarian or vegan, talk to your doctor or healthcare provider about possible vitamin B12 supplements.
See Cooking from the Heart for healthy and delicious meal ideas. - Avoid excessive alcohol consumption.
What is the treatment for peripheral neuropathy?
Besides medications used to treat pain generally (analgesics), specific medications used to relieve peripheral neuropathy can include:
- Anticonvulsants: While these drugs were originally developed to control seizures in people with epilepsy, some anticonvulsants can help relieve nerve pain and are often considered the first choice in neuropathic pain treatment. Side-effects of these medications may include drowsiness, dizziness and nausea.
However, not all anticonvulsants will help relieve your neuropathic pain. Therefore, your doctor will choose medicines that have been shown in medical studies to work on the particular type of nerve pain you have. - Antidepressants: Certain types of antidepressants can also be used as the first choice for treating neuropathic pain, including:
- Tricyclic antidepressants: These medications have been used for a very long time and although they are not used as often today to treat depression, they can play an important role in managing neuropathic pain, as shown in many studies. However, tricyclic antidepressants can cause also side-effects, like dizziness, constipation, blurred vision and nausea. Additionally, these medications might not be safe for people with certain conditions like heart disease.
- SNRIs (serotonin and norepinephrine reuptake inhibitors): These are the newer, and now more common, type of antidepressant that also seem to help relieve nerve pain. Generally, these drugs have fewer side-effects than tricyclic antidepressants and might be safer for some people, especially older people with heart problems. However, they might not be as effective as tricyclics in relieving neuropathic pain.
What are the potential complications associated with peripheral neuropathy?
Problems caused by peripheral neuropathy can include:
- Skin trauma: Because of numbness, you might not feel temperature changes or pain, especially in the feet.
- Infection: Your feet and other areas lacking sensation can become injured without you knowing, and these injuries, in turn, can become infected, potentially causing gangrene.
- Falls: Muscle weakness from motor neuron disease and any loss of sensation can cause a lack of balance, making you more prone to falls.
- Sexual dysfunction: This includes erectile dysfunction in men.
- Urinary incontinence.
- Charcot Foot: This is a rare condition that occurs in people with diabetic neuropathy where there is inflammation, swelling and significant joint instability in the feet.
Sources
National Institute of Neurological Disorders and Stroke. (2020) Peripheral Neuropathy Fact Sheet. NIH, US. Accessed on July 4, 2020. Available from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet#3208_6
The National Health Service. (2019) Overview: Peripheral neuropathy. NHS, UK. Accessed on July 4, 2020. Available from: https://www.nhs.uk/conditions/peripheral-neuropathy/
WebMD. (n.d.) Understanding Peripheral Neuropathy – the Basics. Accessed on July 4, 2020. Available from: https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#1
Morrison W. (2019) Peripheral Neuropathy. Healthline. Accessed on July 4, 2020. Available from: https://www.healthline.com/health/peripheral-neuropathy#treatments
Wu B. (2018) Everything You Should Know About Diabetic Neuropathy. Healthline. Accessed on July 4, 2020. Available from: https://www.healthline.com/health/type-2-diabetes/diabetic-neuropathy
Sources
National Institute of Neurological Disorders and Stroke. (2020) Peripheral Neuropathy Fact Sheet. NIH, US. Accessed on July 4, 2020. Available from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet#3208_6
The National Health Service. (2019) Overview: Peripheral neuropathy. NHS, UK. Accessed on July 4, 2020. Available from: https://www.nhs.uk/conditions/peripheral-neuropathy/
WebMD. (n.d.) Understanding Peripheral Neuropathy – the Basics. Accessed on July 4, 2020. Available from: https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#1
Morrison W. (2019) Peripheral Neuropathy. Healthline. Accessed on July 4, 2020. Available from: https://www.healthline.com/health/peripheral-neuropathy#treatments
Wu B. (2018) Everything You Should Know About Diabetic Neuropathy. Healthline. Accessed on July 4, 2020. Available from: https://www.healthline.com/health/type-2-diabetes/diabetic-neuropathy