What Is Peripheral Neuropathy? Understanding Nerve Damage, Symptoms, and Causes

Peripheral neuropathy is a condition resulting from damage to your peripheral nerves. These nerves form a network that connects your brain and spinal cord (the central nervous system) to the rest of your body. When these nerves are damaged, it can disrupt communication between your brain and other parts of your body. This disruption can lead to a range of symptoms, primarily affecting the hands and feet, but potentially impacting other areas and bodily functions.

The peripheral nervous system is crucial for both motor and sensory functions. Motor nerves transmit signals from the brain to muscles to initiate movement. Sensory nerves, conversely, relay sensations like touch, temperature, and pain from the body back to the central nervous system for processing. Peripheral neuropathy interferes with these essential functions, leading to a variety of symptoms depending on the type and location of the nerve damage.

Peripheral neuropathy can arise from a multitude of factors, including traumatic injuries, infections, metabolic disorders, inherited conditions, and exposure to toxins. Notably, diabetes is one of the most prevalent causes of this condition. Individuals experiencing peripheral neuropathy often describe the pain as sharp, burning, or tingling. In many instances, particularly when the underlying cause is treatable, symptoms can improve over time. Furthermore, various medical treatments are available to help manage and alleviate the pain associated with peripheral neuropathy.

Symptoms of Peripheral Neuropathy

Each nerve within the peripheral system plays a distinct role, and consequently, the symptoms of peripheral neuropathy are diverse and depend significantly on the specific types of nerves affected. Peripheral nerves are broadly categorized into:

Sensory nerves: These nerves are responsible for transmitting sensations from the skin, such as temperature, pain, vibration, and touch. Damage to sensory nerves can lead to altered sensations.
Motor nerves: Motor nerves control voluntary muscle movements. Damage here can result in muscle weakness and impaired movement.
Autonomic nerves: This category of nerves regulates involuntary bodily functions, including blood pressure, heart rate, digestion, sweating, and bladder control. Autonomic nerve damage can affect these vital functions.

The symptoms of peripheral neuropathy can manifest in various ways, including:

Gradual onset of numbness, tingling, or prickling: Often starting in the feet or hands and potentially spreading up into the arms and legs. This is often one of the earliest and most common symptoms of nerve damage.
Sharp, throbbing, jabbing, or burning pain: Neuropathic pain is frequently described as intense and can significantly impact quality of life.
Extreme sensitivity to touch: Even light touch may feel painful, a condition known as allodynia.
Pain during non-painful activities: Experiencing pain in the feet when putting weight on them or even when they are simply under a blanket is a hallmark symptom.
Lack of coordination and increased falls: Muscle weakness and sensory loss can impair balance and coordination, leading to a higher risk of falls.
Muscle weakness: This can range from mild weakness to significant difficulty in moving affected limbs.
Sensation of wearing gloves or socks when not wearing them: This phantom sensation is a common and peculiar symptom of peripheral neuropathy.
Inability to move: In severe cases where motor nerves are significantly affected, paralysis can occur.

When autonomic nerves are involved, symptoms can include:

Heat intolerance: Difficulty tolerating warm temperatures due to impaired sweating regulation.
Abnormal sweating: This can manifest as excessive sweating (hyperhidrosis) or the inability to sweat (anhidrosis).
Bowel, bladder, or digestive problems: These can include constipation, diarrhea, incontinence, and difficulty with digestion.
Drops in blood pressure: Leading to dizziness or lightheadedness, particularly when standing up quickly (orthostatic hypotension).

Peripheral neuropathy can affect a single nerve (mononeuropathy), multiple nerves in different areas (multiple mononeuropathy), or many nerves throughout the body (polyneuropathy). Carpal tunnel syndrome, a common condition affecting the wrist, is an example of mononeuropathy. However, the majority of individuals with peripheral neuropathy experience polyneuropathy, indicating widespread nerve damage.

When to Seek Medical Advice for Neuropathy

It is crucial to seek medical attention promptly if you experience unexplained tingling, weakness, or pain in your hands or feet. Early diagnosis and treatment are paramount in managing peripheral neuropathy symptoms and preventing further nerve damage. Consulting a healthcare professional at the first signs of these symptoms can significantly improve your long-term outcomes and quality of life.

Causes of Peripheral Neuropathy

Peripheral neuropathy is not a disease itself but rather a result of nerve damage caused by a variety of underlying conditions. Understanding these causes is essential for effective diagnosis and management. Some of the primary health conditions and factors that can lead to peripheral neuropathy include:

Diabetes and Metabolic Syndrome: Diabetes is the most common underlying cause of peripheral neuropathy. Elevated blood sugar levels over time can damage nerves throughout the body. Metabolic syndrome, a cluster of conditions including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels, also increases the risk. It is estimated that over half of individuals with diabetes will develop some form of neuropathy during their lifetime.
Autoimmune Diseases: In autoimmune diseases, the body’s immune system mistakenly attacks its own tissues, including nerves. Conditions such as Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP), and vasculitis are associated with peripheral neuropathy. Paraneoplastic syndromes, which are autoimmune responses to cancer, can also cause polyneuropathy.
Infections: Certain bacterial and viral infections can directly damage nerves or trigger immune responses that lead to neuropathy. These infections include Lyme disease, shingles (herpes zoster), hepatitis B and C, leprosy, diphtheria, and HIV.
Inherited Disorders: Hereditary neuropathies, such as Charcot-Marie-Tooth disease, are genetic conditions passed down through families that cause progressive nerve damage.
Tumors: Both cancerous (malignant) and noncancerous (benign) tumors can cause neuropathy. Tumors can grow directly on nerves or press on surrounding nerves, leading to damage.
Bone Marrow Disorders: Certain bone marrow disorders can lead to neuropathy. Monoclonal gammopathies, characterized by abnormal proteins in the blood, myeloma, lymphoma, and amyloidosis can all contribute to nerve damage.
Other Diseases: Various systemic diseases can indirectly cause neuropathy. Kidney disease, liver disease, and hypothyroidism (underactive thyroid) can disrupt metabolic processes and lead to nerve damage.

