Peripheral neuropathy 

Introduction 

Electron micrograph of a section through nerve tissue, showing peripheral neuropathy or nerve damage. A dying nerve axon is at the centre.

Peripheral neuropathy or polyneuropathy?

Many neurologists now prefer to use the term ‘polyneuropathy’ rather than ‘peripheral neuropathy’ as the former term makes clear that multiple nerves are damaged simultaneously. 

In clinical terms, peripheral neuropathy could be used to describe cases where only one nerve is damaged.

However, as peripheral neuropathy is more widely used and understood by the public, this term will be used for the rest of this article.

Peripheral neuropathy is a term for damage to the peripheral nervous system.

The peripheral nervous system

The nervous system consists of:

  • the central nervous system, which includes the brain and spinal cord
  • the peripheral nervous system – which includes all parts of the nervous system that lie outside the central nervous system, including the motor nerves, which the brain uses to control the muscles

The peripheral nervous system is made up of three main types of nerves, each with its own specific function:

  • automatic nerves help regulate the automatic functions of the body, such as blood pressure, bladder function and sweat levels
  • motor nerves control the muscles of the body
  • sensory nerves pass sensations – such as cold, heat or pain – from the affected area of the body to the brain

If the peripheral nerves become damaged it can cause the following symptoms:

  • numbness and tingling in the feet and hands
  • a burning, stabbing or shooting pain
  • loss of co-ordination in the affected body parts
  • muscle weakness

Generally, the sooner that peripheral neuropathy is diagnosed the lower the chance of developing serious complications. That means it is important to see a GP if you experience symptoms of peripheral neuropathy.

Read more about the symptoms of peripheral neuropathy.

What causes peripheral neuropathy?

In England, 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.

It is estimated that around one in five people with diabetes has diabetic polyneuropathy.

Peripheral neuropathy can have a wide range of other causes. For example, it can be caused by a viral infection, such as HIV, or as a side effect of certain medications.

People who are at increased risk of periperhal neuropathy are recommended to have regular check-ups so that their nerve function can be assessed.

Read about the causes of peripheral neuropathy for more information.

Who is affected

Peripheral neuropathy is a relatively common condition that affects around one in 50 people in England. Peripheral neuropathy usually affects older people: 8% of people who are 55 or over are affected by it.

Outlook

The outlook for peripheral neuropathy can vary widely depending on the underlying cause and what sort of peripheral nerves have been damaged.

For example, if the sensory nerves of the hands or feet are affected, the outlook is generally good. However, it is important that the underlying cause, often diabetes, is treated.

This is because over time, diabetic polyneuropathy can cause a diabetic foot ulcer (an open sore that develops in the foot). If the ulcer becomes infected, there is a risk that the foot tissue will begin to die and it may be necessary to amputate the foot.

The outlook is not so good in cases where neuropathy affects the automatic functions of the heart and circulation system (cardiovascular automatic neuropathy). This is because the condition can increase the risk of sudden death as a result of the heart suddenly stopping (cardiac arrest).

Read more about the complications of peripheral neuropathy.

As well as addressing the underlying cause of peripheral neuropathy, treatment can also include medication to treat the symptoms of nerve pain. Read more about how peripheral neuropathy is treated.

Last reviewed: 27/06/2012

Next review due: 27/06/2014

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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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