Peripheral neuropathy 

Introduction 

Electron micrograph of a section through nerve tissue, showing peripheral neuropathy or nerve damage

Peripheral neuropathy and polyneuropathy

Peripheral neuropathy may affect only one nerve (mononeuropathy), several nerves (mononeuritis multiplex), or all the nerves in the body longer than a certain length (polyneuropathy).

Polyneuropathy is the most common type and starts by affecting the longest nerves first, so typically begins in the feet. Over time it gradually starts to affect shorter nerves so feels as if it is spreading upwards, and later affects the hands.

Peripheral neuropathy is a term for a group of conditions in which the peripheral nervous system is damaged.

The peripheral nervous system is the network of nerves that lie outside the central nervous system (the brain and spinal cord).

It includes different types of nerves with their own specific functions, including:

  • sensory nerves – responsible for transmitting sensations, such as pain and touch
  • motor nerves – responsible for controlling muscles
  • autonomic nerves – responsible for regulating automatic functions of the body, such as blood pressure and bladder function

Signs and symptoms

Damage to the peripheral nerves can cause a wide range of symptoms depending on the specific nerves affected.

In many cases, the condition first develops in the extremities of the body, such as the feet, hands, legs and arms.

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 fluctuate.

Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications. It's therefore important to see a GP if you experience symptoms of peripheral neuropathy.

Read more about the symptoms of peripheral neuropathy and diagnosing peripheral neuropathy.

What causes peripheral neuropathy?

In the UK, diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy.

Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy.

Peripheral neuropathy can also have a wide range of other causes. For example, it can be caused by physical injury to the nerves, a viral infection such as shingles, or as a side effect of certain medications.

People who are known to be at an increased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed.

Read more about the causes of peripheral neuropathy.

Who is affected?

Peripheral neuropathy is a relatively common condition that affects around 1 in 50 people in the UK. The condition becomes more common as you get older, and has been estimated to affect almost 1 in every 10 people who are 55 or over to some degree.

How peripheral neuropathy is treated

Treatment for peripheral neuropathy depends on the underlying cause and the type of symptoms you are experiencing.

Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes, controlling your blood sugar better, stopping smoking and cutting down on alcohol may help.

Nerve pain may be treated with special prescribed medication as standard painkillers don't usually 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 the use of walking aids.

If peripheral neuropathy affects the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy), you may need treatment to increase your blood pressure, or possibly a pacemaker.

Read more about treating peripheral neuropathy.

Outlook

The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged.

Some cases may improve with time if the underlying cause is treated, whereas for some people the damage may be permanent or may get gradually worse with time.

In cases of peripheral neuropathy caused by diabetes, bringing your diabetes under better control can help prevent further nerve damage and may help improve your existing symptoms.

If the underlying cause of peripheral neuropathy is not treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected.

This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated.

Read more about the complications of peripheral neuropathy.

Page last reviewed: 02/07/2014

Next review due: 02/07/2016

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Comments

The 26 comments posted are personal views. Any information they give has not been checked and may not be accurate.

phoebeGB said on 03 June 2014

I believe I have this. My legs are so painful I can't bear any bedcovers on them at night.
I've been taking amitriptyline for nerve pain in back (spondylolisthesis) but this has not helped with legs. I do not have diabetes. Vit B12 is low but considered OK by docs.

I have no medical training, just desparation. I read about alpha lipoic acid and thought I'd try it. Large oval pill - time release - 600mg. Recommended dose is 1x a day. I have been taking 2x a day. (came across research that this has been used in Germany at far higher doses). I know this might be risky, but every day is a challenge without respite. It is giving some relief. I now can walk a little so hopefully will gain some muscle strength in time. Not recommending, just sharing.

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val78 said on 18 May 2014

Have suffered with peripheral neuropathy in my feet for several years and now have carpaal tunnel syndrome. I was on lithium for several years and seem to remember reading that this could affect the peripheral nerves. Have you any information on this and on how I can prevent it from getting any worse. It keeps me awake at night and I suffer quite alot of leg cramps.

