Peripheral neuropathy

Peripheral neuropathy is a disorder of the peripheral nerves. These nerves send messages between the central nervous system, the brain and the spinal cord, and the rest of the body.

Peripheral neuropathy is a general term that describes many conditions caused by damage to the peripheral nervous system, which is responsible for sending sensory information to and from the central nervous system. For example, the peripheral nerves can tell the body when the hands are cold.

Peripheral neuropathy affects more than 20 millionTrusted Source people in the United States. In general, the condition can cause a loss of normal nerve signals, or cause inappropriate or distorted signals.

The condition can affect a range of different nerves, so it can impact a variety of locations in different ways. It can affect a single nerve or several nerves at the same time.

Examples of peripheral neuropathy include:
  • postherpetic neuralgia, which can follow shingles and last for many months after the rash disappears
  • ulnar nerve palsy, such as after an injury to the elbow.
  • carpal tunnel syndrome, which is a compression of the nerves in the wrist.
  • peroneal nerve palsy, which is caused by compression of the fibular nerve in the leg.
  • Bell’s palsy, which is a single-nerve neuropathy that affects the face.


Symptoms of peripheral neuropathy may vary according to the type of neuropathy. Researchers have identified 100 different types of neuropathy.

Generally, the types are classified into three categories, each with its own set of symptoms. They are:

Sensory neuropathy

This affects the sensory nerves, which impact the sensations of pain, touch, and temperature.

The person may have:
  • decreased sensation of vibration and touch
  • pins and needles and hypersensitivity
  • increased pain or inability to feel pain
  • loss of ability to detect changes in heat and cold
  • difficulty with coordination and balance
  • burning, stabbing, lancing, boring, or shooting pains, which may be worse at night
Especially in cases when the cause is diabetes, sensory neuropathy can also lead to foot and leg ulcers, infection, and gangrene.

Motor neuropathy

This affects the muscles that the brain controls consciously.

Symptoms include:
  • muscle weakness, leading to unsteadiness and difficulty performing small movements such as buttoning a shirt
  • muscle wasting
  • muscle twitching and cramps
  • muscle shrinking

Autonomic neuropathy

The affects body processes that the brain controls involuntarily. Symptoms may include:
  • problems with sweating
  • heat intolerance
  • problems with bowel or bladder control
  • problems with blood pressure
  • problems with swallowing


Treatment either targets the underlying cause, or it aims to provide symptomatic pain relief and prevent further damage. Treatments may include:
  • Maintaining nerve health by keeping a healthy lifestyle. This can include exercising, eating healthy, keeping a healthy weight, correcting any vitamin deficiencies, and not drinking alcohol or smoking.
  • Managing blood sugar in cases of diabetic neuropathy, to prevent further nerve damage.
  • Taking immunosuppressive drugs when the cause is an autoimmune disorder, or using plasmapheresis, a procedure that cleans the blood to reduce inflammation.
  • Removing the exposure to a suspected toxin, or stopping a problematic drug, to halt further nerve damage.
  • Using hand and and foot braces or orthopedic shoes to help cope with physical disability from motor symptoms.

Medications for neuropathic pain

Medications that may help relieve symptoms, but do not cure the problem, include:
  • drugs normally used for epilepsy, such as carbamazepine
  • antidepressants, such as venlafaxine
  • Duloxetine, which may help people with chemotherapy-induced neuropathy.
  • prescription skin patches, such as Lidoderm, for temporary, localized pain relief. This contains the local anesthetic lidocaine. The patches are like bandages, and a person can cut them to size.
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which may help control milder pain. These are available over the counter.
  • Topical ointments and creams, such hot pepper-containing capsaicin, which may also ease pain. A person can also get patches.
A person’s choice of treatment should take into account any medications that person is taking for other conditions in order to avoid unwanted interactions.

Treatments for mononeuropathies

When a person’s neuropathy happens as a result of compression of a single nerve, treatment is similar regardless of which nerve is involved. The approach depends on whether the compression is fixed or transient.

