Peripheral Neuropathy is a common condition affecting the nerves in your peripheral nervous system, the network of nerves outside your brain and spinal cord. Approximately 1 in 10 adults aged 55 or over in the UK is affected by Peripheral Neuropathy, with the hands, feet and arms being the most affected.

Here, we’ll explore the symptoms and causes of Peripheral Neuropathy and the best treatments and medications. For more information and support in navigating Peripheral Neuropathy, sign up to Carecircle and connect with fellow patients, carers and experts.

What is Peripheral Neuropathy?

Peripheral Neuropathy is a fairly common condition affecting the peripheral nervous system, which is the network of nerves that lie outside of the brain and spinal cord (the central nervous system).

When the nerve cells are damaged or destroyed, neuropathy is caused, disrupting the information signals that the central nervous system and the network of nerves around it send to each other. The condition can affect one nerve or nerve type, a combination of nerves or many peripheral nerves around the body.

Neuropathies most frequently start in the hands and feet and common first signs of the condition include numbness or tingling sensations, shooting pains, loss of balance and muscle weakness.

Types of Peripheral Neuropathy

There are three main types of Peripheral Neuropathy. They include:

• Mononeuropathy – where only one nerve is affected
• Mononeuritis multiplex – where several nerves are affected
• Polyneuropathy – where many nerves throughout the body are affected. This is the most common type of Peripheral Neuropathy

Peripheral Neuropathy can also affect different types of nerves. People with the condition may have:

• Motor neuropathy – where the nerves responsible for controlling muscles are affected. People with motor neuropathy may experience a lack of coordination and problems speaking
• Sensory neuropathy – where the nerves responsible for transmitting sensations (like pain or touch) are affected. Patients with sensory neuropathy may struggle with their ‘feeling’ senses
• Autonomic nerve neuropathy – where nerves that regulate automatic body functions like blood pressure and digestion are affected. Patients with autonomic nerve neuropathy may develop serious heart and respiratory problems
• Combination neuropathies – where various nerve types are affected. The most common combination of neuropathies is motor and sensory. Many patients may experience a loss of sensation and motor control.

Peripheral Neuropathy symptoms

Symptoms of Peripheral Neuropathy depend on the type and location of the condition. Common signs and symptoms of Peripheral Neuropathy include:

• Numbness or tingling sensations – particularly in the hands and feet
• Burning, stabbing or shooting pains in the affected areas
• Changes in sensations – this can result in an inability to feel pain and extreme sensitivity to touch
• Loss of balance and coordination
• Muscle weakness – especially in the feet
• Muscle twitching, cramps or spasms
• Low blood pressure or abnormal heart rate – this can cause dizziness, fainting or lightheadedness
• Paralysis – patients may struggle to move certain parts of the body
• Unintentional weight loss
• Sexual function problems
• Sweating or inability to control body temperature
• Digestion problems – including bloating, nausea, vomiting, diarrhoea and constipation
• Bladder and urination issues

Stages of Peripheral Neuropathy

There are 5 different stages of Peripheral Neuropathy and each one can become worse if left untreated. The 5 stages include:

• Stage 1: Numbness and pain – These symptoms usually start in the hands and feet and may come and go. Usually, the symptoms recur every few weeks and become more regular from there. Balance and reflexes may also be affected
• Stage 2: Regular and persisting symptoms – If your pain and numbness become more persistent and impossible to ignore, you may have entered the second stage. This is usually the stage when people recognise that something is wrong
• Stage 3: Debilitating pain – The third stage is when the pain occurs daily or almost daily and affects everyday activities. At this point, pain can be quite severe and specialist medication may need to be prescribed
• Stage 4: Constant numbness – In the fourth stage, the number of healthy nerves carrying signals to the brain has diminished. As a result, your legs and feet will become very numb and it may be difficult to walk. Patients at this stage will require urgent treatment
• Stage 5: Complete loss of feeling – The final stage is when all feeling in the lower legs and feet has gone. As there are no nerves sending signals to your brain, you won’t feel pain – only numbness. A wheelchair will likely be required at this point.

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Causes of Peripheral Neuropathy

There are many causes of Peripheral Neuropathy including health conditions and certain medicines. Sometimes the exact cause can’t be identified. In this situation, the condition is termed idiopathic neuropathy.

The main causes of Peripheral Neuropathy are:

• Diabetes – Both Type 1 Diabetes and Type 2 Diabetes can cause Peripheral Neuropathy due to high blood sugar levels likely causing damage to blood vessels that supply the nerves. People with diabetes are more likely to develop Peripheral Neuropathy if they smoke, drink alcohol heavily or are aged 40 and over.
• Medicines – Certain medications can cause Peripheral Neuropathy as a side effect in some people including some cancer chemotherapy, antibiotics if taken over a long period.

