What Is Peripheral Neuropathy?
Peripheral neuropathy is a general term for nerve damage that causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body and bodily functions including digestion and blood pressure control.
The peripheral nerves make up a network that connects your brain and spinal cord to your muscles, skin, and internal organs. Damage to these nerves interrupts communication between your brain and other parts of your body. This can cause muscle weakness, tingling, and pain in your arms, hands, legs, and feet.
Types of Peripheral Neuropathy
There are over 100 types of peripheral neuropathy, each with its own causes and symptoms that stem from a variety of issues. They range from carpal tunnel syndrome (an overuse injury) to diabetes-related nerve damage.
Doctors and researchers categorize peripheral neuropathies in many ways. Here are some of the terms you might hear:
Damage to a single peripheral nerve is called mononeuropathy. Physical injury or trauma, such as from an accident, is the most common cause. Pressure on a nerve for a long time, caused by being sedentary for extended periods (such as sitting in a wheelchair or lying in bed), or continuous, repetitive motions, can trigger mononeuropathy.
Here are examples of mononeuropathies that can cause weakness, tingling, numbness, and other symptoms in affected parts of the body, such as your hands and feet:
Carpal tunnel syndrome is the most common type of mononeuropathy, making up about 90% of all cases. It's called an overuse or repetitive strain injury, which happens when the nerve that travels through your wrist is compressed. If your work requires repeated motions with your wrists -- for example, working on an assembly line or typing on a computer all day -- you are at greater risk.
Ulnar nerve palsy happens when the nerve that passes close to the surface of your skin at your elbow is damaged. You can often feel numbness in your fourth and fifth fingers.
Radial nerve palsy is caused by injury to the nerve that runs along the underside of your upper arm. It can happen with fractures of the humerus bone in the upper part of your arm. Poorly fitted crutches can also cause it by putting pressure on the inside of your arm near your armpit.
Peroneal nerve palsy happens when the nerve at the top of your calf on the outside of your knee is compressed. This leads to a condition called "foot drop," in which it becomes difficult to lift your foot.
Mononeuritis multiplex, also known as multiple mononeuropathy, happens when there is damage to at least two separate nerve areas. Unlike polyneuropathy, which generally affects the same nerves on both sides of your body, mononeuritis multiplex shows up in random areas. It also doesn’t typically involve more than a few specific nerves. It can affect these nerves all at once or only a couple at a time.
Certain long-term (chronic) illnesses are often the cause of mononeuritis multiplex. These include diabetes, vasculitis, lupus, and rheumatoid arthritis. Sometimes a viral infection, such as Hansen's disease (leprosy), can also be responsible.
If you have mononeuritis multiplex, you may have pain, weakness, and unusual feelings in the areas where the affected nerves are. If your condition becomes worse, your symptoms may show up on both sides of your body, which is what happens with polyneuropathy.
Polyneuropathy accounts for the greatest number of peripheral neuropathy cases. It occurs when multiple peripheral nerves throughout the body malfunction at the same time.
The most common symptoms of polyneuropathy are tingling and numbness or a burning sensation in the feet or hands. Symptoms of polyneuropathy typically show up in the same areas on both sides of the body.
Polyneuropathy can have a wide variety of causes, including exposure to certain toxins, alcohol abuse, poor nutrition (such as low vitamin B12), and complications from diseases such as cancer or kidney failure.
One of the most common forms of chronic polyneuropathy is diabetic neuropathy, a condition that can happen if you have diabetes. It is more severe if your blood sugar levels aren't well controlled.
Motor neuropathy is damage to nerves that control the muscles you consciously use, such as those involved in walking, talking, sitting, or holding onto things.
Some motor neuropathies are acute, meaning symptoms come on suddenly and may quickly become severe. This type is most commonly seen in people with Guillain-Barré syndrome, a disorder that causes your immune system to attack your body’s peripheral nervous system. About 95% of people recover fully or almost fully from Guillain-Barré syndrome.
Other motor neuropathies are chronic and generally get worse over time. This is more common if you have a motor neuron disease. These illnesses destroy brain cells that control movements such as walking, speaking, swallowing, and breathing. This includes conditions such as amyotrophic lateral sclerosis (ALS) and Kennedy’s disease, a rare inherited condition that causes muscle loss and weakening, particularly in your arms and legs.
This type of neuropathy affects the nerves that transmit sensations, such as pain, touch, and temperature.
If you have sensory neuropathy, you might feel pins and needles or electric shock-like jolts in your arms and legs. Your skin may become ultrasensitive so even the lightest touch triggers pain. Or you may lose sensation, which can raise your risk of burning or hurting yourself and not being aware of it.
