This information describes peripheral neuropathy, including causes, symptoms, and ways to manage it.
Peripheral neuropathy (per-IF-er-al nur-OP-a-thee) is the general term used to describe changes that happen when peripheral nerves are damaged.
Peripheral nerves are all of the nerves outside of your brain and spinal cord. There are 3 types of peripheral nerves:
- Sensory nerves that help you feel pain, touch, temperature, position, and vibration.
- Motor nerves that help you move and maintain muscle tone.
- Autonomic nerves that control things that happen automatically, such as how fast your heart beats and how much you sweat.
Symptoms of Peripheral Neuropathy
The symptoms of peripheral neuropathy are different depending on which peripheral nerves are damaged. Sometimes, just one type of nerve is damaged. More often, several types are damaged and you may have several symptoms. Be sure to discuss your symptoms with your doctor or nurse.
Depending on what caused the peripheral neuropathy, the symptoms may improve over time, or they may be lifelong.
Many people with peripheral neuropathy experience changes in feeling in their toes, feet, fingers, or hands. These feelings may not go beyond your wrist or ankle.
If your sensory nerves are damaged, you may have a feeling of “pins and needles” or “electric shocks.” You may also feel cold, prickling, pinching, or burning in your hands and feet. Some people become very sensitive to touch, while other people feel numbness.
When peripheral neuropathy affects motor nerves, it can cause muscle weakness, cramping, and twitching, as well as loss of balance and coordination. This may make it difficult to walk, drive, or handle small objects (such as holding a pen or buttoning a shirt).
When peripheral neuropathy affects autonomic nerves, it can cause your heart to beat faster or slower than normal. You may sweat more or less than you normally do, or you may notice differences in your bowel and bladder function.Back to top
Causes of Peripheral Neuropathy
The most common cause of peripheral neuropathy is diabetes. However, peripheral neuropathy has many other causes, including:
- Some medications, including certain types of chemotherapy. See “Chemotherapy,” later in this section.
- Low levels of vitamin B12, B6, B1, or E
- Some forms of kidney disease
- Hypothyroid disease (when your thyroid doesn’t produce enough thyroid hormone)
- Some autoimmune diseases
- Alcohol abuse
- Lead poisoning
- External pressure on your nerves
- Hereditary peripheral neuropathy (passed on to you from your mother or father before you were born)
- Some infectious diseases (for example, brucella and leprosy)
- Some forms of cancers (for example, leukemia induced neuroleukemiosis)
If you have any of these possible causes of peripheral neuropathy, talk with your doctor or nurse. Tell your doctor or nurse what medications you’re currently taking, including over-the-counter medications and supplements, and what medications you have taken regularly in the past.
Sometimes, there is no known cause of peripheral neuropathy.
Some common types of chemotherapy drugs can cause peripheral neuropathy. We have listed some of them below along with the kind of symptoms they cause.
- You may have numbness, pain, or burning feelings in your feet or hands.
- You may have difficulty knowing where your hands and feet are in space (“position sense”). If this happens, you could slip out of shoes or slippers if they are not tied or if they don’t come up past the middle of the top of your foot (your instep).
- When you walk, you may not be able to feel the floor under your feet. You may feel as if your bare feet have socks on them or as if you are walking on broken glass.
- You may have difficulty feeling the shape of an object in your hand or picking up small objects.
- Vincristine, vinblastine, and paclitaxel
- You may have difficulty telling the difference between hot and cold temperatures.
In addition, with all of these medications, you may have problems doing things that need muscle strength and coordination. For example, you may have a hard time lifting your foot from the gas pedal to the brake while driving. Some people also describe a feeling of muscle cramps, heaviness, swelling that is not there, or weakness in the arms or legs.
Some of these symptoms may decrease over the first 6 to 18 months following treatment.Back to top
Managing Peripheral Neuropathy
Because peripheral neuropathy can cause decreased feeling in your hands and feet, driving is sometimes not safe. Ask your healthcare provider if it is safe for you to drive based on your symptoms. A rehabilitation specialist may need to assess you to see if it is safe for you to drive.
It may be helpful for you and a family member or friend to look through each room in your house to make sure each one is free of hazards. Also, inspect the garage, the yard, your car, and your place of work to make sure that they are safe.
Because you won’t feel things the way you used to, you will depend more on visual cues. Your rooms should be well lit so you don’t fall.
- Install light switches or place lamps at every doorway. The light switch should be visible to you and easy to turn on with your fingers.