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burtonaj said on 15 May 2014

Exercise, exercise and more exercise would be my recommendation, it seems to work for me !

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pod11 said on 26 April 2014

Just to try and help some of you there are NICE clinical guidelines for the management of neuropathic pain (http://publications.nice.org.uk/neuropathic-pain-pharmacological-management-cg173) which you may find of use/ interest?

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Emzi25 said on 10 March 2014

Hi Melissa, I have been diagnosed with PN for just under 9 mths now, but I think I've had these same symptoms for 2yrs! The pain is totally as you describe it as...someone putting the muscles out of ur feet n legs.
I have been back n forwards to GP n consultant, the appointment took so long to get, I had togo A&E cos I was exhausted from the pain (at that time I had no medication). Since then I've been on gabapentin 300mg td, which is high for my age (32yrs). Had loads of blood test..not diabetic n they have no ideas why I've got PN but yet again I have waited n now they want to do lumbar test n biopsy on my nerves in my foot! What next I wonder??

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Lostinfrance said on 29 January 2014

My PN relates to a back operation I had in May 2012, or perhaps more likely the terrible state I was in with a herniated disc before the operation. My consultant and various doctors had warned me that the PN could last anything from 12-30 months so I still have a way to go. Like many of the posts I find it a relentless condition that few others can understand. My primary symptom is a stiff foot/big toe. I have found lyrica better than gabapentene and take no other drugs other than Vitamin B complex, which one doctor recommended. I feel that all of these control rather than relieve pain or aid recovery. I also use a TENS machine. What a gadget! I find this relieves residual pain in my back and I use it on the pulse setting on my foot at night. This is the only way I can sleep. Above all I find that exercise, exercise, exercise is the best antidote, both for relief and improvement. Cycling is the best. I hope this is helpful and my fingers are crossed that at the end of 2014 my PN will disappear.

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catshannon said on 26 January 2014

It is nice to share our experience on here but its just a shame its not set out like a proper forum where people can help each other. I wrote about my problem feet and back a year ago and no one actually helped me by answering. This is not their fault its just the way this website is set out. A place to air your problem but no one actually helping. Its a waste of time. My feet are just as bad a year down the line and no help from the medical profession. One says its peripheral neuropathy affecting my feet and another says its small fibre disease and another says no one really knows. The medical profession are just guessing !!!!
Guessing with peoples lives is not very good so why don't they find out more to help us. I take 400mg lyrica a day as well as diclofenic and co-codomol as well as 3 blood pressure, a tranquilliser. And 75mg of Amitriptyline andrattle. Funnily enough my problems are during the day when my weight goes on and I start to bend. Walking on prickly nettles and awful pain in my back. Cat Shannon

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Broadsman said on 21 January 2014

Last year, having suffered from Peripheral Neuropathy in my feet and legs for well over a decade, I experimented with controlling my pain with a TENS machine and gained near perfect results within a few minutes! This, I should add, was while I still took my normal doses of pain quelling drugs but the result was pretty staggering as the relief was total. If you are thinking of buying one firstly make sure you declare that you have been diagnosed with chronic pain by your GP. If so you can then buy the product and the VAT is zero-rated. The other point is to buy one that has a cover to prevent the controls being pressed inadvertently. TENS machines are portable and the electrical signal it emits is usually programmable - I found the best option was a “massage” program. From the machine there are four wires that run to electrodes. These are attached to the skin using sticky/gel pads. As the pain was in the lower half of my body I placed two, either side of my lower spine. However, I found there were issues. In my case I found that the pads irritated my skin badly. Hypoallergenic pads are available and I changed to these finding I could use them for several days at a time but once again my skin became overly sensitive and I had to stop using the device for a few days while the skin recovered. Another issue is that the wires hang around and do not make the device easy to use. Finally, and more importantly I find my pain is worse at night and the makers advise that the machine should not be used while asleep or while driving. So they are not a 24/7 option but in my case it does provide very good temporary relief.
However, the idea of a machine sending out an electrical signal which intercepts and “destroys” the pain signals coming from my feet still seemed such a logical idea. I then researched spinal cord stimulators and my GP referred me to the Pain Clinic at the local hospital. I am weighing up whether the insertion of a spinal cord stimulator is a sensible option.

