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What is peripheral neuropathy?

Peripheral neuropathy is damage to nerves in the extremities of the body - such as the feet and hands - causing pain, tingling, numbness and weakness.

Peripheral neuropathy is a common health condition affecting around 1 in 10 over-55s to some degree in the UK.

Unmanaged diabetes is a common cause of peripheral neuropathy.

Peripheral nerves

The peripheral nerves link the brain and spinal cord (central nervous system) to other parts of the body.

These include:

  • Sensory nerves transmitting pain and touch signals
  • Motor nerves to control muscles
  • Autonomic nerves to control things we don't think about but happen automatically, such as regulating blood pressure.

What are the symptoms of peripheral neuropathy?

Depending on the cause, peripheral neuropathy symptoms can come on suddenly or develop over time. Symptoms are usually grouped into the main types of peripheral neuropathy:

Sensory neuropathy (senses)

  • Tingling, prickling, pins and needles
  • Numbness, unable to feel pain, heat or cold
  • Sharp pain, burning pain
  • Pain from very light touch (allodynia)
  • Balance or co-ordination problems, unable to tell where the feet and hands are to help movement (sensory ataxia).

Motor neuropathy (movement)

  • Muscle cramps
  • Twitching
  • Muscle weakness
  • Paralysis of some muscles
  • Muscle wasting
  • Foot drop.

Autonomic neuropathy (the body's auto pilot)

Mononeuropathy (single nerve damaged)


Polyneuropathy

  • This describes having more than one of these groups of symptoms, such as sensorimotor polyneuropathy where both sensory and motor neuropathy are experienced.

What causes peripheral neuropathy?

Causes of peripheral neuropathy include:

  • Undamaged diabetes blood sugar levels causing nerve damage
  • Long-term alcohol abuse
  • Low vitamin B12 levels
  • Accident, injury or surgical problem damaging nerves
  • Underactive thyroid (hypothyroidism)
  • Shingles
  • Lyme disease
  • Diphtheria
  • Botulism
  • HIV
  • Vasculitis blood vessel inflammation
  • Chronic liver disease
  • Chronic kidney disease
  • Monoclonal gammopathy of undetermined significance (MGUS) - abnormal blood proteins
  • Lymphoma - cancer of the body's lymphatic system
  • Multiple myeloma - bone marrow cancer
  • Charcot-Marie-Tooth (CMT) - inherited disease causing motor sensory problems
  • Toxins, arsenic, lead or mercury
  • Guillain-Barré syndrome
  • Amyloidosis
  • Rheumatoid arthritis
  • Lupus
  • Sjogren's syndrome
  • Side effects of some medications
  • Idiopathic neuropathies, where the cause is not known.

How is peripheral neuropathy diagnosed?

Diagnosis will be based on examinations and tests and may involve a referral to a specialist. Diagnosis steps may include:

  • Symptoms
  • Medical history, having other medical conditions such as diabetes
  • Physical examination
  • Likely causes, accidents, type of work
  • Diabetes blood tests
  • Vitamin B12 deficiency blood test
  • Nerve conduction test (NCS), where electrodes placed on the skin measure nerve signal speed and strength
  • Electromyography (EMG), where electrical activity of the muscles is measured using a needle under the skin
  • Tests for genetic conditions
  • Nerve biopsy tissue sample taken for laboratory testing
  • X-ray
  • CT scan
  • MRI scan.
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