Beyond these health conditions, other factors can also induce peripheral neuropathy:

Alcohol Use Disorder: Chronic alcohol abuse and associated poor nutrition can lead to vitamin deficiencies, particularly B vitamins, which are crucial for nerve health. Alcohol itself can also be toxic to nerves.
Exposure to Toxins: Exposure to various toxic substances, including industrial chemicals and heavy metals such as lead and mercury, can cause significant nerve damage.
Medications: Certain medications, most notably chemotherapy drugs used in cancer treatment, are known to cause peripheral neuropathy as a side effect.
Nerve Injury or Pressure: Physical trauma from accidents, falls, or sports injuries can directly sever or damage peripheral nerves. Nerve compression, such as from casts, crutches, or repetitive motions like typing, can also lead to neuropathy, as seen in carpal tunnel syndrome.
Vitamin Deficiencies: Inadequate levels of certain vitamins, particularly B vitamins (B1, B6, B12), as well as vitamin E and copper, are essential for nerve health. Deficiencies in these nutrients can contribute to neuropathy.

In some cases, despite thorough investigation, the underlying cause of peripheral neuropathy cannot be identified. This is termed idiopathic peripheral neuropathy.

Risk Factors for Peripheral Neuropathy

Several factors can increase your risk of developing peripheral neuropathy. Being aware of these risk factors can aid in prevention and early detection:

Diabetes: Poorly controlled blood sugar levels significantly elevate the risk of diabetic neuropathy.
Alcohol Misuse: Excessive alcohol consumption is a major risk factor due to both direct nerve toxicity and associated nutritional deficiencies.
Vitamin Deficiencies: Low levels of essential vitamins, especially vitamin B12, are linked to increased neuropathy risk.
Infections: Certain infections, such as Lyme disease, shingles, hepatitis B and C, and HIV, can trigger neuropathy.
Autoimmune Diseases: Conditions like rheumatoid arthritis and lupus, where the immune system attacks the body’s tissues, increase neuropathy risk.
Kidney, Liver, or Thyroid Disorders: These conditions can disrupt metabolic balance and increase susceptibility to nerve damage.
Exposure to Toxins: Occupational or environmental exposure to toxins increases the risk.
Repetitive Motions: Jobs or activities involving repetitive movements can lead to nerve compression and neuropathy.
Family History of Neuropathy: Having a family history of neuropathy, particularly inherited forms, increases your individual risk.

Complications of Peripheral Neuropathy

Peripheral neuropathy can lead to various complications that impact quality of life and overall health:

Burns, Skin Injuries, and Foot Wounds: Numbness associated with neuropathy can impair the ability to feel temperature changes or pain. This lack of sensation increases the risk of burns, injuries, and unnoticed wounds, particularly on the feet.
Infection: Due to reduced sensation, injuries, especially to the feet, may go unnoticed and untreated, leading to infections. This is particularly concerning for individuals with diabetes who have compromised healing abilities. Regular foot checks and proper wound care are essential.
Falls: Muscle weakness, impaired balance, and loss of sensation all contribute to an increased risk of falls in individuals with peripheral neuropathy.

Prevention of Peripheral Neuropathy

While not all causes of peripheral neuropathy are preventable, you can take steps to reduce your risk and protect your nerve health:

Manage Underlying Conditions

The most effective way to prevent peripheral neuropathy is to diligently manage underlying medical conditions that increase your risk, especially diabetes. Maintaining healthy blood sugar levels is crucial for preventing diabetic neuropathy. Similarly, managing autoimmune diseases and other systemic conditions can reduce the risk of nerve damage.

Adopt Healthy Lifestyle Choices

Healthy lifestyle habits play a significant role in supporting nerve health:

Balanced Diet: Consume a diet rich in fruits, vegetables, whole grains, and lean protein. Ensure adequate intake of B vitamins by including meat, fish, eggs, low-fat dairy, and fortified cereals in your diet. Vegetarians and vegans should consider fortified cereals and consult a healthcare professional about vitamin B12 supplements.
Regular Exercise: Aim for at least 30 minutes to an hour of moderate-intensity exercise most days of the week, after consulting with your healthcare provider. Exercise improves overall health and nerve function.
Avoid Nerve-Damaging Factors: Minimize or eliminate exposure to factors that can damage nerves, such as repetitive motions, toxic chemicals, smoking, and excessive alcohol consumption.

By adopting these preventive measures and seeking early medical attention for any concerning symptoms, you can significantly reduce your risk of peripheral neuropathy and maintain optimal nerve health.

By Mayo Clinic Staff

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Sept. 02, 2023

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