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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Author:

Standiford Helm II, MD

Standiford Helm II, MD

Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Peripheral neuropathy facts
• What is peripheral neuropathy?
• What causes peripheral neuropathy?
• What are the symptoms of peripheral neuropathy?
• How is peripheral neuropathy diagnosed?
• Is there any treatment for peripheral neuropathy?
• Can peripheral neuropathy be prevented?
• Patient Comments: Peripheral Neuropathy - Symptoms
• Patient Comments: Peripheral Neuropathy - Experience
• Find a local Neurologist in your town
• Peripheral Neuropathy Index

The symptoms of peripheral neuropathy somewhat depend on the cause. Typically, peripheral neuropathy affects the nerves of sensation. As a result, patients affected by peripheral neuropathy develop pain, burning, or tingling in the distribution of the affected nerves. Most commonly this is in the feet and/or hands. This can cause tingling, numbness, and/or burning in the toes or fingers.

When shingles causes peripheral neuropathy, the particular nerve affected causes a very localized burning and itching sensation. This could be, for examples, in the side of the chest, the face, the buttock, etc.

Because peripheral neuropathy has so many causes and so many presentations, the first step to diagnosis is performing a thorough medical history and physical examination. Certain tests done during the physical exam, including vibration and monofilament testing, are very accurate in diagnosing certain types of peripheral neuropathy, such as large fiber peripheral neuropathy seen with diabetes. Blood tests for exposure to toxins and electrodiagnostic studies, such as nerve conduction studies (NCS) and electromyelography (EMG) are also very useful, although these tests will not help with the diagnosis of small fiber neuropathy. Either skin biopsies or quantitative sudomotor axon reflex testing (QSART) are occasionally used to help diagnose small fiber neuropathy.

The treatment for peripheral neuropathy depends on its cause. The first step in treatment is, therefore, to look for the cause.

• Vitamin deficiencies can be corrected.
• Diabetes can be controlled, although control may not reverse the neuropathy. The goal with diabetes is early detection and adequate treatment to prevent the occurrence of neuropathy.
• Neuropathies that are associated with immune diseases can improve with treatment of the autoimmune disease.
• Neuropathy caused by nerve entrapment can be treated by physical therapy, injections, or surgery.
• Prompt treatment with sympathetic injections can minimize the chance of shingles progressing to postherpetic neuralgia.

If a specific treatment isn't available, the pain of the neuropathy can usually be controlled with medications. The simplest treatment is over-the-counter (OTC) medications, such as acetaminophen, ibuprofen, or aspirin. Tricyclic antidepressants such as amitriptyline (Elavil) or nortriptyline (Pamelor) and antiseizure medications, such as carbamazepine (Tegretol) have been used to relieve the pain of neuropathy. Capsaicin, the chemical responsible for chili peppers being hot, is available over-the-counter as a cream to help relieve the pain of a peripheral neuropathy. A prescription patch of 8% capsaicin (Qutenza) is approved for the treatment of postherpetic neuralgia. Pregabalin (Lyrica) is a medication that is used for the treatment of postherpetic neuralgia and diabetic peripheral neuropathy, while duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy. In some instances, opioids can be used to help control the pain that can be associated with peripheral neuropathy.

Both Vitamin B6 and alpha-lipoic acid have been used for relief in chemotherapy-induced peripheral neuropathy.

There is ongoing research into treatments for peripheral neuropathy, ranging from evaluating the effectiveness of topical gels to bone marrow treatments. As this research progresses, new therapies will become available.

A person who believes that he or she has peripheral neuropathy should contact their healthcare professional since many causes of peripheral neuropathy can be successfully treated.