Peripheral neuropathy causes & treatment

The peripheral nervous system branches out from the central nervous system, which consists of the brain and spinal cord. Signals from the brain and spinal cord communicate with the nerves in the peripheral nervous system to move the body or conduct functions such as breathing and digestion.

Peripheral neuropathy is caused by nerve damage within the peripheral nervous system. It typically affects the hands and feet, but it also can affect the arms and legs. More than 100 types of peripheral neuropathy have been identified. Peripheral neuropathy symptoms vary depending on the type of nerve damage.

What causes peripheral neuropathy?

Peripheral neuropathy occurs when nerves are damaged or destroyed and can no longer send messages from the brain and spinal cord to the muscles or organs in the body.

Diabetes is the most common cause of peripheral neuropathy. One-third to one-half of people with diabetes have peripheral neuropathy. Over time high blood sugar can cause nerve damage, interfering with the ability to send signals to the brain and spinal cord. High blood sugar also can weaken small blood vessels that supply the nervous system with oxygen and nutrients.

Other causes of neuropathy include:

Peripheral neuropathy symptoms

The peripheral nervous system consists of three main types of nerves: sensory, motor and autonomic. Peripheral neuropathy symptoms vary depending on which type of nerve is damaged.

Sensory or motor nerve damage can cause peripheral neuropathy symptoms such as:

• Muscle weakness
• Numbness and tingling in the hands or feet
• Throbbing or burning neuropathic pain
• Sharp or jabbing neuropathic pain
• Feeling like you’re wearing socks or gloves when you’re not
• Extreme sensitivity to touch

Autonomic nerve damage can cause peripheral neuropathy symptoms such as:

• Intolerance to heat
• Excessive sweating or being unable to sweat
• Low blood pressure that leads to lightheadedness or dizziness
• Bowel, bladder or digestive issues

Peripheral neuropathy diagnosis

Your doctor will ask about your possible peripheral neuropathy symptoms and anything that triggers or relieves them. They may also ask you about any exposure to toxins, alcohol or tobacco use, history of infections or diabetes, and family history of neurological diseases.

Various blood tests may be ordered to detect diabetes, vitamin deficiencies, liver, thyroid or kidney dysfunction, infections or signs of abnormal immune system activity.

The doctor may also recommend nerve function and imaging tests to identify the type, location and extent of any nerve damage.

Nerve function tests

• Nerve conduction velocity (NCV) test: This test measures signal strength and speed along specific large motor and sensory nerves and reveals the location of nerve damage.
• Electromyography (EMG) test: For this test, tiny needles connected to electrodes are inserted into specific muscles to record their electrical activity at rest and during contraction. Test results show any abnormal muscular electrical and can help differentiate between muscle and nerve disorders.

Imaging tests

• MRI: An MRI of the spine can reveal tumors or nerve root compression, also known as a pinched nerve, that could be causing your peripheral neuropathy.
• CT scan: CT scans of the spine can show herniated discs, spinal stenosis (narrowing of the spinal canal), tumors and bone irregularities that may affect nerves.

Peripheral neuropathy treatment

Although there is no way to repair the nerves, you can stop further nerve damage and relieve neuropathic pain by incorporating the following peripheral neuropathy treatments into your routine:

• Strict control of blood glucose levels if you have diabetes
• Hand or foot braces to stabilize the muscles and nerves
• Orthopedic shoes to improve walking difficulties and help prevent foot injuries
• Splints for carpal tunnel problems to reduce pressure on the compressed nerve and allow it to heal
• Stopping smoking, as it constricts the blood vessels that supply nutrients to the peripheral nerves
• Regular exercise to deliver more blood, oxygen and nutrients to nerve endings, improve muscle strength and limit muscle atrophy
• Massage and cognitive behavioral therapy to help with neuropathic pain management
• Physical therapy to learn muscle stretching and strengthening techniques that can help with neuropathic pain relief
• Medications recommended to treat depression can also help relieve chronic neuropathic pain
• Topical creams or skin patches for neuropathic pain
• Surgery for pinched nerves or carpal tunnel syndrome

Managing peripheral neuropathy in the feet

If you have peripheral neuropathy, it's important to inspect your feet regularly to check for injuries or infection. Because decreased sensation may develop eventually, you might not notice an injury or infection. For example, someone who has diabetes and peripheral neuropathy could step on a tack without noticing it. If you can’t inspect your own feet, ask a family member or friend to help or use a mirror.

People with peripheral neuropathy should also wear properly fitted shoes and avoid walking barefoot to prevent injury.

How to prevent neuropathic pain

The best treatment for neuropathic pain is prevention. Here are some ways to prevent common causes of neuropathy:

• Reduce nerve and muscle injuries by wearing protective gear when participating in sports, limiting repetitive activities, wearing your seatbelt and driving safely, and using assistive equipment such as a walker or cane if needed to help prevent trips and falls.
• Get a shingles vaccine, especially if you’re over 50 or if you’ve had shingles in the past. Shingles can cause neuropathy, but the vaccine can prevent more than 95% of shingles cases.
• Ask your doctor to minimize use of medications that are known to cause or worsen neuropathy, especially if alternative medications are available.