Other causes of the condition include:

• Long-term excessive alcohol drinking
• Low levels of Vitamin B12 and other vitamins
• An underactive thyroid gland
• Physical damage to the nerves as a result of surgery or injury
• Blood vessel inflammation
• Chronic liver disease or kidney disease
• Certain infections including Lyme disease, shingles, HIV and diphtheria
• Certain cancer types including lymphoma and multiple myeloma
• Abnormal proteins in the blood
• High levels of toxins in the body (arsenic, for example)
• Guillain-Barré syndrome, a rare condition causing quick paralysis
• Immune system disorders including lupus and coeliac disease

Peripheral Neuropathy diagnosis

To diagnose Peripheral Neuropathy, a GP will carry out a number of tests and body examinations. They’ll ask you about your symptoms and may test your sensations, strength and reflexes. They may also carry out blood tests to check for diabetes and Vitamin B12 deficiency.

In some cases, you may need to see a neurologist, which is a specialist in nervous system health conditions. They may carry out further tests including a:

• Nerve conduction test (NCS) – This test measures the speed and strength of your nerve signals by releasing tiny electric shocks into your nerves by applying small metal wires called electrodes onto your skin
• Electromyography (EMG) – This test measures the electrical activity of your muscles by inserting a small needle through your skin and into your muscle

A nerve biopsy may also be used to diagnose Peripheral Neuropathy, however, it’s rarely required. The minor surgical procedure works by collecting a small sample of a peripheral nerve near your ankle.

To identify the cause of your condition, your GP will analyse your symptoms, physical examination results and the sugar levels in your blood and urine. Diabetic neuropathy is usually quite easy to diagnose. If your GP suspects that any medicine you’re taking is causing the condition, they may reduce or temporarily stop your dosage to see if your symptoms improve.

If diabetes and medications have been ruled out, you may be referred to a neurologist for more blood tests to determine whether you have a genetic abnormality (for example, Charcot-Marie-Tooth disease) or a rare acquired cause that may be responsible.

Lumbar punctures, X-rays, CT scans and MRI scans may also be required to look for any underlying causes of your condition.

What to do if you have Peripheral Neuropathy?

If you have symptoms of Peripheral Neuropathy such as tingling in feet, you should make an appointment with your GP, who will be able to diagnose your condition and identify the underlying cause. This will be done with a discussion about your symptoms, a physical examination and occasionally, blood tests.

Sometimes your doctor may refer you to a neurologist for further testing if required. Once they diagnose Peripheral Neuropathy and determine what stage of the condition you have, you will be advised on suitable treatments.

If you have already been diagnosed with the condition and you develop a cut or ulcer on your foot that isn’t getting better, you should arrange to see your doctor immediately.

It is important to treat Peripheral Neuropathy as soon as you have been diagnosed as leaving the condition untreated can lead to serious complications.

Join Carecircle for free and find help, hope, and control with your Peripheral Neuropathy diagnosis. Our global network for health makes you part of a worldwide community where your voice matters. Together, we can work toward a better future.

Peripheral Neuropathy Treatment

If you have been diagnosed with Peripheral Neuropathy and the underlying cause has been determined, the first step would be to treat the underlying cause and its symptoms. For example, if you have diabetes, your doctor may recommend certain lifestyle changes to control your blood sugar levels including eating a healthy diet and exercising regularly.

Should your condition be caused by a Vitamin B12 deficiency, you may be prescribed B12 injections or tablets. If your doctor thinks that medication may be the cause, your dosage may be temporarily stopped or reduced to see if your symptoms improve.

Less common types of Peripheral Neuropathy may be treated with:

• Steroids – to reduce inflammation
• Immunosuppressants – to reduce your immune system activity
• Immunoglobulin injections – to increase the levels of antibodies in your immune system

If the condition is causing you nerve pain, you may also be recommended:

• A common treatment for headaches and depression
• A treatment also used for bladder problems and depression
• Treatments used for epilepsy, headaches and anxiety
• Capsaicin cream – a topical cream that relieves pain in the affected area
• Powerful painkillers
• Alternative therapies such as acupuncture, herbal medicines, benfotiamine (a form of vitamin B1) supplements and alpha-lipoic acid (an antioxidant) supplements

All treatments may cause side effects so it’s important to speak to your doctor before agreeing to any medication. To find help, hope and control with your Peripheral Neuropathy, you can also join Carecircle for free. Our global network for health makes you part of a worldwide community where your voice matters.

