Neuromyopathy

Neuromyopathy, commonly known as peripheral neuropathy, is a condition that affects nerves outside the brain and spinal cord, causing pain, weakness, numbness, and tingling—most often in the hands and feet.

Table of contents

• What is peripheral neuropathy?
• Causes of peripheral neuropathy
• Symptoms and types
• How neuropathy is diagnosed
• Treatment options
• Living with neuropathy

What is peripheral neuropathy?

Peripheral neuropathy refers to conditions that affect nerves outside your brain and spinal cord. Your nervous system has two main parts: the central nervous system (your brain and spinal cord) and the peripheral nervous system (all other nerves in your body). The peripheral nervous system acts like a messaging highway, constantly carrying signals to and from your brain to control everything from muscle movement to sensing pain and temperature^[1][2].

When these peripheral nerves become damaged or stop working properly, signals get disrupted. This disruption can mean that signals that should be sent aren’t, signals are sent when they shouldn’t be, or the messages being sent contain errors^[3]. The result is peripheral neuropathy, which can cause a wide range of symptoms depending on which nerves are affected.

This condition is quite common. About 2.4% of people globally have some form of peripheral neuropathy. Among people aged 45 and older, that percentage rises to between 5% and 7%^[2][7]. In the UK, it’s estimated that almost 1 in 10 people aged 55 or over are affected^[5].

Causes of peripheral neuropathy

Peripheral neuropathy can result from many different conditions and circumstances. In the United States and UK, diabetes is the most common cause, eventually affecting about half of all people with this condition^[5][13]. When high blood sugar levels remain elevated over time, they can damage nerves and the small blood vessels that nourish them.

Beyond diabetes, many other factors can cause peripheral neuropathy. These include physical injury to nerves from accidents or from pressure on a nerve (such as with carpal tunnel syndrome, casts, braces, or crutches). Infections such as shingles, HIV, hepatitis C, and Lyme disease can damage nerves^[1][6].

Other medical conditions that can lead to neuropathy include autoimmune diseases such as rheumatoid arthritis and lupus, thyroid problems (particularly an underactive thyroid gland), kidney disease, and poor blood flow to the legs^[1][13]. Vitamin deficiencies—particularly of vitamins B1, B6, B12, and E—can also cause nerve damage^[7].

Some medications and treatments can trigger neuropathy as a side effect. Chemotherapy drugs are a well-known cause, with the type of nerve damage depending on the chemotherapy type, dosage, and frequency^[15][19]. Long-term alcohol use and exposure to toxic chemicals or heavy metals can also damage peripheral nerves^[1][7].

Some people inherit conditions that cause peripheral neuropathy, such as Charcot-Marie-Tooth disease, which affects nerves in the arms, hands, legs, and feet^[13]. In some cases, despite thorough investigation, doctors cannot identify a specific cause. These cases are called idiopathic peripheral neuropathy^[13].

Symptoms and types

The symptoms of peripheral neuropathy depend on which type of nerves are affected. Your peripheral nervous system includes three main types of nerves. Sensory nerves transmit information about sensations like touch, temperature, and pain. Motor nerves control the movement of muscles you consciously control. Autonomic nerves regulate automatic body functions you don’t consciously think about, such as breathing, digestion, heart rate, and blood pressure^[1][3].

Most people with neuropathy experience problems with all three types of nerve fibers to varying degrees, though some conditions affect primarily one or two types^[3]. The most common symptoms include gradual onset of numbness, prickling, or tingling in the feet or hands. These sensations can spread upward into the legs and arms. People often describe the pain as stabbing, burning, shooting, or like electric shocks^[1][6].

Other symptoms can include extreme sensitivity to touch, where even light pressure causes pain. Muscle weakness, twitching, or cramps are common, as is loss of balance and coordination. Many people find that their symptoms are worse at night^[1][4]. Some experience difficulty with fine motor tasks like picking up objects or buttoning clothing^[15].

Most neuropathies are “length-dependent,” meaning the symptoms develop first or are worse in the parts of the body farthest from the brain—typically the feet. In severe cases, symptoms can spread upward toward the central parts of the body^[3].

When autonomic nerves are affected, people may experience problems with digestion (such as feeling full faster when eating), bowel function (including diarrhea or constipation), bladder control, sexual function (such as erectile dysfunction), sweating, or feeling lightheaded when standing^[1][6].

How neuropathy is diagnosed

Diagnosing peripheral neuropathy can be challenging because there are so many different types and causes. The diagnostic process typically begins with a thorough medical history. Your doctor will ask about your symptoms, when they started, whether they’re getting worse, and how they affect your daily life. They’ll also review your medical history, family history, lifestyle factors, exposure to toxins, drinking habits, and medications^[9][14].

A physical examination and neurological exam follow. During the neurological exam, your doctor will check your tendon reflexes, muscle strength and tone, ability to feel certain sensations, and your balance and coordination^[9].

Based on these initial findings, your doctor may order several tests. Blood tests can detect vitamin deficiencies, diabetes, signs of inflammation, or metabolic problems that can cause peripheral neuropathy^[9]. Imaging tests such as CT or MRI scans can look for herniated disks, compressed nerves, growths, or other problems affecting blood vessels and bones^[9].