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melissani25 said on 18 November 2013

Hey everyone, im so sorry to hear about your pain, although it is nice to know im not alone, im 21 years old and was diagnosed with PN 2 years ago although have had my pain for longer, when i was 14 i had Leukaemia cancer of the blood, I was on chemotherapy for 3 years and it was the chemo that gave me PN and 3 fractures in my spine and i have been told i will have pain for the rest of my life. I want to be a wife and a mum and have a good career and be happy and able to control my pain, this all sounds like an impossible dream rite now and im very depressed, on the other hand I would like to share with you that I am on a pain management course at the moment and i think some of you may find this useful so get in touch with your gp, im desperate to have someone to talk to who knows what im going through, the stone cold numb feet, the pain in your legs that can only be described as a feeling of electrocution or some one stabbing you or trying to pull the muscles out of your legs, the Jhon Wayne walk when you get out of bed, the aching knees, the difficulty walking, the restless legs in bed and the total lack of sleep, it would be great to have someone to talk to and i welcome any of you to get in touch, for now, take care, Melissa

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angievara said on 06 October 2013

I have been diagnosed type 2 diabetic since April this year and have had pains in legs and hands for a long time, when i told the doctor she said that i could take painkillers specially for the pain but they make people very sleepy and also the pills are used for stress and anxiety so maybe i will ask for some as i am stressed most of the time anyway.

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User807192 said on 27 September 2013

I am 68 and have had PN for about 15 years, mostly a burning sensation on the soles of the feet, especially bad at night. My best relief in the daytime is bare feet on a cold tiled floor.

I came to this site hoping to find out if anyone had had any success with a TENS machine, which emits short electrical pulses to the skin, but no one here seems to have had much to say about that.

I am not diabetic but I do have Rheumatoid Arthritis and a few other auto-immune conditions, but the PN predates most of them.

The good news for those of you suffering from PN is that some of my original symptoms have totally disappeared. So changes do happen.

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spinnaker said on 26 September 2013

I am 60 and have idiopathic peripheral neuropathy diagnosed about 8 years ago. Numb feet and gradually affecting lower legs then sensory reduction in fingers. Two years ago I discovered my B12 level was low c180nm/l. I then discovered that it was only about 220 six years earlier but never flagged. The condition deteriorated over the first 6 years but when B12 injections prescribed has improved significantly so that I can sleep although now worsening slightly. Latest problems lack of co-ordination in hands and muscle loss and painful legs when trying to sleep prior to 3 monthly jabs. Recent blood tests have shown 400 to 600nm/l B12. I have just found out that min B12 levels in Japan have been raised to 550nm/l.
It seems clear to me that the medical professionals failed me by not realising that permanent nerve damage can be caused/exacerbated by B12 levels that are too low but still above current UK minimum set. Suggest anyone with this condition tries B12 jabs if blood levels towards the low end of normal.

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tuttut said on 01 July 2013

just logged in and found this site - can't believe there are so many people feeling the same as me! Have been in pain for at least 3 years with my feet and feel I must add to these comments. It seems that GPs and podiatrists in some areas do not believe there is any help to be given for neuropathy - ie there is nothing we can do but don't get depressed about the pain! To try and explain the pain is like trying to explain what it would be like to win the lottery (big time). I've been diagnosed with diabetes for approx. 10 years and wasn't treated correctly so have not only changed hospitals, but also districts for my treatment. Today I have been told that there are treatments that can help relieve some of the pain. Hurray!!

