Peripheral neuropathy

Overview

Peripheral neuropathy is a condition that affects the nerves outside your brain and spinal cord — the 'peripheral' nerves. These nerves send signals between your body and your brain. When they are damaged, you may feel numbness, tingling, weakness, or pain, often in your hands and feet.

Peripheral neuropathy is fairly common, especially among older adults and people with long-term conditions like diabetes. It affects millions of people worldwide.

It can affect anyone, but it is more common in people with diabetes, those over 65, heavy alcohol users, and people with certain autoimmune conditions or vitamin B deficiencies.

Symptoms

Common symptoms

• Numbness or reduced sensation in the hands or feet
• Tingling, prickling, or burning feeling (like 'pins and needles')
• Sharp, stabbing, or shooting pain
• Weakness in the arms or legs
• Sensitivity to touch
• Loss of coordination or balance

Symptoms in children

• Similar symptoms as adults, such as numbness or tingling in hands/feet
• Clumsiness or frequent tripping
• Trouble grasping objects or writing
• Pain that wakes them up at night
• Changes in walking pattern

Symptoms in older adults

• Increased risk of falls due to loss of balance and muscle weakness
• Numbness that makes it hard to feel injuries (e.g., burns or cuts)
• More gradual onset of symptoms
• Often affects both sides of the body equally
• May be mistaken for normal aging

Causes

Main causes

• Diabetes (the most common cause, called diabetic neuropathy)
• Heavy alcohol use over time
• Autoimmune diseases (such as lupus or rheumatoid arthritis)
• Infections (like shingles, Lyme disease, or HIV)
• Vitamin B12 deficiency or other nutritional imbalances
• Certain medications (e.g., some cancer treatments)
• Hereditary conditions (such as Charcot-Marie-Tooth disease)
• Trauma or injury to nerves

Risk factors

• Having diabetes, especially if blood sugar is not well-controlled
• Drinking large amounts of alcohol regularly
• Being over 65
• Having a family history of neuropathy
• Having an autoimmune disorder
• Receiving certain chemotherapy drugs
• Working with chemicals or heavy metals

When to see a doctor

See a doctor urgently if:

• Sudden weakness or numbness that spreads quickly
• Inability to move a part of your body
• Trouble speaking, seeing, or swallowing
• Loss of bladder or bowel control

Book a routine appointment if:

• Gradual numbness, tingling, or pain that does not go away
• Unexplained muscle weakness or trouble with coordination
• Burns, cuts, or sores on feet that you do not feel
• Symptoms that affect your daily activities

Diagnosis

Your doctor will ask about your symptoms, medical history, and lifestyle, then do a physical and neurological exam to check your reflexes, muscle strength, and sensation.

Tests that may be done

• Blood tests to look for diabetes, vitamin deficiencies, and other conditions
• Nerve conduction studies to measure how fast nerves send signals
• Electromyography (EMG) to test muscle response to nerve signals
• Nerve biopsy (taking a small sample of a nerve for examination) in some cases

What to expect at your appointment

The process may take a few visits and tests, but it is usually painless. Your doctor will work to find the cause so treatment can be targeted. You may be referred to a neurologist (a nerve specialist).

Treatment

Treatment focuses on managing the underlying cause, relieving symptoms, and preventing further nerve damage. It often involves a combination of approaches tailored to you.

Self-care at home

• Check your feet daily for cuts, blisters, or sores if you have numbness
• Wear well-fitting shoes and avoid walking barefoot
• Avoid alcohol and smoking
• Eat a balanced diet rich in B vitamins
• Protect hands and feet from extreme temperatures and injuries
• Use assistive devices like handrails or a cane to prevent falls

Medical treatments

Your doctor may recommend medications to help control nerve pain — these are not painkillers like ibuprofen, but special nerve pain medications such as certain antidepressants or antiseizure drugs. Topical creams (applied to the skin) may also be used. Physical therapy can help with strength and balance. Treatment for the underlying cause, such as better blood sugar control or vitamin supplements, is essential.

When is surgery considered?

Surgery is rarely needed for peripheral neuropathy, but it may be considered if the neuropathy is caused by a physical compression of a nerve (like a herniated disc or carpal tunnel syndrome) that does not improve with other treatments.

Living with this condition

Living with peripheral neuropathy means adjusting to changes in how you feel and move. It is important to protect your hands and feet from injury, since you may not feel pain. Regular check-ups with your healthcare team help keep symptoms under control.

Lifestyle tips

• Stay active with gentle exercises like walking, swimming, or yoga to maintain muscle strength and balance
• Quit smoking and limit alcohol intake
• Use good safety habits indoors and outdoors to prevent falls and injuries
• Check your feet daily and care for them properly
• Manage stress through relaxation techniques or talking to a counselor

Diet and exercise

Eat a healthy, balanced diet with plenty of vegetables, fruits, whole grains, and lean protein. Foods rich in B12 (like eggs and fish) and other B vitamins may help nerve health. Regular exercise — even gentle stretches — can improve blood flow and reduce pain. Always talk to your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Chronic pain and loss of sensation can lead to frustration, anxiety, or depression. It is normal to feel upset about changes in your body. Talking to a mental health professional or joining a support group can help you cope.

Prevention

Some causes of peripheral neuropathy can be prevented. Managing diabetes well, limiting alcohol, eating a balanced diet, and protecting yourself from toxins all reduce your risk. If you have a family history, regular check-ups can catch symptoms early.

Vaccines

Some infections that can lead to neuropathy (like shingles) are preventable with vaccines. Ask your doctor if you are due for any recommended vaccines.

Screening programmes

If you have diabetes, your doctor should screen your feet and nerves at least once a year. People with a strong family history of hereditary neuropathy may benefit from genetic counseling.

Complications

If left untreated

• Numbness can lead to unnoticed injuries, infections, and wounds that do not heal
• Muscle weakness may increase the risk of falls and fractures
• Severe pain can interfere with sleep, work, and daily activities
• Long-term nerve damage may become permanent

Long-term outlook

The outlook depends on the cause. With proper treatment, many people see their symptoms improve or stop getting worse. Early care can often prevent serious complications. While some nerve damage may not fully reverse, you can still lead an active, fulfilling life with the right support and management.

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