14737 Peripheral Neuropathy

Overview

Peripheral neuropathy is damage to the nerves outside your brain and spinal cord. These nerves carry signals between your body and your brain. When they are damaged, you may feel tingling, numbness, pain, or weakness, often in your hands and feet.

Peripheral neuropathy is quite common. Around 1 in 10 people over the age of 55 may be affected, although it can also happen in younger people.

Anyone can develop peripheral neuropathy, but it is more likely if you have diabetes, are older, have certain vitamin deficiencies, drink too much alcohol, or have a family history of nerve problems.

Symptoms

Common symptoms

• Tingling or 'pins and needles' in the hands or feet
• Numbness that makes it hard to feel hot, cold, or pain
• Sharp, burning, or throbbing pain
• Muscle weakness, especially in the feet or hands
• Sensitivity to touch — even a light bedsheet can feel uncomfortable
• Loss of balance or poor coordination

Symptoms in children

• Children may complain of burning or tingling feet or hands, or lose their balance and fall often.
• They may feel pain at night that wakes them up.
• Because children may not describe their feelings clearly, watch for clumsiness, avoiding walking, or becoming unusually quiet.

Symptoms in older adults

• Numbness in the feet, which raises the risk of falls and unnoticed injuries.
• A burning or shooting pain that is often worse at night.
• Difficulty with balance or using the hands for buttons, writing, or holding objects.

Causes

Main causes

• Diabetes — the most common cause, especially when blood sugar levels are not well controlled
• Physical injury or pressure on a nerve
• Autoimmune diseases, such as rheumatoid arthritis or lupus
• Infections, such as shingles, Lyme disease, or HIV
• Vitamin B12 deficiency or other vitamin imbalances
• Kidney or liver disease
• Underactive thyroid gland
• Some medications, including certain chemotherapy drugs
• Excessive alcohol use
• Inherited nerve disorders, such as Charcot-Marie-Tooth disease

Risk factors

• Diabetes
• Older age
• Obesity or high blood pressure
• Smoking
• Drinking too much alcohol
• Vitamin B12 deficiency
• Family history of neuropathy
• Chronic kidney disease
• Taking certain medicines long-term

When to see a doctor

See a doctor urgently if:

• Symptoms that are getting worse quickly
• Severe pain that is not controlled by simple measures
• A foot sore with redness, swelling, or discharge, especially if you have diabetes
• Difficulty standing or walking for any reason

Book a routine appointment if:

• Tingling, numbness, or pain in your hands or feet that lasts for more than a few weeks
• Frequent falls or balance problems
• Muscle weakness that is getting worse
• Changes in how your hands or feet feel when you touch things

Diagnosis

Your doctor will talk through your symptoms, ask about your medical and family history, and do a physical exam. They will check your strength, reflexes, and sensation. They may also recommend blood tests or tests on your nerves.

Tests that may be done

• Blood tests – to check blood sugar, vitamin B12, kidney and thyroid function
• Nerve conduction studies – to see how well electrical signals travel along your nerves
• Electromyography (EMG) – to test how your muscles respond to nerve signals
• MRI or CT scan – if there may be a problem in your spine, brain, or a compressed nerve
• Sometimes a nerve biopsy – taking a tiny sample of nerve tissue – for unusual causes

What to expect at your appointment

The appointment may take up to 30 minutes. Your doctor will examine you and may refer you to a neurologist (nerve specialist) for more tests. You usually do not need to prepare, but it helps to bring a list of your medicines and any home blood sugar or blood pressure readings you have.

Treatment

Treatment aims to manage the underlying cause and help you feel better. Even when nerve damage cannot be fully reversed, most people can get good relief from symptoms with the right care.

Self-care at home

• Check your feet daily for cuts, blisters, redness, or swelling — especially if you have diabetes
• Wear well-fitting shoes and loose socks to protect your feet
• Use warm water (not hot) and test the temperature with your elbow or a thermometer before washing
• Make your home safer — add nightlights, keep floors clear, and use handrails
• Avoid heavy alcohol intake
• Do not smoke

Medical treatments

Your healthcare team may recommend medicines commonly used for nerve pain, such as certain antidepressants, anti-seizure medicines, or numbing creams. These are different from ordinary painkillers. They may also treat the underlying cause, for example improving blood sugar control, giving vitamin B12 replacement, or adjusting a medicine that is harming your nerves. Physiotherapy, occupational therapy, and pain management clinics can also help.

When is surgery considered?

Surgery is rarely needed. It may be considered if a nerve is physically squeezed, such as in carpal tunnel syndrome. Your specialist will help you decide if surgery could be beneficial.

Living with this condition

You can live well with peripheral neuropathy by making small changes. Take your time when walking, use handrails, and keep rooms well lit. Protect your hands and feet from injury, and check them every day. Ask your pharmacist about aids that make daily tasks easier.

Lifestyle tips

• Keep your blood sugar at a healthy level if you have diabetes
• Stay active – walking, swimming, and cycling are gentle and helpful
• Avoid excess alcohol
• Do not smoke
• See your GP or practice nurse regularly for check-ups

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruits, whole grains, and lean proteins. If you have diabetes, follow the meal plan your healthcare team recommends. Try gentle exercise most days, and ask a physiotherapist for safe stretches if balance is a problem.

Mental health and emotional wellbeing

Living with pain, numbness, or weakness can be frustrating and tiring. It is common to feel anxious or low. Talk to your doctor, family, or friends about how you feel. You may also benefit from talking therapy or a support group. If you ever have thoughts of harming yourself, reach out for crisis support immediately.

Prevention

In some cases, yes. If you can prevent or control the underlying cause — such as keeping diabetes well managed, avoiding too much alcohol, and treating vitamin B12 deficiency early — you can lower your risk. In hereditary forms, prevention is not possible, but early treatment can help limit symptoms.

Screening programmes

If you have diabetes, you should have your feet checked at least once a year as part of your regular diabetes review. Early detection of foot problems can prevent serious complications.

Complications

If left untreated

• Foot ulcers and infections, especially in people with diabetes, which can sometimes become severe
• Falls and fractures from poor balance and numbness
• Muscle weakness and loss of muscle tissue
• Digestive, bladder, or heart problems if autonomic nerves are affected
• Persistent chronic pain that affects daily life

Long-term outlook

With the right care, most people can manage their symptoms and stop problems from getting worse. If the cause is found early and treated, such as improving blood sugar or correcting a vitamin B12 deficiency, symptoms can improve or even go away. Even when nerve damage is permanent, many people continue to live active, fulfilling lives with support from their healthcare team.

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