Peripheral neuropathy

Peripheral neuropathy - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Peripheral neuropathy Peripheral neuropathy About peripheral neuropathy Symptoms of peripheral neuropathy Causes of peripheral neuropathy Diagnosing peripheral neuropathy Treating peripheral neuropathy Complications of peripheral neuropathy About peripheral neuropathy Peripheral neuropathy develops when nerves in the bodys extremities  such as the hands, feet and arms  are damaged. The symptoms depend on which nerves are affected. In the UK, its estimated that almost1 in 10 peopleaged 55 or over are affected by some degree of peripheral neuropathy. The peripheral nervous system Theperipheral nervous system is the network of nerves that lieoutside the central nervous system (the brain and spinal cord). It includes different types of nerves with their own specific functions, including: sensory nerves  responsible for transmitting sensations, such as pain and touch motor nerves  responsible for controlling muscles autonomic nerves  responsible for regulating automatic functions of the body, such as blood pressure and bladder function Symptoms of peripheral neuropathy The main symptoms can include: numbness and tingling in the feet or hands burning, stabbing or shooting pain in affected areas loss of balance and co-ordination muscle weakness, especially in the feet These symptoms are usually constant, but may come and go. Read more about symptoms of peripheral neuropathy When to see your GP Its important to see your GP if you experience the early symptoms of peripheral neuropathy, such as: pain, tingling or loss of sensation in the feet loss of balance or weakness a cut or ulcer on your foot that isnt getting better Its recommended that people at highest riskof peripheral neuropathy, such as people withdiabetes, have regular check-ups. Your GP will ask about your symptoms and may arrange some teststo help identify the underlying cause. You may be referred to a hospital to see a neurologist(a specialist in conditions affecting the nervous system). Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications. Read more about diagnosing peripheral neuropathy Causes of peripheral neuropathy In the UK,diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy. Peripheral neuropathy can also have a wide range of other causes. For example, it can be caused by: physical injury to the nerves aviral infection such as shingles a side effect of certain medications ordrinking too muchalcohol People who are known to be at anincreased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed. Read more about thecauses of peripheral neuropathy Treatingperipheral neuropathy Treatment for peripheral neuropathy depends on the symptoms and underlying cause. Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes it may help to gain better controlof yourblood sugar level, stop smoking, and cut down on alcohol. Nerve pain may be treated with prescribed medications called neuropathic pain agents, as standard painkillers are often ineffective. If you have other symptoms, these may need to be treated individually. For example, treatment for muscle weakness may involve physiotherapyand the use of walking aids. Read more about treating peripheral neuropathy . Complications of peripheral neuropathy The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged. Some cases may improve with time if the underlying cause is treated, whereasin some people the damage may be permanent or may get gradually worse with time. If the underlying cause of peripheral neuropathy isnt treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated. Peripheral neuropathy mayaffect the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy). You may need treatment to increase your blood pressure or,in rare cases, a pacemaker . Read more about complications of peripheral neuropathy Symptoms of peripheral neuropathy Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly. The main types of peripheral neuropathy include: sensory neuropathydamage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain motor neuropathydamage to the nerves that control movement autonomic neuropathydamage tothe nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure mononeuropathy damage to a single nerve outside of the central nervous system In many cases, someone with peripheral neuropathy may have more than one of these types at the same time. Acombination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy). The symptoms of the main types of peripheral neuropathy are described below. Sensory neuropathy Symptoms of sensory neuropathy can include: prickling and tingling sensation in the affected body partpins and needles numbness and less of an ability to feel pain or changes in temperature, particularly in your feet a burning or sharp pain, usually in the feet feeling pain from something that should not be painful at all, such as a very light touch (allodynia) loss of balance or co-ordination caused by less ability to tell the position of the feet or hands (sensory ataxia) Motor neuropathy Symptoms of motor neuropathy can include: twitching and muscle cramps muscle weakness orparalysis affecting one or more muscles thinning (wasting) of muscles foot drop difficulty lifting up the front part of your foot and toes, particularly noticeable when walking Autonomic neuropathy Damage to the autonomic nerves can result in a wide range of symptoms depending on where in the body the damage occurs. Symptoms of autonomic neuropathy caninclude: constipation or diarrhoea , particularly at night feeling sick, bloating and belching low blood pressure (postural or orthostatic hypotension), which can make you feel faint or dizzy when standing up rapid heartbeat (tachycardia) excessive sweating or a lack of sweating problems with sexual function, such as erectile dysfunction in men difficulty fully emptying your bladder of urine bowel incontinence (loss of bowel control) Mononeuropathy Depending on the specific nerve affected, symptoms of mononeuropathy can include: altered sensation or