Peripheral Neuropathy

Peripheral neuropathy refers to a range of conditions that involve damage to the peripheral nervous system, the vast network of nerves that transmits information between the central nervous system (brain and spinal cord) and the rest of the body. These nerves include sensory nerves that receive sensations like touch, temperature, and pain; motor nerves that control muscle movement; and autonomic nerves that regulate functions like blood pressure, heart rate, digestion, and bladder function. Damage to these nerves can cause a variety of symptoms depending on which nerves are affected. Peripheral neuropathy may affect a single nerve (mononeuropathy), several nerves in different areas (multiple mononeuropathy), or many nerves simultaneously (polyneuropathy). With proper diagnosis and treatment, many people with peripheral neuropathy can manage their symptoms and maintain quality of life.

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What Causes It?

Diabetes mellitus - The most common cause of peripheral neuropathy worldwide, resulting from prolonged high blood sugar levels.

Alcoholism - Chronic alcohol abuse can lead to nutritional deficiencies and direct toxic effects on nerves.

Autoimmune disorders - Conditions like rheumatoid arthritis, lupus, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy.

Infections - Including Lyme disease, shingles, HIV/AIDS, leprosy, and diphtheria.

Vitamin deficiencies - Particularly B vitamins (B1, B6, B12) and vitamin E.

Medications - Certain chemotherapy drugs, anticonvulsants, antibiotics, and treatments for HIV/AIDS.

Toxins - Exposure to heavy metals (lead, mercury), industrial chemicals, or environmental toxins.

Trauma or pressure on nerves - From injuries, repetitive stress, or prolonged pressure (such as tight casts or prolonged bed rest).

Kidney and liver disorders - These can lead to imbalances in salts and chemicals that affect nerve function.

Genetic disorders - Inherited forms of neuropathy such as Charcot-Marie-Tooth disease.

Tumors - Can press on nerves or infiltrate them, or trigger paraneoplastic syndromes affecting nerves.

Connective tissue disorders - Such as rheumatoid arthritis, Sjögren's syndrome, and lupus.

Hypothyroidism - Low thyroid hormone levels can cause fluid retention that damages nerves.

Idiopathic - In some cases, no cause can be identified despite thorough evaluation.

Signs & Symptoms

Numbness and tingling - Often beginning in the feet or hands and potentially spreading upward.

Burning pain - Sharp, jabbing, throbbing, or burning sensations that may worsen at night.

Extreme sensitivity to touch - Even light touch can cause pain (allodynia).

Muscle weakness - Particularly in the affected areas, which can cause difficulties with daily activities.

Coordination problems - Including difficulty with fine motor tasks or unsteadiness when walking.

Feeling as if wearing gloves or socks when not - Called "stocking-glove" distribution, common in polyneuropathy.

Paralysis - In severe cases, when motor nerves are significantly affected.

Autonomic symptoms - Including heat intolerance, excessive or insufficient sweating, digestive problems, changes in blood pressure, or sexual dysfunction.

Changes in skin, hair, or nails - The affected area may show changes due to autonomic nerve involvement.

Symptoms that progress - Often beginning subtly and gradually worsening over time.

Asymmetric symptoms - In mononeuropathy or multiple mononeuropathy.

Symmetric symptoms - Typically in polyneuropathy, affecting both sides of the body similarly.

Phantom sensations - Feeling things that aren't there, such as vibrations or skin crawling.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Medical History and Physical Examination

Your doctor will ask detailed questions about your symptoms, medical conditions, family history, medications, alcohol use, and exposure to toxins. A thorough neurological examination will check your reflexes, muscle strength, sensation to touch, vibration and temperature, and coordination.

Blood Tests

These can check for diabetes, vitamin deficiencies, abnormal immune function, liver and kidney disorders, and other conditions that might cause neuropathy. Specific tests may include blood sugar, vitamin B12, thyroid function, and tests for inflammation or autoimmune conditions.

Nerve Conduction Studies (NCS)

These tests measure how quickly electrical signals travel through your nerves. Electrodes placed on the skin deliver tiny electrical impulses to nerves, and the response is measured. Slowed conduction indicates nerve damage.

Electromyography (EMG)

Often performed alongside NCS, this test measures the electrical activity in your muscles when they contract and when they're at rest. A needle electrode is inserted into specific muscles to evaluate electrical activity, helping distinguish between nerve and muscle disorders.

Nerve Biopsy

In some cases, a small portion of a peripheral nerve (usually the sensory nerve at the ankle) is removed and examined for abnormalities. This is typically done only when other tests haven't provided a clear diagnosis.

Skin Biopsy

A minimally invasive procedure that removes a small skin sample to examine nerve fiber endings, particularly useful for diagnosing small fiber neuropathy that might not show up on conventional nerve tests.

Imaging Tests

MRI or CT scans may be used to look for abnormalities like tumors, herniated disks, or other conditions that might be causing pressure on nerves.

Autonomic Testing

For suspected autonomic neuropathy, specialized tests can evaluate functions like heart rate variability, blood pressure response to position changes, and sweat production.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Treating the Underlying Cause

When possible, addressing the condition causing neuropathy is the first step. This might include better glucose control for diabetic neuropathy, nutritional supplements for deficiencies, changing medications that cause nerve damage, treating infections, or addressing autoimmune conditions.

