Peripheral Neuropathy

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Peripheral neuropathies are common neurologic diseases and are often encountered in hospitals as well as outpatient clinics and general practitioners’ offices. Peripheral neuropathy encompasses a wide spectrum of clinical syndromes, which can be divided according to anatomic region and distribution across the peripheral nervous system. A first distinction that can be made is the involvement of one peripheral nerve, in case of mononeuropathies, or multiple peripheral nerves, in case of multifocal neuropathies and polyneuropathies. These three main categories can be subdivided into smaller groups, making distinctions according to cause of the disease (compressive or noncompressive), time course of the disease (chronic or acute), or type of neuropathy (axonal or demyelinating neuropathy). Despite the high frequency of occurrence of peripheral neuropathies, there is much less epidemiologic data available than for diseases of the central nervous system, such as stroke, dementia, or Parkinson's disease. In this chapter we discuss the clinical phenotype, prevalence, incidence, risk factors, and treatment of peripheral neuropathies, with a focus on the most common and the most studied variants . The chapter is divided into four parts. In the first part we discuss


Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:

Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin

Motor nerves that control muscle movement

Autonomic nerves that control functions such as blood pressure, perspiration, heart rate, digestion and bladder function

Signs and symptoms of peripheral neuropathy might include:

Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms

Sharp, jabbing, throbbing or burning pain

Extreme sensitivity to touch

Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight on them or when they're under a blanket

Lack of coordination and falling

Muscle weakness

Feeling as if you're wearing gloves or socks when you're not

Paralysis if motor nerves are affected

If autonomic nerves are affected, signs and symptoms might include:

Heat intolerance

Excessive sweating or not being able to sweat

Bowel, bladder or digestive problems

Drops in blood pressure, causing dizziness or lightheadedness


Neuropathy is not caused by a single disease. Many conditions and events that impact health can cause neuropathy, including:

Diabetes: This is a leading cause of neuropathy in the United States. Some 60% to 70% of people with diabetes experience neuropathy. Diabetes is the most common cause of small fiber neuropathy, a condition that causes painful burning sensations in the hands and feet.

Trauma: Injuries from falls, car accidents, fractures or sports activities can result in neuropathy. Compression of the nerves due to repetitive stress or narrowing of the space through which nerves run are other causes.

Autoimmune disorders and infections: Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjogren’s syndrome and chronic inflammatory demyelinating polyneuropathy are autoimmune disorders that can cause neuropathy. Infections including chickenpox, shingles, human immunodeficiency virus (HIV), herpes, syphilis, Lyme disease, leprosy, West Nile virus, Epstein-Barr virus and hepatitis C can also cause neuropathy.

Other health conditions: Neuropathy can result from kidney disorders, liver disorders, hypothyroidism, tumors (cancer-causing or benign) that press on nerves or invade their space, myeloma, lymphoma and monoclonal gammopathy.

Medications and poisons: Some antibiotics, some anti-seizures medications and some HIV medications among others can cause neuropathy. Some treatments, including cancer chemotherapy and radiation, can damage peripheral nerves. Exposure to toxic substances such as heavy metals (including lead and mercury) and industrial chemicals, especially solvents, can also affect nerve function.

Vascular disorders: Neuropathy can occur when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.

Abnormal vitamin levels and alcoholism: Proper levels of vitamins E, B1, B6, B12, and niacin are important for healthy nerve function. Chronic alcoholism, which typically results in lack of a well-rounded diet, robs the body of thiamine and other essential nutrients needed for nerve function. Alcohol may also be directly toxic to peripheral nerves.

Inherited disorders: Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy. CMT causes weakness in the foot and lower leg muscles and can also affect the muscles in the hands. Familial amyloidosis, Fabry disease and metachromatic leukodystrophy are other examples of inherited disorders that can cause neuropathy.

Risk factors

Diabetes, especially if your sugar levels are poorly controlled.

Alcohol misuse.

Vitamin deficiencies, particularly B vitamins.

Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV.

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Burns and skin injuries. You might not feel temperature changes or pain on parts of your body that are numb.

Infection. Your feet and other areas lacking sensation can become injured without your knowing. ...

Falls. Weakness and loss of sensation may be associated with lack of balance and falling.


You can take steps to preventTrusted Source peripheral neuropathy and lower your risk by:

talking with your doctor about genetic risk and steps to prevent onset of hereditary neuropathy

You can take steps to preventTrusted Source peripheral neuropathy and lower your risk by:

talking with your doctor about genetic risk and steps to prevent onset of hereditary neuropathy

asking about medications that have lower neuropathy risk

getting vaccinated for conditions like shingles that can cause neuropathy

treating the underlying cause of neuropathy, like managing blood sugar if you have diabetes

quitting smoking to promote healthy circulation

avoiding caffeine to improve sleep

Eating healthy to prevent vitamin deficiency and support vascular health is of particular importance. Keeping a balanced diet that includes all the food groups is your best course of action.

However, the Foundation for Peripheral Neuropathy has a list of some specific nutrients and vitamins to look out for in your food that may play a role in improving some symptoms

If you have diabetes, take special care of your feet. Wash and inspect your feet daily, and keep the skin moist with lotion.