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How Bad Can Peripheral Neuropathy Get: Exploring Severity and Complications

Peripheral neuropathy is a condition that results from damage to the peripheral nerves, which are responsible for transmitting signals between the brain, spinal cord, and the rest of the body. These nerves play a crucial role in our day-to-day functioning, including activities such as walking, sensing pain or temperature, and controlling muscle movements. When the peripheral nerves become damaged, it can lead to a wide range of symptoms, including weakness, numbness, and pain – most commonly in the hands and feet. However, peripheral neuropathy can also affect other areas and body functions, such as digestion, urination, and circulation Mayo Clinic.

There are numerous causes of peripheral neuropathy, ranging from genetic factors to underlying medical conditions or injuries. In some cases, the condition may be linked to a kidney disorder, hormone imbalance, or physical trauma Johns Hopkins Medicine. Due to the wide variety of potential causes and the diverse symptoms that can manifest, the severity of peripheral neuropathy can vary significantly among individuals. In the following article, we will explore the various factors that determine the severity of peripheral neuropathy, as well as potential treatment options and strategies to manage the condition.

Causes of Peripheral Neuropathy

Peripheral neuropathy is a condition caused by damage to the peripheral nerves and can result in pain, numbness, and weakness, typically in the hands and feet. There are various factors that can cause peripheral neuropathy. In this section, we will explore some of the leading causes.

Diabetes and Blood Sugar Levels

One of the most common causes of peripheral neuropathy is diabetes. High blood sugar levels can damage nerve fibers, particularly in the legs and feet. This is why people with unmanaged type 2 diabetes may experience a loss of feeling in their feet and lower legs.

Vitamin Deficiencies and Diet

A diet lacking in essential vitamins, such as vitamin B12, can lead to peripheral neuropathy. Individuals with vitamin deficiencies may experience symptoms like numbness and tingling in their hands and feet. Maintaining a balanced diet and addressing any vitamin deficiencies can help prevent or alleviate the symptoms of peripheral neuropathy.

Injuries and Infections

Physical injuries, such as those sustained in car accidents or through sports, can cause damage to the peripheral nerves. Additionally, some infections, like Lyme disease, leprosy, and HIV, can lead to peripheral neuropathy.

Chemotherapy and Toxic Chemicals

Exposure to toxic chemicals or undergoing chemotherapy can also result in peripheral neuropathy. Certain medications and treatments can damage the peripheral nerves, leading to symptoms like pain and numbness. It is essential to consult with a healthcare professional if you suspect your neuropathy is caused by exposure to harmful substances.

Autoimmune Disorders and Infectious Diseases

Some autoimmune disorders, such as lupus and rheumatoid arthritis, can cause peripheral neuropathy. Additionally, alcoholism can lead to nerve damage and peripheral neuropathy symptoms. Infectious diseases, such as hepatitis C and Lyme disease, can also contribute to nerve damage, increasing the risk of developing peripheral neuropathy.

Types and Symptoms

Peripheral neuropathy can manifest in different forms, affecting various aspects of the nervous system. In this section, we will discuss three major categories: Polyneuropathy and Myelin, Mononeuropathy and Sensory Nerves, and Autonomic Nerves and System.

Polyneuropathy and Myelin

Polyneuropathy refers to a condition where multiple peripheral nerves are damaged or dysfunctional. This often results from diseases or conditions that affect the entire peripheral nervous system, such as diabetes or autoimmune disorders. The myelin sheath, which covers and protects the axons, can be damaged in this process, leading to a range of motor and sensory symptoms.

  • Motor symptoms: These include muscle weakness, cramping, and loss of muscle mass. Patients may have difficulty walking, gripping objects, or coordinating their movements.
  • Sensory symptoms: Numbness, tingling, and burning sensations are common, especially in the hands and feet. Individuals may also experience reduced sensitivity to touch, temperature, or pain. Hyperalgesia (excessive pain sensitivity) or allodynia (pain from innocuous stimuli) can also occur.

