Your peripheral nervous system connects the nerves from your brain and spinal cord, or central nervous system, to the rest of your body. This includes your:

  • arms and hands
  • legs and feet
  • face and mouth
  • internal organs

The job of these nerves is to deliver signals about physical sensations back to your brain. They also make sure your body’s internal functions, like blood circulation and food digestion, work as they should.

Peripheral neuropathy occurs when these nerves don’t work properly because they’re damaged or destroyed. This disrupts the nerves’ normal functioning. They might send signals of pain when there’s nothing causing pain, or they might not send a pain signal even if something is harming you. This can be due to:

  • injury
  • systemic illness
  • infection
  • hormonal imbalance
  • certain medications
  • vitamin deficiency
  • an inherited disorder

The causes are therefore vast, as are the types of the condition. More than 100 different types of peripheral neuropathy exist. Each type has unique symptoms and specific treatment options.

Medical researchers also classify peripheral neuropathies further classified by the type of nerve damage involved. Mononeuropathy occurs when only one nerve is damaged. Polyneuropathies, which are more common, happen when multiple nerves are damaged.

The disorder is uncomfortable, but treatments can be very helpful. The most important thing to determine is whether the neuropathy is the result of a serious underlying condition.

There are three types of nerves in the body. Since there are so many types of peripheral neuropathy, doctors will diagnose your type by the group of nerves it affects. The three groups are:

  • Motor. These nerves are responsible for muscle movement, like walking, talking, or using your hands or arms.
  • Sensory. These are responsible for sensory information, like hot or cold, pain, or touch.
  • Autonomic. These are responsible for body processes you don’t see, like breathing, heartbeat, and digestion.

Peripheral neuropathy can affect one nerve group, two groups, or all three. Sometimes it will affect one nerve only, and that’s called mononeuropathy.

The symptoms of peripheral neuropathy depend on the kind of neuropathy.

Motor neuropathy symptoms include:

  • muscle cramps
  • twitching
  • muscle weakness
  • foot drop
  • muscle wasting
  • paralysis

Sensory neuropathy symptoms include:

  • prickling and tingling sensation, or “pins and needles”
  • numbness
  • reduced sensations of pain or hot and cold
  • increased pain from things that shouldn’t cause pain, like light touch
  • burning or sharp pain
  • loss of balance or coordination

Autonomic neuropathy symptoms include:

  • constipation or diarrhea
  • bloating, belching, or feeling of sickness
  • faint or dizziness upon standing from low blood pressure
  • rapid heart rate
  • sweating too much or too little
  • problems with sexual function
  • loss of bowel control
  • difficulty emptying bladder completely

Symptoms can cause challenges in daily life, like trouble walking or sleeping because of pain in the feet and legs.

These symptoms can also indicate other conditions. Make sure you tell your doctor about all of your symptoms so they can find the right diagnosis and the best treatment.

A variety of factors and underlying conditions can cause this condition. In rare cases, peripheral neuropathy is genetic, but most cases are acquired.

An acquired case of peripheral neuropathy is often idiopathic, which means doctors don’t know why it’s happening. In most cases, doctors can connect the condition to one or more causes.

Generalized diseases

Nerve damage caused by diabetes is one of the most common forms of neuropathy. This leads to numbness, pain, and a loss of sensation in the extremities.

The American Diabetes Association recommends taking these steps to delay or prevent nerve damage:

  • Monitor your blood sugar level to keep it in target range and to assess whether your diabetes care plan is on track.
  • Inspect your feet for signs of injury, infection, or hot spots.
  • Report signs of neuropathy to your doctor and get early treatment.
  • Protect your feet with special shoes and take care when washing and exercising.

According to the National Institutes of Health, 60 to 70 percent of people with diabetes have some sort of nerve damage.

Other chronic diseases that may cause nerve damage include:

  • autoimmune diseases like lupus or rheumatoid arthritis
  • kidney or liver disorders
  • vascular and blood disorders

Injury

Physical trauma is a common cause of injury to the nerves. This can include car accidents, falls, or fractures. Inactivity, or holding still too long in one position, can also cause neuropathy.

Increased pressure on the median nerve, a nerve in the wrist that supplies feeling and movement to the hand, causes carpal tunnel syndrome. This is a common type of peripheral neuropathy.

Alcohol and toxins

Alcohol can have a toxic effect on nerve tissue, putting people with severe alcohol use disorder at a higher risk of peripheral neuropathy.

Exposure to toxic chemicals like glue, solvents, or insecticides, either through chemical abuse or in the workplace, can also cause nerve damage. Additionally, exposure to heavy metals such as lead and mercury can also cause this condition.

Infections and autoimmune disorders

Certain viruses and bacteria directly attack nerve tissue.

Viruses such as herpes simplex, varicella-zoster virus (which causes chickenpox and shingles), and Epstein-Barr virus damage sensory nerves and cause intense episodes of shooting pain.

Bacterial infections such as Lyme disease can also cause nerve damage and pain if they aren’t treated. People with HIV or AIDS can also develop peripheral neuropathy.

Autoimmune diseases like rheumatoid arthritis and lupus affect the peripheral nervous system in various ways. Chronic inflammation and damage to tissues throughout the body, as well as pressure caused by inflammation, can all lead to severe nerve pain in the extremities.

Medications

Certain medications may also cause nerve damage. These include:

A 2020 study found that although there’s no direct evidence that statins, a class of drugs used to lower cholesterol and prevent cardiovascular disease, cause neuropathy, statins may increase the risk of neuropathy from other causes.

