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Overview
Peripheral neuropathy develops when nerves in the body's extremities, such as the hands, feet and arms, are damaged. The symptoms depend on which nerves are affected.
Different types of peripheral neuropathy
Peripheral neuropathy may affect:
- only 1 nerve (mononeuropathy)
- several nerves (mononeuritis multiplex)
- all the nerves in the body (polyneuropathy)
Polyneuropathy is the most common type and starts by affecting the longest nerves first, so symptoms typically begin in the feet.
Over time it gradually starts to affect shorter nerves, so feels as if it's spreading upwards, and later affects the hands.
Symptoms
The main symptoms of peripheral neuropathy 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.
Causes
Diabetes is the most common cause of peripheral neuropathy.
Neuropathy can also be caused by other health conditions and certain medicines.
In some cases, no cause can be identified and this is termed idiopathic neuropathy.
Diabetes
Peripheral neuropathy caused by either type 1 diabetes or type 2 diabetes is called diabetic polyneuropathy.
It's probably caused by high levels of sugar in your blood damaging the tiny blood vessels that supply your nerves.
Peripheral neuropathy becomes more likely the longer you have had diabetes.
Up to 1 in 4 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 drink large amounts of alcohol
- are over 40 years old
If you have diabetes, examine your feet regularly to check for open wounds or sores (ulcers) 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 nerves, such as from an injury or during surgery
- an underactive thyroid gland
- certain infections, such as shingles, Lyme disease, diphtheria, botulism and HIV
- inflammation of the blood vessels
- chronic liver disease or chronic kidney disease
- the presence of an abnormal protein in the blood (monoclonal gammopathy of undetermined significance, or MGUS)
- 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) disease and other types of hereditary motor sensory neuropathy, genetic conditions that cause nerve damage, particularly in the feet
- having high levels of toxins in your body, such as arsenic, lead or mercury
- Guillain-Barré syndrome, a rare condition that causes rapid onset of paralysis within days
- amyloidosis, a group of rare but serious health conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body
- health conditions caused by overactivity of the immune system, such as rheumatoid arthritis, lupus, Sjögren's syndrome or coeliac disease
Medicines
A few medicines 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 or nitrofurantoin
- phenytoin, used to treat epilepsy, if taken for a long time
- amiodarone and thalidomide
Diagnosis
A number of tests may be used to diagnose peripheral neuropathy and its underlying cause.
When you see a GP, they'll ask about your symptoms and examine the affected area of your body. This may involve testing sensation, strength and reflexes.
The GP may also arrange blood tests, especially to check for causes such as diabetes or vitamin B12 deficiency.
Confirming if you have a neuropathy
Some people may need to see a neurologist, a specialist in health conditions affecting the nervous system, in hospital for further tests.
These may include:
- a nerve conduction test (NCS), where small metal wires called electrodes are placed on your skin that release tiny electric shocks to 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 EMG are usually carried out at the same time.
Identifying the cause of a neuropathy
The GP can usually identify the underlying cause of a peripheral neuropathy.
If diabetes is suspected, they can usually make a confident diagnosis based on your symptoms, a physical examination, and checking the levels of sugar in your blood and urine.
If you're taking a medicine known to cause peripheral neuropathy, the GP may temporarily 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 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 a clear, colourless fluid that surrounds and supports the brain and spinal cord (cerebrospinal fluid) for inflammation.
Biopsy and scans
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.
It's then checked for changes that could be a sign of certain types of peripheral neuropathy. But nerve biopsies are rarely needed.
You may also need a scan to look for any underlying cause of your neuropathy, such as:
- an X-ray
- a CT scan
- an MRI scan
Treatment Options
Treatment for peripheral neuropathy depends on the symptoms and underlying cause.
Not all of the underlying causes of neuropathy can be treated.
For example, if you have diabetes, it may help to gain better control of your blood sugar level, stop smoking and cut down on alcohol.
Nerve pain may be treated with prescribed medicines called neuropathic pain agents, as standard painkillers often do not work.
If you have other symptoms associated with peripheral neuropathy, these may need to be treated individually.
For example, treatment for muscle weakness may involve physiotherapy and walking aids.
When To See A Doctor
It's important to see a GP if you experience the early symptoms of peripheral neuropathy.
These include:
- pain, tingling or loss of sensation in the feet
- loss of balance or weakness
- a cut or ulcer on your foot that's not getting better
It's also recommended that people at highest risk of peripheral neuropathy, such as people with diabetes, have regular check-ups.
A GP will ask about your symptoms and may arrange some tests to help identify the underlying cause.
You may be referred to hospital to see a neurologist, a specialist in health problems affecting the nervous system.
Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications.
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