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catshannon said on 24 April 2013

I am at my wits end with tingling, burning and pins and needles in my feet. I have had this on and off for six years but it seems now I have it all the time.
I have lumbar spinal problems namely spondylolthesis, stenosis, disc protrusion, and facet joint arthritis. As if thats not enough pain I now get the feet bothering me too.
I cant walk very far and going round the supermarket is awful as all I feel is the pins and needles in my feet.
I waited six months to see the neurosurgeon and am now waiting on an up to date MRI ( been waiting forever ). He has suggested a spinal op but would be a waste of time if itnever took the foot problem away. I am on gabapentin, Amitriptyline, co-codomol, diclofenic, 3 blood pressure tabs and surely rattling . GP is no good as doest know what wrong with my feet.
Thinking of going to see podiatrist privately but dont know if it would help. Who knows. Im only 58 and it seems a bit young to have all this. Fed up as every painful day the same.
Any help would be appreciated

Cat

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KeithG said on 22 March 2013

I was diagnosed with PN this year I am 68 and I am not diabetic, when I was told I had this problem I was offered no treatment at all I was not even told how to deal with it I had to write to the neurologist and ask what I should do and how it would affect me long term and all I got back was "take these 2 pills and see if they help and you may have some Muscle loss and that was it so please do not tell me we have an all caring NHS.
The tingling I get in my hands ,legs, feet is awful I try to keep very active but when walking down the High Street all I want to do is stop and scratch.
I would welcome any good advice.
Thanks

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ms samantha said on 01 February 2013

Hi guys, so sorry to hear of all your pain(s)
Much like a lot of you, My father-in-law is suffering with severe pain due to Diabetes type 2 and also seems to be suffering with Peripheral neuropathy in his big toe! He has got to the point where he cannot sleep due to the horrific pain worsening at night time. He has been prescribed Gabapentin along with pain killers etc..
We have been looking into different thing that may help i.e Tens machine and now have been recommended 'Revitive V3 Circulation Booster' does anyone here have any experience and/or advice? I worry about using anything electrical when it comes to Nerve damage, the reason I ask this question is because I have also suffered nerve damage due to a Viruis called 'Ramsay Hunt Syndrome' I also took Gabapentin, various people suggested I try the Tens machine and other stimulants to help repair the damaged nerves but then later I was advised this would actually do more damage to the nerves
Sorry for essay!!! but I would apprecicate any knowledge and advice any of you may have!

I wish all of you some sort of relief from your suffering

Many Thanks
Samantha

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Tardisgirl said on 11 September 2012

I am coming up to two years suffering from Small Fibre Polyneuropathy. Tried all the antidepressant & anti-epileptic medication for pain to no avail. I am managing on 50% pain relief with opiates & tramadol. Alas, I am awaiting medical retirement from my job as it has mainly affected my hands. I wear gloves most of the time as a barrier to the sensitivity and a speech recognition programme for the computer.

Sleeping is the worst, isn't it? I'm currently trying things like camomile tea and fresh cut lavender from the garden by my bedside for that. But I (as are probably yourselves) well acquainted with 1am & 3am when the tramadol wears off!

The stiffness has become more lately, sometimes I walk like a cyberman or feel that my legs have turned to concrete overnight! I am Diabetic, but before all this I was very fit, a friend of the gym and a passionate cyclist. Ate well kept sugar levels nice and low. But the doctors believe the damage was probably done by undiagnosed diabetes years ago :(

Life has changed, but now I am trying to work with it rather than fight it.

Anyone who wants to stay in touch please fee free :)
I wish you all well

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slymp said on 15 February 2012

Hi, I have a bit of peripheral neuropathy following kidney failure. I haven't tried the following cream yet, but Google:

capsaicin cream

I think you can only get it on prescription. It might work for some.

