Table of ContentsView AllTable of ContentsTypesSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Diagnosis
Treatment
Peripheral neuropathy is a medical condition in which the nerves outside of your brain and spinal cord—called peripheral nerves—are damaged. This can cause mild to severe pain, numbness, muscle twitching, and other symptoms in the hands, feet, and other parts of the body.
Theperipheral nervous systemis one of two parts of the nervous system. It is made up of nerves that relay messages back and forth to thecentral nervous system(comprised of the brain and spinal cord). Peripheral nerves not only control muscle movements but a regulate involuntary functions like digestive and heart rate, and provide sensations such as itching, warmth, or pain.
Alcohol abuse, autoimmune diseases, toxins, medications, and diseases like shingles and diabetes are among the many conditions that can cause peripheral neuropathy. Peripheral neuropathy can’t always be cured, but it can be managed.
This article explains types of peripheral neuropathy, how it affects your body, and ways to manage the condition.
Verywell / JR Bee
Types of Peripheral Neuropathy
There are many causes of peripheral neuropathy, each of which has different symptoms and affects different parts of the body. The approach to treatment can also vary.
Mononeuropathy
Mononeuropathy is a type of neuropathy involving only one nerve. It can result from direct nerve injury, nerve compression, or reduced blood flow (ischemia) to a nerve.
Mononeuropathy is localized (limited to a part of the body) and may worsen with certain movements or activities.
Common causes of mononeuropathy include:
Polyneuropathy
Polyneuropathy is when many nerves in various body parts are affected. It is a more complicated condition that usually arises from a systemic (whole-body) disease. Symptoms tend to develop gradually rather than abruptly.
Polyneuropathy is strongly associated with a process calleddemyelinationin which the insulating coating of nerve cells, calledmyelin, is either damaged or stripped away. When this happens, peripheral nerve cells can “misfire” and trigger nerve pain and other neuropathy symptoms.
Polyneuropathies are usually bilateral (affecting both sides of the body) and symmetrical (affecting both sides of the body equally). The hands and feet are most commonly involved.
Common causes of polyneuropathy include:
Mononeuritis Multiplex
Mononeuritis multiplex falls somewhere between mononeuropathy and polyneuropathy. It is caused when two or more separate nerve bundles are simultaneously affected.
It is differentiated from polyneuropathy in that it tends to be unilateral (one-sided). With that said, the condition can sometimes progress and affect both sides of the body asymmetrically.
Mononeuritis multiplex is also associated more with the loss of sensory or motor function of individual nerves. Oftentimes, the pain, if any, may be deep and aching rather than sharp and severe.
Causes of mononeuritis multiplex can overlap with those of polyneuropathy, including:
Peripheral Neuropathy Symptoms
Peripheral neuropathy affects peripheral nerves. These includesensory nervesthat provide sensations,motor nervesthat regulate voluntary muscle movements, andautonomic nervesthat regulate involuntary muscle movements.
Damage to these nerves can cause “negative” symptoms (meaning the loss of normal function) or “positive” symptoms (meaning new problems that arise because of nerve damage).
Sensory Symptoms
Damage to this body of nerves can cause:
Motor Symptoms
Motor nerves regulate themusculoskeletal systemwhich enables locomotion (movement) and the articulation of joints. This differs from proprioception in that it involves the loss of motor function rather than sensory function.
Motor symptoms of peripheral neuropathy include:
Autonomic Symptoms
Disruption of these systems can lead to:
Diagnosing Peripheral Neuropathy
The diagnosis of peripheral neuropathy starts with a review of your medical history, a physical exam, and a neurological examination (to determine the extent of your negative and positive symptoms). Additional tests and procedures may be ordered to narrow the possible causes.
Neurological Exam
During a neurological exam, your healthcare provider willcheck your reflexesand evaluate for sensory dysfunction—especially on your feet and hands—using vibration, temperature, and pinprick. Your muscle strength and gait will also be evaluated.
Blood Tests
In addition to the neurological exam, your healthcare provider will order a series of blood tests to narrow the possible causes of your peripheral neuropathy.
Some of the more common include:
Autoantibody testingmay be ordered if an autoimmune disease is suspected, while disease-specific tests for HIV, Lyme disease, and hepatitis C can diagnose these diseases with a simple blood test. Genetic testing can help detect diseases like Charcot-Marie-Tooth disease.
Nerve Tests
Certain nerve tests can help confirm the diagnosis and characterize the extent of your peripheral neuropathy. They can also help exclude certain causes, like nerve compression, to support the diagnosis.