Pain Management Medications

Various medications can help manage neuropathic pain, including anticonvulsants (like gabapentin and pregabalin), antidepressants (particularly tricyclic antidepressants and SNRIs), topical treatments (lidocaine patches or capsaicin cream), and in some cases, opioid painkillers for severe, resistant pain.

Physical Therapy

A physical therapist can teach exercises to improve strength, balance, and coordination. They may also recommend assistive devices like braces, canes, or specialized footwear to compensate for muscle weakness or prevent falls.

Occupational Therapy

An occupational therapist can help you find ways to perform daily activities despite hand or arm weakness or sensory loss, recommending adaptive equipment and alternative techniques for essential tasks.

Neuromodulation Therapies

These include transcutaneous electrical nerve stimulation (TENS), spinal cord stimulation, or peripheral nerve stimulation, which use electrical impulses to interrupt pain signals. These approaches may be considered when medications don't provide adequate relief.

Complementary Therapies

Some people find relief with acupuncture, massage, relaxation techniques, biofeedback, or certain supplements, though scientific evidence varies. These should complement, not replace, conventional medical treatment.

Plasmapheresis and Immunoglobulin Therapy

For inflammatory or autoimmune neuropathies, these treatments may help by removing harmful antibodies from the blood (plasmapheresis) or providing healthy antibodies to reduce immune system activity (immunoglobulin therapy).

Home Remedies

Foot Care

For those with decreased sensation in the feet, daily foot inspections are crucial. Check for cuts, blisters, or other injuries that might not be felt. Wash feet daily, moisturize to prevent cracking (but not between toes), wear comfortable shoes that fit well, and see a podiatrist regularly.

Exercise

Regular, gentle exercise improves circulation, helps control blood sugar, reduces pain, and maintains muscle strength. Walking, swimming, or water aerobics are often well-tolerated. Always start slowly and increase intensity gradually, with your doctor's approval.

Healthy Diet

Focus on balanced nutrition with plenty of fruits, vegetables, whole grains, and lean proteins. Limit alcohol, which can worsen neuropathy. For diabetic neuropathy, careful management of carbohydrate intake and meal timing is important for blood sugar control.

Quit Smoking

Smoking constricts blood vessels that supply nutrients to peripheral nerves and can worsen neuropathy symptoms. Seek support for smoking cessation through your healthcare provider, support groups, or cessation programs.

Hand and Foot Protection

Wear gloves when working with hands and protective footwear (never go barefoot) to prevent injury to areas with reduced sensation. Use potholders in the kitchen and check water temperature with a thermometer or unaffected body part to prevent burns.

Stress Reduction

Practice stress-management techniques such as deep breathing, meditation, yoga, or progressive muscle relaxation. Stress can exacerbate pain perception and make symptoms feel worse.

Warm or Cold Therapy

Apply warm or cold packs to painful areas for temporary relief. Some people prefer heat for muscle pain, while others find cold more soothing for burning sensations. Experiment to see what works best, but limit application to 20 minutes and always protect skin with a cloth barrier.

Elevation

If you experience swelling in your feet or hands due to neuropathy, elevate these extremities when resting to help reduce fluid accumulation and related discomfort.

Prevention Tips

Manage underlying conditions like diabetes with careful blood sugar control.

Monitor and manage your blood pressure to prevent nerve damage from hypertension.

Maintain a healthy weight through balanced nutrition and appropriate exercise.

Avoid or limit alcohol consumption, which can damage nerves directly and lead to nutritional deficiencies.

Don't smoke, as smoking constricts blood vessels that supply oxygen and nutrients to nerves.

Protect against repetitive motion injuries by taking breaks, using proper ergonomic equipment, and varying activities.

Use protective gear when working with chemicals or in situations with risk of toxic exposure.

Consider a vitamin B-complex supplement if at risk for deficiencies (discuss with your doctor first).

Get vaccinated against diseases that can cause neuropathy, such as shingles, when appropriate.

Regular exercise improves circulation and can help prevent neuropathy or slow its progression.

Inspect areas with reduced sensation daily for injuries you might not feel.

Wear proper footwear that fits well and protects your feet.

Follow your doctor's recommendations for regular check-ups and monitoring.

Report new or worsening neuropathy symptoms promptly to your healthcare provider.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Nerve Decompression Surgery

For neuropathies caused by pressure on a nerve (compression neuropathies), surgery can release the nerve from surrounding structures. Examples include carpal tunnel release for median nerve compression in the wrist, cubital tunnel release for ulnar nerve entrapment at the elbow, or tarsal tunnel release for tibial nerve compression in the ankle. These procedures can relieve pain and prevent further nerve damage.

Nerve Repair or Grafting

For traumatic nerve injuries, microsurgical techniques can reconnect severed nerves or bridge gaps with nerve grafts taken from elsewhere in the body or artificial conduits. These procedures aim to restore nerve function, though recovery is typically slow and may be incomplete, depending on the severity and timing of the injury.

Implantable Neuromodulation Devices

For severe, treatment-resistant neuropathic pain, surgical implantation of nerve stimulation devices may be considered. These include spinal cord stimulators, which deliver mild electrical impulses to interrupt pain signals, or intrathecal pain pumps, which deliver pain medication directly to the spinal fluid for more effective relief with fewer side effects.

Sympathectomy

In some cases of complex regional pain syndrome or other neuropathic pain conditions involving the sympathetic nervous system, a surgical procedure to cut or destroy certain sympathetic nerves may be considered. This is typically reserved for severe cases that haven't responded to other treatments, as it carries risks and may not be effective for all patients.

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