Mononeuropathy and Sensory Nerves

Mononeuropathy, on the other hand, involves damage to a single peripheral nerve. This is typically caused by an injury, compression, or inflammation of the nerve. Sensory nerves are responsible for transmitting sensory information from the body to the central nervous system. When these nerves are affected, the following symptoms may arise:

  • Localized pain: Pain may be confined to a specific area of the body where the sensory nerve is impaired.
  • Loss of sensation: An individual might feel numbness or tingling in areas supplied by the affected nerve(s).
  • Paresthesias: These are abnormal sensations, such as prickling or "pins and needles," experienced in the absence of any external stimulus. Paresthesias are often the first noticeable symptoms.

Autonomic Nerves and System

Autonomic nerves regulate involuntary body functions, such as digestion, heart rate, and blood pressure. When peripheral neuropathy affects these nerves, a variety of autonomic symptoms can occur:

  • Digestive problems: Patients may experience constipation, diarrhea, nausea, or vomiting due to impaired bowel function.
  • Cardiovascular issues: Damage to autonomic nerves can lead to dizziness, fainting, or irregular heartbeats as the body struggles to regulate blood pressure and heart rate.
  • Urinary problems: Individuals may have difficulty with bladder control, leading to urinary retention or incontinence.

Peripheral neuropathy can be a complex and debilitating condition, with its symptoms and severity depending on the nerves and underlying causes involved. Accurate diagnosis and appropriate treatment are crucial for managing these symptoms and improving the quality of life for those affected.

Diagnosis and Tests

Medical History Examination

The diagnosis of peripheral neuropathy begins with a thorough examination of the patient's medical history. This includes reviewing the patient's symptoms, lifestyle, exposure to toxins, drinking habits, and family history of nervous system diseases. The doctor may also ask about any pre-existing conditions or medications that could contribute to nerve damage (Mayo Clinic).

Blood Tests and Imaging Tests

Blood tests play a crucial role in identifying the possible causes of peripheral neuropathy. These tests can detect:

  • Diabetes
  • Vitamin deficiencies
  • Liver or kidney dysfunction
  • Other metabolic disorders
  • Infections
  • Signs of abnormal immune system activity (NINDS)

Further imaging tests, such as CT scans and MRI scans, may be necessary to get a better look at nerve damage. These tests help doctors identify specific areas affected by neuropathy and can contribute to a more accurate diagnosis (Johns Hopkins Medicine).

Nerve and Skin Biopsies

In some instances, nerve and skin biopsies may be conducted to confirm the diagnosis and evaluate the extent of nerve damage. An electromyography (EMG) and nerve conduction studies may also be performed to assess the severity of peripheral neuropathy and determine the nerves affected (NYU Langone Health).

Treatments and Management

Pain Relievers and Antidepressants

Pain management is crucial when it comes to peripheral neuropathy. Over-the-counter pain relievers such as ibuprofen, and naproxen may be helpful for mild pain. For more severe pain, a doctor may prescribe stronger medications like opioids. However, these can have additional risks and side effects.

In some cases, antidepressants like tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) are used to manage neuropathic pain. These drugs may help control pain by altering the way the brain perceives pain signals.

Physical Therapy and Exercise

Physical therapy and exercise play an essential role in managing peripheral neuropathy. Exercise can improve muscle strength, increase blood flow to the affected nerves, and maintain joint flexibility. A physical therapist will work with the individual to develop a tailored exercise plan to target specific muscle groups and maximize mobility. Physical therapy may also include gait training to help with balance and stability, ultimately preventing falls.

Additionally, proper foot hygiene, appropriate footwear, and weight loss (if necessary) are important preventive measures for those with lower extremity peripheral neuropathy.

Surgery and Transcutaneous Electrical Nerve Stimulation (TENS)

In some cases, surgery may be required, particularly if the peripheral neuropathy is caused by a tumor or other compressive lesions. The surgical removal of the tumor or lesion can alleviate nerve pressure and improve symptoms.

Transcutaneous electrical nerve stimulation (TENS) is another potential treatment option that involves applying electrical stimulation via electrodes placed on the skin. This method delivers a gentle electric current at varying frequencies, helping to alleviate neuropathic pain. TENS sessions should be applied for 30 minutes daily for about a month.

Managing peripheral neuropathy involves a combination of treatments, focusing on improving overall quality of life and minimizing symptoms. A healthcare provider will consider the specific type of nerve damage, location, and severity of the condition before recommending the most appropriate treatment plan.