A palsy of the ulnar, radial, or peroneal nerve may be temporary and reversible if a person simply avoids the cause of the nerve compression. For example, a person with ulnar nerve palsy should not lean on the affected elbow.

The person may need to rest, use heat, or take a limited course of drugs to reduce inflammation.

In carpal tunnel syndrome, conservative therapy includes splinting the wrist and taking oral or injected corticosteroid drugs.

If a single-nerve neuropathy does not respond to these measures, surgery may be an option in rare cases. Surgery may also be necessary if the nerve compression is fixed, for example when the cause is a tumor.

A doctor should consider referring a person to pain specialist or a relevant clinical specialty at any stage if:
  • their pain is severe
  • their pain significantly limits daily activities and quality of life
  • an underlying health condition is getting worse

Natural treatments

Non-drug measures for peripheral neuropathy can include using warm or cold packs, unless heat or cold makes the symptoms worse.

Stress relief and other complementary therapies include meditation, relaxation techniques, massage, and acupuncture. These may help a person cope with pain from the condition.

Some people find that using a transcutaneous electrical nerve stimulation (TENS) machine helps. This device interrupts nerve messages by delivering a small electric current. Research has not confirmed the effectiveness of this treatment.


Many types of neuropathy are “idiopathic,” or of unknown cause, but a number of conditions can trigger the problem. These include:
  • Chronic kidney disease: If the kidneys are not functioning normally, an imbalance of salts and chemicals can cause peripheral neuropathy.
  • Injuries: Broken bones and tight plaster casts can put pressure directly on the nerves.
  • Infections: Shingles, HIV infection, Lyme disease, and viral illnesses can lead to nerve damage.
  • Guillain-Barré syndrome: This is a specific type of peripheral neuropathy triggered by infection.
  • Some autoimmune disorders: These include rheumatoid arthritis and systemic lupus erythematosus (SLE).
  • Some kinds of cancer: These including lymphoma and multiple myeloma
  • Chronic liver disease
Other causes can include:
  • excessive alcohol intake
  • some medications, such as chemotherapy and HIV treatment drugs
  • B12 or folate vitamin deficiencies
  • exposure to toxins such as insecticides and solvents
Disorders of the small blood vessels can reduce blood supply to the nerves, resulting in nerve tissue damage. Certain benign tumors can also affect nerve tissue and lead to neuropathic pain.

Diabetic neuropathy

Diabetes is the most common cause of chronic peripheral neuropathy in the U.S. About 60-70Trusted Source percent of people with diabetes will have some form of damage to their sensory, motor, or autonomic nerves. Many will have foot problems and ulcers.

High blood sugar levels cause damage to the walls of the tiny blood vessels that supply oxygen and nutrients to the nerves in the ends of the hands and feet, and the essential organs in the body, such as the eyes, kidneys, and heart. Whenever skin becomes damaged, the loss of sensation further increases the risk of damage.


Peripheral neuropathy causes a variety of symptoms with many possible causes.

A doctor will usually begin by taking a person’s medical history. This includes gathering information about all the symptoms, but also details about a person’s life, potential environmental exposures, and any risks of infectious or neurological diseases.

The next step should be a physical and neurological exam that will help the doctor identify any nerve damage. Potential tests a doctor may perform include nerve conduction velocity (NCV) and electromyography (EMG). These tests measure nerve signal strength and electrical activity.

A doctor may also do a nerve biopsy. In cases of suspected autonomic peripheral neuropathy, a person can get a QSART test, which measures their ability to sweat.

For some types of neuropathies, like nerve compression, a person can also get a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan. Another option is a muscle and nerve ultrasound, but this is not common.

If the doctor confirms that neuropathy is present, the doctor will look for the cause. The doctor may then send the person to get blood tests in order to check for diabetes and other potential underlying conditions.

The doctor may check for vitamin deficiencies, liver or kidney dysfunction, infections, metabolic disorders, or any immune cells that may indicate an immune disorder. In some cases, the doctor may order a test to rule out a genetic disorder.

If none of these tests can point to a cause, a doctor may conduct additional tests.