First, your doctor will perform a physical exam and ask about your medical history. They might perform other tests, which include:

Electromyography

Electromyography can show problems with how your body’s nerve signals move to your muscles.

For this test, your doctor will place a small needle into your muscle. Your doctor will then ask you to move your muscle gently. Probes in the needle will measure the amount of electricity moving through your muscle.

This test may feel like you’re receiving a shot. Sometimes the area becomes sore for a few days afterward.

Nerve conduction study

In a nerve conduction study, your doctor places electrodes on your skin. They then pulse tiny amounts of electricity through your nerves to see if the nerves are transmitting signals properly.

This procedure is slightly uncomfortable while it’s happening, but it shouldn’t hurt afterward.

Treatment for the symptoms of peripheral neuropathy focuses on treating the underlying disorder. If diabetes is the cause, the focus is on blood sugar control. If a vitamin deficiency is causing the problem, then correcting the deficiency is the treatment.

Many treatments can bring relief and help you return to your regular activities. Sometimes a combination of treatments works best.

Pain medications

Over-the-counter (OTC) oral pain medications like acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, can be very helpful in controlling moderate pain.

If you take them in excess, these drugs can affect your liver or stomach function. It’s important to avoid using them for an extended period, especially if you drink alcohol regularly.

The Foundation for Peripheral Neuropathy includes a list of additional topical OTC medications you may consider trying. They include:

  • Absorbine Jr. This is a blend of menthol and other herbal ingredients that can soothe muscle pain. Other menthol-based creams may also help. They include Flex-All, Flexgen, Tiger Balm, or Vicks VapoRub.
  • Capsaicin cream. This cream contains chili pepper oils, which create a heating effect that helps relieve pain for some people. There are brands and formulations.
  • Neuragen PN. Made from botanical oils, this cream is meant specifically for nerve pain on hands and feet.
  • Sore No More. This is another botanical anesthetic that may provide some relieve for neuropathic discomfort.

Prescription medication

Many prescription pain medications can also help to control the pain of this condition. These include narcotics, some antiepileptic medications, and some antidepressants. Other helpful prescription medications include:

  • lidocaine in a patch on the affected area
  • pregabalin (an anti-epileptic medication)
  • duloxetine (an antidepressant)
  • steroids
  • anesthetics

Prescription drugs for sexual dysfunction in men due to nerve damage include phosphodiesterase 5 inhibitors (PDE5Is) like:

  • sildenafil
  • vardenafil
  • tadalafil
  • avanafil

Medical treatments

Your doctor can use several medical treatments to control the symptoms of this condition. Plasmapheresis is a blood transfusion that removes potentially irritating antibodies from your bloodstream.

If you get a nerve block, your doctor will inject an anesthetic directly into your nerves.

Transcutaneous electronic nerve stimulation (TENS)

Transcutaneous electronic nerve stimulation (TENS) doesn’t work for everyone, but many people like it because it’s a drug-free therapy.

During TENS, electrodes placed on the skin send small amounts of electricity into the skin. The goal of this treatment is to disrupt nerves from transmitting pain signals to the brain.

Ergonomic casts or splints

Ergonomic casts or splints can help you if your neuropathy affects your muscles. Splints can help with:

  • muscle weakness
  • stability

These casts provide support for the part of your body that’s uncomfortable. This can relieve pain. For example, a cast or splint that holds your wrists in a proper position while you sleep can relieve the discomfort of carpal tunnel syndrome.

Self-care

In addition to OTC pain relievers, many people have found relief for peripheral neuropathy through:

  • having a foot bath with chamomile or nettle leaves for at least 30 minutes
  • using a heating pad or electric socks
  • applying an ice pack to affected areas for 10 minutes twice daily in the morning and the evening
  • trying acupuncture
  • undergoing biofeedback
  • trying different types of holistic therapy such as reflexology, tai chi, or reiki
  • massaging affected areas to promote circulation
  • avoiding pressure on the affected area, like not crossing legs or leaning on elbows
  • seeking social support and activities with others
  • setting priorities daily and not doing more than you feel you are capable of
  • avoiding caffeine and developing a regular bedtime routine to promote sleep

Moderate, regular exercise can also help lessen discomfort.

If you drink alcohol or smoke, consider cutting back or stopping. Both alcohol and tobacco aggravate nerve pain and can cause nerve damage when used for long periods.

Take precautions at home

If you have peripheral neuropathy, you’re potentially at greater risk for accidents in the home. You can do the following to improve your safety:

  • Use safety guards and other tools for sharp objects like scissors and knives.
  • Use thermometers to measure the temperature of bath or tap water.
  • Use potholders and gloves when handling hot items.
  • Use a walker or cane for added stability.
  • Install nightlights to avoid tripping in the dark.
  • Carefully wrap your hands and feet when it’s cold out.

If your neuropathy is due to an underlying, treatable condition, you may be able to stop your peripheral neuropathy by treating the larger problem.

However, if this isn’t the case for you, you can successfully manage the symptoms of your peripheral neuropathy. Speak with your doctor to determine the best medical treatment for you, and explore complementary and self-care options that can supplement your medical care.

You can take steps to prevent 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.

Peripheral neuropathy is the result of damage to one or more groups of nerves. The effect on your body depends on which nerve groups aren’t working the way they should.

An injury, systemic illness, and medications are all potential causes. By treating the underlying reason for neuropathy, you can delay its onset or stop it from getting worse. Self-care strategies like daily planning can help you manage the condition and improve daily life.