What is peripheral neuropathy?

Peripheral neuropathy is when there is damage to your peripheral nerves. Peripheral nerves refer to 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 and autonomic nerves or a combination.

What are the symptoms of peripheral neuropathy?

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

• tingling, pins and needles or electric type pains
• numbness
• areas that feel ‘hot’ or have a burning sensation
• cold areas which are difficult to warm up
• the sensation 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.

What causes peripheral neuropathy?

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

Other health conditions that can cause peripheral neuropathy include:

• autoimmune diseases — rheumatoid arthritis, lupus, vasculitis and Guillain-Barre syndrome
• inherited disorders
• infections — shingles, diphtheria and AIDS
• chronic kidney disease, thyroid disease
• some cancers including myeloma and cancer treatments such as immunomodulatory therapies chemotherapy, radiotherapy

Other causes of peripheral neuropathy include:

• long-term, heavy alcohol use
• damage to the nerves caused by injury or surgery
• vitamin deficiencies — vitamin B12 and thiamine (vitamin B1)
• toxins such as lead, mercury and arsenic
• low levels of certain vitamins
• thyroid
• continuous repetitive motions

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

When should I see my doctor?

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 chemotherapy.

How is peripheral neuropathy diagnosed?

To diagnose peripheral neuropathy, your doctor will ask you about your symptoms, medical history and lifestyle factors or toxins that could increase your risk and perform a physical examination.

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

• blood tests
• MRI scan
• ultrasound

• nerve conduction studies — used to investigate your nerve function

How is peripheral neuropathy treated?

Treatment for peripheral neuropathy includes treating the cause of your peripheral neuropathy and managing the impact of your symptoms on your health and wellbeing.

For example, if diabetes or a vitamin deficiency is causing peripheral neuropathy, your doctor will discuss treating these conditions to reduce your symptoms.

Sometimes the cause of your condition may be untreatable or unknown.

If you experience pain because of peripheral neuropathy (neuropathic pain), your doctor may discuss treatments such as:

• some types of antidepressant medicines
• some types of antiepileptic medicines
• capsaicin cream

Opioid medicines are not usually effective in managing neuropathic pain, especially in the long-term. They should only be used under specialist advice.

Other symptoms such as muscle weakness may be addressed by allied healthcare professionals such as occupational therapists, physiotherapists and podiatrists.

Can peripheral neuropathy be prevented?

Not all causes of peripheral neuropathy are preventable.

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

Maintaining a healthy lifestyle with a balanced diet and limited alcohol consumption may reduce your chance of developing peripheral neuropathy as the result of vitamin deficiencies.

Complications of peripheral neuropathy

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

Resources and support

• Diabetes Australia has more information on diabetic neuropathy. You can also call the National Diabetes Services Scheme helpline on 1800 637 700.
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.
• If you or someone you know has myeloma, Myeloma Australia have a useful guide on managing peripheral neuropathy.