Peripheral Neuropathy FAQs

It’s natural to have questions about Peripheral Neuropathy. Here are the answers to some FAQs.

How bad can Peripheral Neuropathy get?

How bad Peripheral Neuropathy gets depends on the underlying cause, what stage of the condition you have, which nerves have been affected and whether it’s left untreated.

If Peripheral Neuropathy is ignored, you are at risk of developing serious complications such as foot ulcers, which can develop into gangrene if left untreated. This may lead to the requirement for foot amputation.

Sometimes Peripheral Neuropathy gets worse over time and causes complete paralysis in the affected areas. That’s why it’s important to treat the condition as soon as you have been diagnosed.

What is the best medication for nerve pain?

There are a number of medications to treat nerve pain which should be prescribed by your doctor. You could also try applying capsaicin cream to the affected areas if the pain is confined to one area of the body.

You may also find relief with acupuncture, herbal medicines, benfotiamine supplements and alpha-lipoic acid supplements.

Where to buy capsaicin cream in the UK?

Capsaicin cream is made from capsaicin, which is the substance that makes chilli peppers hot. It works by stopping the nerves from sending pain messages to the brain, which reduces pain. Side effects can include skin irritation and a burning sensation in the treated area at the start of the treatment.

You can get capsaicin cream on prescription in the form of gels, creams and plasters. It is important to speak to your GP first so they can determine whether it’s a suitable treatment for you.

Is foot numbness dangerous?

If you have foot numbness, it means that the nerves in your feet may be dead or impaired. This is dangerous because it essentially means that you’re unable to feel any pain. If you stepped on a pin, you might not even know. This can be dangerous because it could lead to infections.

In addition, things like stress fractures can become far worse and potentially lead to deformities if you have foot numbness. It’s important to be able to feel pain so that issues like these can be diagnosed.

On an even more serious note, foot numbness caused by Peripheral Neuropathy also puts you at risk of developing foot ulcers. If these are left untreated, it may lead to infections like gangrene and the need for amputation.

What is neuropathic pain?

Neuropathic pain refers to any pain and discomfort you experience as a result of damaged or impaired nerves. It’s not always easy to determine the source of neuropathic pain but it can be caused by Peripheral Neuropathy, diabetes, HIV, shingles, certain medications and alcoholism.

How do I know if nerve damage is healing?

When nerve damage is in a state of repair, the area around the nerve supplies may feel unpleasant and tingly as it recovers. As the nerve fibres grow, you may experience electric shock sensations. Over time, these sensations will subside and you’ll begin to feel more normal again.

Join Carecircle for free and find help, hope, and control with your Peripheral Neuropathy diagnosis. Our global network for health makes you part of a worldwide community where your voice matters. Together, we can work toward a better future.

Peripheral Neuropathy Resources

If you’re suffering from the effects of Peripheral Neuropathy, you may find the following resources and links useful:

• Peripheral Neuropathy – NHS
• British Peripheral Nerve Society
• The Foundation for Peripheral Neuropathy
• Peripheral Neuropathy – Diabetes UK
• Peripheral Neuropathy – Macmillan Cancer Support

Peripheral Neuropathy is a condition that affects the nerves outside your central nervous system. It most commonly affects the hands, feet and arms and typical symptoms include numbness, tingling, shooting pains, loss of balance and muscle weakness. It’s important that Peripheral Neuropathy gets diagnosed because if the condition is left untreated, it can lead to serious complications like paralysis and foot ulcers.

It’s never too late to join the conversation on Peripheral Neuropathy. Sign up to Carecircle for free and find help, hope and control with your Peripheral Neuropathy diagnosis. Our global network for health makes you part of a worldwide community where your voice matters. Together, we can work toward a better future.

Guide Sources

• https://www.yalemedicine.org/conditions/neuropathy
• https://www.nhs.uk/conditions/peripheral-neuropathy/
• https://my.clevelandclinic.org/health/diseases/14737-neuropathy
• https://www.selecthealthtc.com/five-stages-of-neuropathy/
• https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/peripheral-neuropathy#complications-of-peripheral-neuropathy
• https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/capsaicin/
• https://www.carolinapodiatry.net/blog/the-dangerous-risks-of-numb-feet.cfm
• https://my.clevelandclinic.org/health/diseases/15833-neuropathic-pain
• http://www.rebeccaayers.co.nz/procedures-and-information/hand-surgery/nerve-surgery-and-nerve-repair