Sensory neuropathy is commonly linked with diabetes, especially when the condition isn’t well controlled. A range of other illnesses and disorders can also bring it on, including HIV, Guillain-Barré syndrome, alcohol use disorder, herpes simplex, Hansen's disease (leprosy), and hepatitis C.
Autonomic neuropathy involves nerves that control involuntary functions, such as breathing, digestion, urination, sweating, sexual response, and blood pressure regulation. It happens because damage to these nerves cuts off communication between your brain and important organs, such as your heart, lungs, bladder, and intestines.
Diabetes is the most common cause of autonomic nerve neuropathy. Autoimmune diseases, certain medications, and viral infections such as HIV and Lyme disease can also cause it.
It’s not uncommon for peripheral neuropathy to affect more than one body system or function. If this is your situation, your doctor might say you have a “combination neuropathy.” They may also tell you that you have “predominantly” one type or another.
The most typical overlap of symptoms occurs between sensory and motor functions. This is often referred to as sensorimotor polyneuropathy. Diabetes is the most common cause of sensorimotor polyneuropathy, which can make you lose sensation in your feet and hands, for example. But muscle weakness and nerve damage can also affect your ability to stand or walk.
Autoimmune peripheral neuropathy
This refers to when your immune system – which protects your body from infections, viruses and other threats– mistakenly attacks your peripheral nerves. Conditions that can cause autoimmune neuropathy include Guillain-Barré syndrome, Sjogren’s syndrome, lupus, and rheumatoid arthritis.
Most inflammatory neuropathies are also autoimmune neuropathies. This is because when the autoimmune system attacks peripheral nerves, it causes harmful inflammation.
Inflammatory neuropathies fall into three basic categories:
Acute. They are marked by a rapid and severe onset, such as with Guillain-Barré syndrome.
Chronic. These conditions come on gradually and can worsen over time. When doctors talk about chronic inflammatory neuropathy, they are often referring to chronic inflammatory demyelinating polyneuropathy. This condition attacks the fatty coverings that protect nerves, which then slows or stops communication from your brain and spinal cord to other parts of your body.
Peripheral nerve vasculitis. It happens when your immune system attacks and inflames blood vessels that supply peripheral nerves. As a result, you can develop neuropathy in parts of your body where that blood supply has been affected.
What Causes Peripheral Neuropathy?
Causes of peripheral neuropathy are divided into three categories:
Acquired peripheral neuropathy. These are caused by environmental factors such as toxins, trauma, illness, or infection. Causes of acquired neuropathies include:
- Some rare inherited diseases
- Poor nutrition or low levels of some vitamins
- Certain kinds of cancer and chemotherapy used to treat them
- Conditions where nerves are attacked by the body’s own immune system or damaged by an aggressive response to injury
- Certain medications
- Kidney and thyroid disease
- Infections such as Lyme disease, shingles, or AIDS
Hereditary peripheral neuropathy. This type is not as common. Hereditary neuropathy is passed down through your family. The most common of these is Charcot-Marie-Tooth disease type 1. Symptoms include:
- Loss of muscle mass in your legs and feet
- Weakness in your legs, ankles, and feet
- Trouble walking and running
- High foot arches and curled toes
- Drop foot (trouble raising your foot at your ankle)
These symptoms usually show up when you are a teenager or young adult.
Dejerine-Sottas syndrome is another hereditary peripheral neuropathy that starts when you are a baby and causes gradually worsening symptoms, such as:
- Tingling, prickly, or burning sensations
- Muscle weakness in the legs
- Starting to walk later than normal
- Gradual loss of ability to walk by your teenage years
- Muscle and forearm weakness
- Breathing problems
Idiopathic peripheral neuropathy. In almost half of all cases, there isn't a specific cause. Your doctor may refer to your condition as "idiopathic."
Medicines that can cause peripheral neuropathy
Peripheral neuropathies can be a side effect of certain medications. This happens because the drugs, in some way, damage your peripheral nerves.