- Turn lights on before you enter a room. The room should be bright enough for you to see all the areas where you walk or do activities.
- Turn lights on before you enter a stairway. All stairways, both inside and outside of your home, should have the lights on before you walk on them.
- Use floor lights that shine light up from the floor toward the ceiling or wall to help reduce glare.
- Keep a night light in your room and along the path you walk during the night if you get up to use the bathroom.
- Keep a flashlight with you or within reach to use when you need more light.
- Use a key chain with a light to help you see keyholes.
- Install handrails on both sides of all stairways and hallways.
- Cover stairs with a non-slip surface.
- Paint stairs in a light color to make them easier to see.
- Clear stairways and hallways of objects, such as small area rugs, toys, and clutter.
- Floors should have non-glare and non-skid surfaces.
- If you use area rugs around sinks or in a bathroom, make sure they have non-slip backing.
- Tape or tack down carpet edges securely.
- If your carpets or area rugs have high edges that you could trip over, consider replacing them with a thinner rug.
- Wipe up spills and liquids immediately.
- Do not use furniture with wheels such as chairs, tables, night stands, or over-bed tables.
- Remove small area rugs, stools, clothes, shoes, and clutter from walkways through your bedroom.
- If you use extension cords, secure them with electric tape along the edge of the floor.
- Remove furniture with sharp edges or corners.
- Use bathtub or sink area rugs with non-slip backing.
- Use non-skid strips or mats in tubs and showers.
- Use portable hand grips over the tub, or install shower grips.
- Use a nonbreakable water thermometer to check your bath water. Make sure the temperature is below 110° F (43.3° C).
- Use a liquid soap dispenser, soap on a rope, or a wash mitt to hold your soap.
- Use long brushes for hard-to-reach areas of your body.
- Use adapted nail clippers to cut your nails. You can buy these at a health supply store.
- Avoid slippery, wet floors. Wipe up liquids immediately.
- If you have an area rug near the sink, use one with non-slip backing.
- Use rubber gloves to wash dishes.
- Use a nonbreakable water thermometer to check the dishwater temperature before you wash dishes. Make sure the water is not hotter than 110º F (43.3º C).
- Use light-weight, nonbreakable glasses, utensils, and plates.
- Shield your fingers when cutting foods.
- Open jars or soda cans with easy jar openers, grippers, or tab grabbers.
- Use heavy-duty pot holders and oven mitts to handle items such as hot pots or pans.
Garage or yard
- Absorb oil spills with sand or kitty litter.
- Store rakes, shovels, and other garden equipment off the floor.
- Place nails, screws, and other hardware in containers with covers.
- Keep walkways clear of toys, wet rags, ropes, hoses, buckets, and other clutter.
- Always wear rubber shoes or work boots when you work in the garage or garden.
- Don’t use lawn mowers, electric branch trimmers or saws, or snow blowers.
Purchase special equipment
You may want to purchase special equipment to help you dress. You can find the following items at a health supply store:
- Zipper pulls
- Molded sock aids
- Elastic shoe laces
- Velcro® straps
- Instep or arch supports for slippers and shoes
- Cuff and collar extenders
- Lightweight dressing sticks to put on garments without bending
You can also purchase special pens, pencils, and utensils that are easier to hold.
Think about your clothing
When choosing what to wear, it may be helpful to:
- Wear shoes that go over the instep of your feet.
- Wear gloves and warm socks in cold weather.
- Wear jewelry that you can put on without help, such as jewelry without fasteners.
Exercising regularly and practicing self-massage will improve your health and help you to manage your symptoms.
- Walking is good exercise for your health and helps keep your muscles flexible.
- Low-back stretches and calf stretches will also help keep your muscles flexible.
- Foot and hand massages may help relieve stiffness. Clean slippery lotions and creams off your hands and feet after the massage.
If you exercise in a gym, tell the instructor that you have peripheral neuropathy. They will tell you what equipment is safe for you to use.
Your doctor or nurse may be able to suggest people who can help you.
- A physical therapist can help with exercise programs and assistive devices.
- An occupational therapist can help you find adaptive devices for work or home.
- A podiatrist can help you care for your feet.
If you have any questions about these services, talk with a member of your healthcare team.
Additionally, the Foundation for Peripheral Neuropathy can give you general information about peripheral neuropathy. They also have support groups. Call 1-877-883-9942 for more information, or visit the website at www.foundationforpn.org.Back to top