These may include:
Autonomic Tests
For people with autonomic symptoms, various tests can aid in the diagnosis. Examples include measuring your blood pressure on atilt table(used to check for orthostatic hypotension) or conducting athermoregulatory sweat testto see if your body regulates temperature normally.
Other Tests
Because the causes of peripheral neuropathy are many, other tests may be needed to diagnose and confirm the underlying condition. Examples include alumbar puncture(spinal tap) to confirm a diagnosis ofGuillain-Barrésyndrome, or a24-hour urine collectionto check for possible heavy metal exposure.
Peripheral Neuropathy vs. Multiple SclerosisPeripheral neuropathy andmultiple sclerosis (MS)are neurological disorders that share many symptoms, including pain and paresthesia, but are distinct and separate conditions.Unlike peripheral neuropathy, MS affects the central nervous system, causing a wider range of symptoms, including visual and speech problems, loss of cognition (ability to think and solve problems), and loss of muscle control (ataxia). While some cases of peripheral neuropathy may be cleared if the underlying condition is resolved, MS cannot be cured.
Peripheral Neuropathy vs. Multiple Sclerosis
Peripheral neuropathy andmultiple sclerosis (MS)are neurological disorders that share many symptoms, including pain and paresthesia, but are distinct and separate conditions.Unlike peripheral neuropathy, MS affects the central nervous system, causing a wider range of symptoms, including visual and speech problems, loss of cognition (ability to think and solve problems), and loss of muscle control (ataxia). While some cases of peripheral neuropathy may be cleared if the underlying condition is resolved, MS cannot be cured.
Peripheral neuropathy andmultiple sclerosis (MS)are neurological disorders that share many symptoms, including pain and paresthesia, but are distinct and separate conditions.
Unlike peripheral neuropathy, MS affects the central nervous system, causing a wider range of symptoms, including visual and speech problems, loss of cognition (ability to think and solve problems), and loss of muscle control (ataxia). While some cases of peripheral neuropathy may be cleared if the underlying condition is resolved, MS cannot be cured.
Treating Peripheral Neuropathy
The treatment of peripheral neuropathy differs based on the underlying cause. In some cases, the resolution of an infection or the discontinuation of a drug is all that is needed to clear the symptoms.
At other times, ongoing management of the underlying cause (like diabetes, kidney disease, or lupus) may be needed to keep your symptoms under control.
Easing Symptoms
In severe or chronic (persistent) cases, medications may be prescribed. This can be challenging because some work better for some people than others and none have been consistently effective across different diseases.
Some of the most common drugs used for peripheral neuropathy include:
In addition to medications, physical therapy or assistive walking devices can help people with neuropathy-related weakness and balance problems.
Most Effective Treatments for Neuropathy
Summary
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Lehman HC, Wunderlich G, Fink GR, Sommer C.Diagnosis of peripheral neuropathy.Neurol Res Pract. 2020;2:20. doi:10.1186/s42466-020-00064-2Hanewinckle R, Ikram MA, Van Doorn PA.Peripheral neuropathies.Handb Clin Neurol.2016:138:263-82. doi:10.1016/B978-0-12-802973-2.00015-XMehndiratta MM, Gulati NS.Central and peripheral demyelination.J Neurosci Rural Pract. 2014;5(1):84-6. doi:10.4103/0976-3147.127887.Chung T, Prasad K, Lloyd TE.Peripheral neuropathy: Clinical and electrophysiological considerations.Neuroimaging Clin N Am. 2014;24(1):49–65. doi:10.1016/j.nic.2013.03.023Castelli G, Desai KM, Cantone RE.Peripheral neuropathy: Evaluation and differential diagnosis.Am Fam Physician.2020 Dec 15;102(12):732-739.Wells R, Tonkin A.Clinical approach to autonomic dysfunction.Intern Med J. 2016;46(10):1134-1139. doi:10.1111/imj.13216Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A.Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol Neuroinflamm.2021;8(1) e914. doi:10.1212/NXI.0000000000000914Watson JC, Dyck PJ.Peripheral neuropathy: A practical approach to diagnosis and symptom management.Mayo Clin Proc. 2015 Jul;90(7):940-51. doi:10.1016/j.mayocp.2015.05.004Juster-Switlyk K, Smith AG.Updates in diabetic peripheral neuropathy.F1000Res. 2016;5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Lehman HC, Wunderlich G, Fink GR, Sommer C.Diagnosis of peripheral neuropathy.Neurol Res Pract. 2020;2:20. doi:10.1186/s42466-020-00064-2Hanewinckle R, Ikram MA, Van Doorn PA.Peripheral neuropathies.Handb Clin Neurol.2016:138:263-82. doi:10.1016/B978-0-12-802973-2.00015-XMehndiratta MM, Gulati NS.Central and peripheral demyelination.J Neurosci Rural Pract. 2014;5(1):84-6. doi:10.4103/0976-3147.127887.Chung T, Prasad K, Lloyd TE.Peripheral neuropathy: Clinical and electrophysiological considerations.Neuroimaging Clin N Am. 2014;24(1):49–65. doi:10.1016/j.nic.2013.03.023Castelli G, Desai KM, Cantone RE.Peripheral neuropathy: Evaluation and differential diagnosis.Am Fam Physician.2020 Dec 15;102(12):732-739.Wells R, Tonkin A.Clinical approach to autonomic dysfunction.Intern Med J. 2016;46(10):1134-1139. doi:10.1111/imj.13216Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A.Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol Neuroinflamm.2021;8(1) e914. doi:10.1212/NXI.0000000000000914Watson JC, Dyck PJ.Peripheral neuropathy: A practical approach to diagnosis and symptom management.Mayo Clin Proc. 2015 Jul;90(7):940-51. doi:10.1016/j.mayocp.2015.05.004Juster-Switlyk K, Smith AG.Updates in diabetic peripheral neuropathy.F1000Res. 2016;5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Lehman HC, Wunderlich G, Fink GR, Sommer C.Diagnosis of peripheral neuropathy.Neurol Res Pract. 2020;2:20. doi:10.1186/s42466-020-00064-2Hanewinckle R, Ikram MA, Van Doorn PA.Peripheral neuropathies.Handb Clin Neurol.2016:138:263-82. doi:10.1016/B978-0-12-802973-2.00015-XMehndiratta MM, Gulati NS.Central and peripheral demyelination.J Neurosci Rural Pract. 2014;5(1):84-6. doi:10.4103/0976-3147.127887.Chung T, Prasad K, Lloyd TE.Peripheral neuropathy: Clinical and electrophysiological considerations.Neuroimaging Clin N Am. 2014;24(1):49–65. doi:10.1016/j.nic.2013.03.023Castelli G, Desai KM, Cantone RE.Peripheral neuropathy: Evaluation and differential diagnosis.Am Fam Physician.2020 Dec 15;102(12):732-739.Wells R, Tonkin A.Clinical approach to autonomic dysfunction.Intern Med J. 2016;46(10):1134-1139. doi:10.1111/imj.13216Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A.Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol Neuroinflamm.2021;8(1) e914. doi:10.1212/NXI.0000000000000914Watson JC, Dyck PJ.Peripheral neuropathy: A practical approach to diagnosis and symptom management.Mayo Clin Proc. 2015 Jul;90(7):940-51. doi:10.1016/j.mayocp.2015.05.004Juster-Switlyk K, Smith AG.Updates in diabetic peripheral neuropathy.F1000Res. 2016;5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2
Lehman HC, Wunderlich G, Fink GR, Sommer C.Diagnosis of peripheral neuropathy.Neurol Res Pract. 2020;2:20. doi:10.1186/s42466-020-00064-2
Hanewinckle R, Ikram MA, Van Doorn PA.Peripheral neuropathies.Handb Clin Neurol.2016:138:263-82. doi:10.1016/B978-0-12-802973-2.00015-X
Mehndiratta MM, Gulati NS.Central and peripheral demyelination.J Neurosci Rural Pract. 2014;5(1):84-6. doi:10.4103/0976-3147.127887.
Chung T, Prasad K, Lloyd TE.Peripheral neuropathy: Clinical and electrophysiological considerations.Neuroimaging Clin N Am. 2014;24(1):49–65. doi:10.1016/j.nic.2013.03.023
Castelli G, Desai KM, Cantone RE.Peripheral neuropathy: Evaluation and differential diagnosis.Am Fam Physician.2020 Dec 15;102(12):732-739.
Wells R, Tonkin A.Clinical approach to autonomic dysfunction.Intern Med J. 2016;46(10):1134-1139. doi:10.1111/imj.13216
Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A.Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol Neuroinflamm.2021;8(1) e914. doi:10.1212/NXI.0000000000000914
Watson JC, Dyck PJ.Peripheral neuropathy: A practical approach to diagnosis and symptom management.Mayo Clin Proc. 2015 Jul;90(7):940-51. doi:10.1016/j.mayocp.2015.05.004
Juster-Switlyk K, Smith AG.Updates in diabetic peripheral neuropathy.F1000Res. 2016;5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
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