Electromyography (EMG) is a common test that measures and records electrical activity in your muscles to detect nerve damage. During an EMG, a thin needle electrode is inserted into the muscle to measure electrical activity as you contract the muscle. A nerve conduction study is typically done at the same time, using flat electrodes placed on the skin with a low electric current to stimulate the nerves and record how they respond^[9].

Other tests may include an autonomic reflex screen to check how autonomic nerve fibers work, a sweat test to measure your body’s ability to sweat, and sensory tests to record how you feel touch, vibration, cooling, and heat^[9]. In some cases, a nerve biopsy may be needed, which involves removing a small portion of nerve tissue for examination. Skin biopsies can also detect damage in certain nerve cells^[4][9].

Treatment options

Treatment for peripheral neuropathy depends on the underlying cause and which symptoms need to be managed. The most effective approach is to address the root cause when possible. For example, if diabetes is the cause, gaining better control of blood sugar levels, stopping smoking, and reducing alcohol consumption may help improve symptoms or at least prevent them from worsening^[5][12].

If vitamin deficiencies are the problem, vitamin B12 injections or tablets can be helpful. When neuropathy is caused by a medication, symptoms may improve if the medicine is stopped (though this should only be done under medical supervision)^[5][12].

Some less common types of peripheral neuropathy may be treated with specific medications such as steroids (powerful anti-inflammatory medicines), immunosuppressants (medicines that reduce immune system activity), or injections of immunoglobulin (a mixture of blood proteins called antibodies)^[5][12].

Managing nerve pain is an important part of treatment. Unlike most other types of pain, neuropathic pain usually doesn’t improve with common painkillers like paracetamol and ibuprofen. Instead, doctors typically prescribe medicines specifically for neuropathic pain^[5][12].

These medications include antidepressants such as amitriptyline or duloxetine, which can treat pain even if you’re not depressed. Other options include pregabalin and gabapentin, which are also used to treat epilepsy, headaches, or anxiety. These medicines are usually started at a low dose and gradually increased until you notice an effect^[5][12].

Capsaicin cream or patches, made from the substance that makes chili peppers hot, can help with pain in specific areas by stopping nerves from sending pain messages to the brain. For severe pain that doesn’t respond to other treatments, stronger painkillers like tramadol may be prescribed, though these are usually only given for short periods due to the risk of addiction^[12].

Other pain management approaches include transcutaneous electrical nerve stimulation (TENS), a method that uses small electrical impulses on specific nerve paths to potentially relieve pain^[11]. In some cases, acupuncture or surgically implanted spinal cord stimulators may be considered^[14].

Physical therapy can help strengthen muscles and improve balance and coordination, especially if you have muscle weakness. Occupational therapy can help you adjust to changes in your body and teach you ways to perform daily tasks more easily. If you have weak ankles, you may need to wear splints for support or use walking aids^[12][14].

Living with neuropathy

Living with peripheral neuropathy presents daily challenges, but there are many strategies that can help you cope and maintain your quality of life. If you have neuropathy that affects sensation in your feet, it’s crucial to inspect your feet daily for any cuts, blisters, redness, or swelling. Use a mirror to check the soles of your feet if needed^[22].

Proper footwear is essential. Invest in well-fitting shoes with good support and cushioning, and avoid going barefoot, even indoors. Keep your feet clean and dry, and moisturize regularly to prevent dry, cracked skin^[22]. Loss of feeling in your feet can make it difficult to detect injuries, which can become infected and lead to serious complications if left untreated.

Regular physical activity can help improve circulation, balance, and overall well-being. Exercise training that includes maintaining your optimum fitness level gives you something you can control and provides many benefits to your physical and emotional well-being^[20]. Consult your doctor before starting any new exercise routine.

Good nutrition is important for nerve health. A diet rich in thiamine, protein, and antioxidants, as well as foods high in vitamin B-12 such as fruits, vegetables, and lean omega-rich proteins like fish or eggs, can support your nervous system^[11][23].

Managing the psychological aspects of living with chronic pain is equally important. Dwelling on what might have been, self-pitying, and thinking of yourself primarily as a patient are ineffective coping strategies that can make symptoms worse^[20]. Instead, try to accept and acknowledge the negative aspects of the illness, then move forward with a positive outlook.

Set priorities for daily tasks, deciding which need to be done and which can wait. Stay active without overdoing it. Consider joining a support group, where you can hear about coping techniques and treatments that have worked for others and meet people who understand what you’re going through^[20].

Implement safety measures in your home to prevent falls, such as installing grab bars and using non-slip mats in the bathroom. Since neuropathy can affect balance and coordination, these precautions become increasingly important^[22].

For people with diabetes, maintaining good blood sugar control is crucial for managing neuropathy and preventing it from worsening^[22]. Other lifestyle changes that can help include stopping smoking, reducing alcohol consumption, and maintaining a healthy weight.

The outlook for peripheral neuropathy varies depending on the underlying cause and which nerves have been damaged. Some cases may improve over time if the underlying cause is treated, while in others the damage may be permanent or gradually worsen. Recovery can take time—neuropathy caused by chemotherapy may take 18 months to five years or longer to improve^[7][21]. However, the peripheral nerves have a great ability to heal, and even though it may take months, recovery can occur in many cases.