weakness in the fingers double vision or other problems with focusing your eyes, sometimes with eye pain weakness of one side of your faceBells palsy foot or shin pain, weakness or altered sensation The most common type of mononeuropathy iscarpal tunnel syndrome (CTS). The carpal tunnel is a small tunnel in your wrist. In CTS, the median nerve becomes compressed where it passes through this tunnel, which may cause tingling, pain or numbness in the fingers. Causes of peripheral neuropathy Diabetes is the most common cause of peripheral neuropathy in the UK. Neuropathy can also be caused by other health conditions andcertain medications. In some cases, no causecan beidentifiedand this is termed idiopathic neuropathy. Diabetes Peripheral neuropathycaused byeither type 1 diabetes or type 2 diabetes is called diabetic polyneuropathy.Its probably caused by high levels of glucose in your blood damaging the tiny blood vessels that supply your nerves. Peripheral neuropathy becomes more likely the longer youve had diabetes. Up to1 in every4 people with the condition experience some pain caused by nerve damage. If you have diabetes, your risk of polyneuropathy is higher if your blood sugar is poorly controlled or you: smoke regularly consume large amounts of alcohol are over 40 years old If you have diabetes, you should examine your own feet regularly to check for ulcers (open wounds or sores) or chilblains. Other causes As well as diabetes, there are many other possible causes of peripheral neuropathy. Health conditions Some of the health conditions that can cause peripheral neuropathy include: excessive alcohol drinking for years low levels of vitamin B12 or other vitamins physical damage to the nervessuch as from an injury or during surgery an underactive thyroid gland (hypothyroidism) certain infectionssuch as shingles , Lyme disease , diphtheria, botulism and HIV inflammation of the blood vessels (vasculitis) chronic liver disease or chronic kidney disease monoclonal gammopathy of undetermined significance (MGUS) the presence of an abnormal protein in the blood certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer) Charcot-Marie-Tooth (CMT) diseaseand other types of hereditary motor sensory neuropathygenetic conditions that cause nerve damage, particularly in the feet having high levels of toxins in your body, such as arsenic, lead or mercury Guillain-Barr syndromea rare condition that causes rapid onset of paralysis within days amyloidosisa group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body conditions caused by overactivity of the immune system such as rheumatoid arthritis , lupus or Sjogrens syndrome Medication A few medications may sometimes cause peripheral neuropathy as a side effect in some people. These include: some types of chemotherapy for cancer especially for bowel cancer , lymphoma or myeloma some antibiotics, if taken for months such as metronidazole ornitrofurantoin phenytoin used to treat epilepsy if taken fora long time amiodarone and thalidomide Diagnosing peripheral neuropathy A number of tests may be used to diagnose peripheral neuropathy and its underlying cause. When you see your GP,theyllask about your symptoms and examine the affected area of your body. This may involve testing sensation, strength and reflexes. Your doctor mayalso arrange blood tests, especially to check forcauses such as diabetes or vitamin B12 deficiency . Confirming if you have a neuropathy Some people may need to see a neurologist (a specialist in conditions affecting the nervous system)in hospital for further tests such as: a nerve conduction test (NCS)wheresmall metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured electromyography(EMG)where a small needle is inserted through your skin into your muscle and used to measure the electrical activity of your muscles NCS and EMGare usually carried out at the same time. Identifying the cause of a neuropathy Your GP can usually identify the underlying cause of a peripheral neuropathy. If diabetes is suspected, they can usually make a confident diagnosis based onyour symptoms, a physical examination and checking the levels of glucose in your blood and urine. If youre taking a medication known to cause peripheral neuropathy, your GP maytemporarily stop or reduce your dose to see whether your symptoms improve. If the cause is uncertain, you may be referred to a neurologist for more extensive blood tests to check: whether you have a rare acquired cause that may be responsible whether you have a genetic abnormality, such as Charcot-Marie-Tooth disease You may need a lumbar puncture to test the cerebrospinal fluid (a clear, colourless fluid that surrounds and supports the brain and spinal cord) for inflammation. Further tests Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope. Its then checked for changesthat could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed. You may also needa scan to look for any underlying cause of your neuropathy, such as: an X-ray a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Treating peripheral neuropathy Treatment for peripheral neuropathymay includetreating any underlying cause or any symptoms youre experiencing. Treatment may be more successfulfor certain underlying causes.For example,ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse. Treating the underlying cause There are many different possible causes of peripheral neuropathy , some of which can be treated in different ways. For example: diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting downon alcohol, maintaining a healthy weight and exercising regularly vitamin B12 deficiency can be treated with B12 injections or tablets peripheral neuropathy caused by a medication youre taking may improve if the medication is stopped Some less common types of peripheral neuropathy may be treated with medication, such as: corticosteroids  powerful anti-inflammatory medication immunosuppressants medications that reduce the activity of the immune system injections of immunoglobulin mixture of blood proteins called antibodies made by the