While the condition has been linked to any number of medications, peripheral neuropathy is commonly associated with the following types:
- Chemotherapy drugs such as cisplatin, oxaliplatin, taxanes, vinca alkaloids, bortezomib, suramin, and misonidazole
- Cardiovascular drugs such as amiodarone, perhexiline, and statins
- TNF-alpha inhibitors used to treat inflammatory conditions such as infliximab, etanercept, and adalimumab
- Anticonvulsants such as phenytoin, phenobarbital, carbamazepine, valproate, gabapentin, levetiracetam, and lacosamide
- HIV/AIDS drugs, such as zalcitabine, didanosine, and astavudine
- Certain antibiotics, including fluoroquinolones
- Disulfiram, used to treat alcohol use disorder
- Vitamin B6 (pyridoxine), when taken in high doses, especially over 200 milligrams daily
- Colchicine, often used to treat gout
- Lithium, particularly when taken in large amounts
- Chloroquine, often used to treat and prevent malaria
- Hydroxychloroquine, used to treat or prevent malaria as well as autoimmune conditions such as rheumatoid arthritis and lupus
Peripheral Neuropathy Complications
Complications and side effects of peripheral neuropathy depend a lot on the cause of your condition and your other health issues. Careful management and good medical care also play an important preventive role. In many, but not all cases, medication, physical therapy, diligent wound and foot care, assistive devices such as walkers and canes, and surgery can help minimize your risk for these and other problems:
Muscle weakness and atrophy. Damage to your peripheral nerves can weaken and shrink the muscles that are connected to them. This most commonly happens in your hands, lower legs, and feet. Such damage can weaken your grip, make you less stable on your feet, or make it difficult or even impossible to walk.
Foot ulcers. These slow-healing sores can affect anyone with peripheral neuropathy. But they are a particular problem for people with diabetes, who often have foot and leg numbness and aren’t aware that they have a wound or irritation. Making things worse, high blood pressure from diabetes reduces the blood supply to your feet, making the ulcer slower to heal and more likely to get infected. In severe cases, loss of tissue and infection from a foot ulcer can lead to gangrene — loss of blood to an area of your body. This could require amputation or even cause death.
Injury. Loss of sensation can raise your risk of hurting yourself and not being aware of it. Since you heal more slowly when you have peripheral neuropathy, a wound can increase your risk for nonhealing ulcers and infection.
Falls. Muscle weakness, decreased coordination, and dizziness from poor blood pressure control can raise your risk of falling. This can bring on a host of other complications from broken bones to pneumonia caused by extended bed rest while recovering from your fall.
Circulatory, digestive, sexual, and vision issues. When peripheral neuropathy affects autonomous nerves that control involuntary functions, it can cause many problems. These include bowel changes (constipation or diarrhea) and loss of bladder control, sudden drops in blood pressure and spikes in heart rate, erectile dysfunction or an inability to achieve orgasm, swelling in your feet and hands, and blurred vision.
Peripheral neuropathy is common, especially among people who have diabetes. If you notice symptoms such as tingling, numbness, stabbing pains in your hands or feet, or other unusual sensations, see your doctor promptly. Early treatment and good management can help get symptoms under control and often prevent your peripheral neuropathy from getting worse.
Peripheral Neuropathy FAQs
Does peripheral neuropathy go away?
It can depend upon what’s causing it. For instance, if any medication or vitamin deficiency is the cause, peripheral nerve damage can be treated and even reversed by stopping the drug, receiving vitamin therapy, and improving your diet. But in many cases, peripheral nerve damage can’t be repaired. If a chronic illness such as diabetes is the root cause, managing your underlying condition can help prevent your peripheral neuropathy from getting worse.
What is the life expectancy of a person with peripheral neuropathy?
Peripheral neuropathy itself isn’t generally life-threatening. But research suggests that it is associated with a higher risk of death from all causes. There are several reasons for this. If a chronic illness is causing your peripheral neuropathy, your life expectancy can be shortened by your underlying illness. Complications from peripheral neuropathy, such as foot ulcers, amputations, a sedentary lifestyle, and falls, are associated with death at an earlier age in older people. If peripheral neuropathy affects vital organs such as your heart, your symptoms can also be dangerous and even life-threatening.
What’s the difference between peripheral neuropathy and neuropathy?
Peripheral neuropathy is a term used to describe many different types of neuropathies. So, they can be used interchangeably.
How do you deal with peripheral neuropathy?
If you notice symptoms such as tingling, numbness, stabbing pains in your hands or feet, or other unusual sensations, see your doctor as soon as possible. In many, but not all cases, medication, better management of any underlying conditions, physical therapy, diligent wound and foot care, assistive devices such as walkers and canes, and surgery can help minimize your risk for complications and improve your quality of life.
How do you treat peripheral neuropathy in the toe?
If you have an underlying condition such as diabetes that’s causing neuropathy in your toes, your first and most important step is working with your doctor to manage your underlying condition as best as possible. You should also see a podiatrist (foot doctor) regularly to make sure your toes, toenails, and feet are well-groomed and carefully monitored for sores and wounds. The podiatrist or another doctor may also be able to reduce your discomfort with various treatments, such as injections, orthotics for your shoes, medications, and sometimes even surgery to ease pressure on affected nerves.