Peripheral neuropathy

Peripheral neuropathy is when there is damage to your peripheral nerves. Peripheral nerves are all the nerves in the body that are outside the brain and spinal cord.

There are 3 types of nerves:

• Sensory nerves carry signals about touch, taste, sight, hearing and smell.
• Motor nerves carry signals to help you move.
• Autonomic nerves carry signals to help with balance, sweating, digestion and many of the things you do without thinking.

Peripheral neuropathy can affect any of your sensory, motor or autonomic nerves, or a combination.

Peripheral neuropathy usually causes symptoms in your hands and feet including:

• tingling, pins and needles or 'electric shock' pains
• numbness
• areas that feel hot or burning
• areas that feel cold and are difficult to warm up
• the feeling of insects crawling on your skin
• muscle weakness, cramps or aching

Symptoms may range from mild to severe. They may begin in your toes and fingertips and move up towards your knees and elbows. Symptoms are often worse at night.

The most common cause of peripheral neuropathy is diabetes, either type 1 diabetes or type 2 diabetes. This is called diabetic neuropathy.

Other health conditions that can cause peripheral neuropathy include:

• autoimmune diseases — such as rheumatoid arthritis, lupus, vasculitis and Guillain-Barre syndrome
• inherited (genetic) disorders
• infections — such as shingles, diphtheria and AIDS
• chronic kidney disease
• thyroid disease
• some cancers — such as myeloma

Other causes of peripheral neuropathy include:

• long-term, heavy alcohol use
• damage to nerves caused by injury or surgery
• vitamin deficiencies (taking too little)— such as vitamin B12 and thiamine (vitamin B1)
• vitamin toxicity (taking too much) – such as vitamin B6 (pyridoxine, pyridoxal or pyridoxamine
• toxins such as lead, mercury and arsenic
• chemotherapy to treat cancer

In some cases, the cause of peripheral neuropathy remains unknown.

You should see your doctor if you have:

• weakness and numbness in your hands or feet
• unusual tingling in your hands or feet
• pain or a feeling of burning in your hands or feet

If you are receiving cancer treatment and start to develop symptoms of peripheral neuropathy, speak to your doctor. They may recommend pausing or stopping treatment.

To diagnose peripheral neuropathy, your doctor will ask you questions and examine you. Your doctor will ask you about:

• your symptoms
• your medical history
• lifestyle factors or toxins that could increase your risk

Depending on their findings, they may refer you for tests including:

• blood tests
• MRI scan
• ultrasound
• nerve conduction studies — used to check how well your nerves work

Treatment for peripheral neuropathy includes treating the underlying cause and managing your symptoms.

For example, if diabetes or a vitamin deficiency is the cause, your doctor will discuss treating these conditions to reduce your symptoms. If taking too much of a vitamin, such as B6, is the cause, your doctor will advise you to stop taking supplements that contain it.

Sometimes the cause may be unknown or cannot be treated

Symptomatic treatment

If you experience pain because of peripheral neuropathy (known as neuropathic pain or neuralgia), common pain medicines may not be effective. Your doctor may discuss medicines for nerve pain such as:

• duloxetine
• amitriptyline
• gabapentin
• pregabalin
• capsaicin cream

Opioid medicines do not usually work well for neuropathic pain, especially in the long term.

Other symptoms, such as muscle weakness, may be treated by allied healthcare professionals such as an occupational therapist, physiotherapist or podiatrist.

Some people might be offered an injection or surgery to help relieve pain.

Even if treatment is available, it does not usually cure your symptoms completely. You may need to use a combination of therapies to help you manage your symptoms.

Peripheral neuropathy can affect many different areas of life, such as sleeping, walking, driving and other daily activities. Some people may need to use a mobility aid such as a wheelchair.

You may find it helpful to join a support group. Ask your doctor what is available in your area.

Peripheral neuropathy can increase your chance of skin injuries and burns, due to reduced sensation in your hands and feet.

It can also increase your chance of falls due to problems with walking.

Not all causes of peripheral neuropathy can be prevented.

If you have diabetes, you can reduce your chance of developing peripheral neuropathy by keeping your blood sugar levels stable.

Maintaining a healthy diet and limiting alcohol may reduce your chance of developing peripheral neuropathy caused by vitamin deficiencies.

Make sure you read labels of supplements you take and know what is in them. Vitamin B6 can sometimes be labelled as pyridoxine, pyridoxal, or pyridoxamine. Vitamin B6 can be found in some magnesium supplements, migraine medicines, protein powders, diet powders and energy drinks.

• Diabetes Australia has more information on diabetic neuropathy (Opens in new tab).
• Cancer Council (Opens in new tab) has a helpful fact sheet about peripheral neuropathy, how it may impact your life and what you can do about it.
• If you or someone you know has myeloma, Myeloma Australia has a useful guide on managing peripheral neuropathy (Opens in new tab).

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.