immune system However, the underlying cause may not always be untreatable. Relieving nerve pain You may also require medication to treat any nerve pain (neuropathic pain)youre experiencing. Unlike most other types of pain, neuropathic pain doesnt usually get better with common painkillers, such as paracetamol and ibuprofen and other medications areoften used. These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, becausethe ideal dose for each person is unpredictable. Higher doses may bebetter at managing the pain, but are also more likely to cause side effects. The most common side effects are tiredness, dizziness or feeling drunk. If you get these, it may be necessary to reduce your dose. Dont drive or operate machineryif you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol. The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GPas it may be possible to change to a different medication that suits you better. Even if the first medication tried doesnt help, others may. Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If youre given an antidepressant , this may treat pain even if youre not depressed.This doesnt mean your doctor suspects youre depressed. The main medications recommended for neuropathic pain include: amitriptyline also used for treatment of headaches and depression duloxetinealso used for treatment of bladder problems and depression pregabalin and gabapentin also usedto treat epilepsy , headaches or anxiety There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below. Capsaicin cream If your pain is confined to a particular area of your body and you cant, or would prefer not to,take the medications above, you may benefit from using capsaicin cream. Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain. A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day. Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment. Dont use capsaicin cream on broken or inflamed skin and always wash your hands after applying it. Lidocaine plaster This is a large sticking plaster that contains a local anaesthetic. Its useful when pain affects only a small area of skin. Its stuck over the area of painful skin and the local anaesthetic is absorbed into the skin thats covered. Tramadol Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesnt respond to other treatments your GP can prescribe. Like all opioids, tramadol can be addictive if its taken for a long time. It will usually only be prescribed for a short time.Tramadol can be useful to take at times when your pain is worse. Common side effects of tramadol include: feeling sick orvomiting dizziness constipation Treating other symptoms In addition to treating pain, you may also require treatment to help you manage other symptoms youre experiencing as a result of peripheral neuropathy. For example, if you have muscle weakness, you may need physiotherapyto learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around. Other problems associated with peripheral neuropathymay be treatable with medication, such as: erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis) In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder. Complications of peripheral neuropathy Peripheral neuropathy can sometimes cause other medical problems, such as foot ulcers and heart rhythm changes, and blood circulation problems. These complications vary depending on the underlying cause of the condition. Diabetic foot ulcer A diabetic foot ulcer is an open wound or sore on the skinthats slow to heal. These are common in people with diabetic polyneuropathy. If you have numb feet, its easy to cut your foot by stepping on something sharp. An ulcer can also occur if you unknowingly develop a blister caused bybadly fitting shoes. If you dont feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer. High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted. A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene. Gangrene If you do develop a wound infection in one of your feet as a result of peripheral neuropathy, theres a risk this couldlead to gangrene(death of part of the skin or underlying tissues). If gangrene does develop, you may need surgery to remove the damaged tissue (known as debridement) and antibiotics to treat any underlying infection. In severe cases your toe or foot may need to be amputated. If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist (a medical professional, also known as a chiropodist, who specialises in foot care). Cardiovascular autonomic neuropathy (CAN) Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem thats common in people with diabetic polyneuropathy. CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat. The two main noticeable symptoms of CAN are: an inability to exercise for more than a very short period of time orthostatic hypotension  a type of low blood pressure that can make you feel dizzy or faint when you stand up Treating CAN You may be able to control the symptoms of orthostatic hypotension by using a number of self care techniques, such as: standing or sitting up slowly and gradually drinking plenty of fluids to increase the volume of your blood and raise your blood pressure wearing compression stockings to help prevent blood falling back down into your legs tilting your bed by raising it at the head end In some cases, medication may be required to treat orthostatic hypotension. Two widely used medications are: fludrocortisonewhich works by increasing the volume of your blood midodrinewhich works by tightening your blood vessels A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest,where your heart stops beating altogether. To prevent this, you may be prescribed medication to help regulate the beating of your heart, such as flecainide, beta-blockers or amiodarone. If you have CAN, youll probably need to have regular check-ups so your heart function can be monitored. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Trigeminal neuralgia Other health sites Pain Concern Trigeminal Neuralgia Assocation UK Diabetes UK: neuropathy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852