Peripheral neuropathy

What is the peripheral nervous system?

The peripheral nervous system is made up of all the nerves in your body that lie outside of your central nervous system. Your central nervous system involves your brain and spinal cord. Your nerves are responsible for certain functions which include:

• Motor function – these nerves control movement of your muscles

• Sensory function – these nerves control the transmission of different sensations, such as pain, heat and touch

• Autonomic function – these nerves are responsible for processes which are automatic, such as bladder control.

What is peripheral neuropathy?

Peripheral neuropathy is where the nerves in the peripheral areas of the body, such as the fingers and toes, become damaged.

What are the symptoms of peripheral neuropathy?

Symptoms depend on which nerves are affected, but typically it causes:

• Changes to sensation such as:

• A burning feeling or sensation

• Tingling and numbness, usually in the hands and feet

• Shooting pains

• Changes to motor function, to result in muscle weakness. This can affect your stability, leading to poor balance

• Weakness

• You might notice an ulcer or change to your skin on the bottom of your foot which does not heal or get better over time.

How common is peripheral neuropathy?

About 1 in 10 people over the age of 55 in the UK are affected by peripheral neuropathy.

What causes peripheral neuropathy?

• Diabetes – this can be either type 1 or type 2 diabetes. It is thought that high blood sugar levels cause damage to the small nerve fibres in your hands and feet.

• Viral infections – these can affect the nerves. Examples include shingles, HIV and Lyme disease

• Guillain-Barré syndrome, an autoimmune disorder

• Charcot-Marie-Tooth disease, an inherited disorder

• Low levels of B12

• An underactive thyroid

• Drinking excessive amounts of alcohol

• Medications such as steroids or chemotherapy

How is peripheral neuropathy diagnosed?

A GP might order blood tests initially, checking for things like diabetes and B12 deficiency if a diagnosis of peripheral neuropathy is suspected.

Other tests which may help with a diagnosis include:

• Nerve conduction studies – this measures how well your nerves are working

• EMG – this tests the electrical activity in your muscles

If a cause cannot be identified, you might be referred for genetic testing to try and assess for an underlying condition.

How is peripheral neuropathy treated?

Initially, the underlying cause of peripheral neuropathy should be assessed.

If the peripheral neuropathy is due to diabetes, making lifestyle changes such as exercising, drinking less alcohol, stopping smoking and controlling your blood sugar levels can help with management.

If the peripheral neuropathy is due to taking a particular medication, you can help manage symptoms by stopping the causative medications.

If it’s due to vitamin B12 deficiency, you can help manage it with B12 replacement, with either injections or tablets.

To manage the symptoms of peripheral neuropathy, such as nerve pain, you might need neuropathic drugs to help relieve symptoms. Examples of neuropathic drugs include amitriptyline, pregabalin and gabapentin.

Sometimes, capsaicin cream can be used and applied over the affected areas to help treat symptoms. Because capsaicin cream is made out of chilli peppers, you need to wash your hands after you use the cream, and the cream should not be applied to broken or dry skin.

Muscle pain and weakness can be helped with physiotherapy.

When should I speak to a doctor?

If you notice a change in sensation in your hands or feet, speak with a GP in the first instance.

How can Livi help?

A Livi doctor can talk to you about your symptoms and give you advice on the next best steps.