Impact on Daily Life

Nerve Damage in Hands and Feet

Peripheral neuropathy can significantly affect an individual's daily life, particularly when it comes to nerve damage in the hands and feet. The symptoms can range from tingling or numbness to more serious effects such as burning pain or paralysis. Symptoms usually start in the extremities like the hands and feet and can impact a person's ability to perform daily activities like walking, holding objects, or maintaining balance. Reduced sensation in the hands can cause difficulty in executing fine motor skills and increase the risk of injury from undetected cuts or burns.

Muscle Weakness and Atrophy

Muscle weakness and atrophy are common consequences of peripheral neuropathy. Motor nerves are responsible for sending messages to and from the brain to control muscle movements, and when they are damaged, the communication between the muscles and the brain is disrupted. As a result, people with peripheral neuropathy may experience muscle weakness, cramps, and difficulty in movement. Over time, muscle atrophy (wasting) can occur as the muscles become weaker and lose their ability to function properly. This can make daily tasks such as walking, climbing stairs, or carrying objects increasingly difficult.

Autonomic Dysfunction

Another aspect of peripheral neuropathy that can greatly impact daily life is autonomic dysfunction. The autonomic nervous system is responsible for regulating many of the body's involuntary functions, such as heart rate, digestion, and body temperature. When peripheral neuropathy affects the autonomic nervous system, it can lead to various issues like:

  • Digestive problems, such as bloating, constipation, or diarrhea
  • Urinary problems, including difficulty starting urination or retaining urine
  • Sweating abnormalities, causing either excessive sweating or insufficient sweating
  • Irregular heart rhythms or blood pressure fluctuations

These autonomic dysfunctions can create additional challenges in managing daily activities and maintaining overall health.

Prevention and Lifestyle Changes

Peripheral neuropathy, which often causes weakness, numbness, and pain, usually in the hands and feet, can also affect other areas and body functions including digestion, urination, and circulation1. Prevention and lifestyle changes can play a significant role in managing and reducing the symptoms of peripheral neuropathy.

Some of the key lifestyle changes that can help prevent or alleviate peripheral neuropathy symptoms include:

  • Regular Exercise: Engaging in regular physical activity, such as walking three times a week, can help reduce neuropathy pain, improve muscle strength, and control blood sugar levels. Gentle routines like yoga and tai chi may also be beneficial.
  • Healthy Diet: Consuming a balanced diet, rich in vitamins and minerals, to correct vitamin deficiencies is essential for maintaining nerve function2. A good diet also helps control blood sugar levels, which can be beneficial for people with diabetes-related peripheral neuropathy.
  • Quit Smoking: Smoking negatively affects circulation and increases the risk of foot problems and other neuropathy complications. Therefore, it is essential to quit smoking to maintain good blood flow to your peripheral nerves3.

Detailed recommendations to mitigate specific nerve-related issues are as follows:

  • Seizures and Low Blood Pressure: Medications and lifestyle adjustments may be needed in order to manage seizures and low blood pressure associated with certain types of peripheral neuropathy. Consult with a healthcare professional for personalized advice.

  • Sweating and Blood Vessel Involvement: Autonomic neuropathy, a subtype of peripheral neuropathy, may cause difficulty with regulating body temperature and changes in sweat production. It is crucial to remain well-hydrated and wear appropriate clothing for the climate to maintain proper body temperature4.

  • Stomach Problems: Gastroparesis and other stomach issues may be a side effect of peripheral neuropathy involving the digestive system. Eating smaller, more frequent meals, avoiding high-fat and high-fiber foods, and consulting with a healthcare professional can help manage these symptoms.

It is crucial to remember that these lifestyle changes must be sustained over time to effectively manage peripheral neuropathy. While not life-threatening, the condition may severely impact the quality of life if not properly addressed. Consult your physician for personalized advice and recommendations tailored to your specific needs.


  1. Peripheral neuropathy - Symptoms and causes - Mayo Clinic

  2. Peripheral Neuropathy | Johns Hopkins Medicine

  3. Peripheral neuropathy - Diagnosis and treatment - Mayo Clinic

  4. Lifestyle Changes for Peripheral Neuropathy - NYU Langone Health