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amazinggrace2505 said on 24 January 2012

I recently found out that I was also suffering from peripheral neuropathy, something i did not even know before.... the pain is excliciating especially at night is the worse time. My mobility has gone from bad to worse now. I am 39 years old, but feel like I am much older! I am currently being given gabapentin to ease the pain... I have undergone all sorts of tests during my week in the hospital but the doctors were amazed by my condition.... I would not wish this pain to my worse enemy! It depresses me now to see myself slowly becoming less able. I refuse to walk with a stick which was given to me on my discharge at the hospital. All i can do is just make sure my legs are well covered as they get very cold and painful when they are cold.

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Liggie said on 18 November 2011

By chance I discovered that an alkaline diet improved things - much less pain. Also avoiding smoked meats and preserved meats is worth trying

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Broadsman said on 05 July 2011

I have had PN in my feet for over 12 years. I am now 60. The cause is unknown although I do suffer with degenerative spine disease. In the earlier, poorly controlled stages, I suffered a lot with burning, tingling and shooting pains, which were almost unbearable. Parts of my feet are now numb and the muscles in my legs ache. Over the years, I have tried everything from gels, foot baths, various zombie producing drugs . . . the list goes on.
In recent years the pain has been controlled with a neuropathic painkiller. Three years ago I was referred to a pain clinic and was given epidurals, which helped for a few weeks. Eventually the pain clinic suggested I take a homeopathic dose of Methadone (4.5ml a day). I have been on this for over two years and combined with the neuropathic painkiller, it makes a huge difference to the quality of my life. It makes you feel a bit tired but you get a really good nights sleep - the latter a real benefit at 60 !

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chris222 said on 18 March 2011

Hi I'm a podiatrist and some of my patients who experience hot and tingly feet at night often report some relief using a deep cooling gel. Another tip is to stand up and try walking on a cold surface like the kitchen floor for a couple of minutes. Hope this helps.

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guenon said on 11 March 2011

I have Type 2 diabetes and have had neuropathy for 18 months - worse at night. A cradle to keep bedclothes off feet is helpful. I had NHS acupuncture and laser treatment with no relief. Specialist said it's successful in two-thirds of cases. I get good sleep after taking sugar-free Amitriptyline prescribed by GP but next day I'm left feeling like a zombie.

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blenkin123 said on 11 January 2011

I am 45 years old and have had peripheral neuropathy for almost 3 years. I have type 1 diabetes, which was diagnosed sixteen years ago. By my own admission my diabetes was not well controlled in the early years, but for the past 3 years has been well controlled. I suffer very badly all the time, the only time I ever get any relief from it is when I finally manage to drop off to sleep from sheer exhaustion. I can't remember the last time I had a good nights sleep. I too have been on Tramadol, Duloxetine, Meptazinol, Pregabalin and Gabapentine. I have also been treated with creams, TENS machines and last month I also had injections in my spine, which I had high hopes for but unfortunately only lasted for the day I had it. I am at my wits end with pain and everyday is just another day of suffering, which is making me extremely depressed. If anybody has any ideas or suggestions, I would love to hear from them.

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donniemurdo said on 21 December 2010

I have Common Variable Immune Deficiency (CVID) 22 years, and 6 years ago was diagnosed with type 1 diabetes. Like 123davec I have suffered with diabetic neuropathy for over 12 months, and similarly have great difficulty getting a decent nights sleep. My GP has prescribed all manor of pain killers including Tramadol but nothing works. I also suffer from lower back pain and pain in some of my joints but that has been attributed to the CVID. I try to maintain good diabetic control but frequently have high sugars. I find that the pain in my legs and feet is worse at night, even an evening in front of the TV can be uncomfortable and sleep is almost impossible. I would give anything for some relief from this and I hope that I will gain some information through this site.

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123davec said on 28 September 2010

i have had diabetic neuropathy for over 12 months,i have been diabetic type 1 for 25 years ,recently i have been having a very lot of pain in my feet and cannot get more than 2 hours sleep a night and no pain killers that my doc has prescribed works,also my diabetes is well controlled but i am starting to sweat a very lot during night,could this be a new problem,i also suffer from a lot of back pain and pain in my shoulders could you please help

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