Peripheral neuropathy

Diagnosis

Peripheral neuropathy has many possible causes. Besides a physical exam, which may include blood tests, diagnosis usually requires:

• A full medical history. Your health care professional will look at your medical history. The history will include your symptoms, lifestyle, exposure to toxins, drinking habits and a family history of nervous system, or neurological, diseases.
• Neurological exam. Your care professional might check your tendon reflexes, muscle strength and tone, ability to feel certain sensations, and balance and coordination.

Tests

A health care professional may order tests, including:

• Blood tests. These can detect low levels of vitamins, diabetes, signs of inflammation or metabolic issues that can cause peripheral neuropathy.
• Imaging tests. CT or MRI scans can look for herniated disks, pinched nerves, also called compressed nerves, growths or other problems affecting the blood vessels and bones.

• Nerve function tests. Electromyography (EMG) measures and records electrical activity in your muscles to find nerve damage. A thin needle (electrode) is inserted into the muscle to measure electrical activity as you contract the muscle.

  During an EMG, a nerve conduction study is typically also done. Flat electrodes are placed on the skin and a low electric current stimulates the nerves. A health care professional will record how the nerves respond to the electric current.

• Other nerve function tests. These might include an autonomic reflex screen. This test records how the autonomic nerve fibers work. Other tests can include a sweat test that measures your body's ability to sweat and sensory tests that record how you feel touch, vibration, cooling and heat.
• Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to try to find the cause of the neuropathy.
• Skin biopsy. A small portion of skin is removed to look at the number of nerve endings.

Treatment

Treatment goals are to manage the condition causing your neuropathy and to improve symptoms. If your lab tests show no condition that's causing the neuropathy, your health care professional might recommend watchful waiting to see if your neuropathy stays the same or gets better.

Medicines

Medicines can be used to treat conditions associated with peripheral neuropathy. There also are medicines used to improve peripheral neuropathy symptoms. These medicines include:

• Pain relievers. Medicines available without a prescription, such as nonsteroidal anti-inflammatory drugs, can improve mild symptoms.
• Anti-seizure medicines. Medicines such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed to treat epilepsy, often improve nerve pain. Side effects can include drowsiness and dizziness.

• Topical treatments. Lidocaine cream that is available without a prescription can be applied to the skin.

  Lidocaine patches are another treatment you apply to the skin to improve pain. Side effects can include drowsiness, dizziness and numbness at the site of the patch.

• Antidepressants. Certain tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor), can help improve pain. These medicines interfere with chemical processes in the brain and spinal cord that cause you to feel pain.

  The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressants venlafaxine (Effexor XR) and desvenlafaxine (Pristiq) also might improve peripheral neuropathy pain caused by diabetes.

  Side effects of antidepressants may include dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain and constipation.

Therapies

Various therapies and procedures might help with the symptoms of peripheral neuropathy.

• Scrambler therapy. This treatment uses electrical impulses to send nonpain messages to the brain. These messages replace the pain messages the nerves send to the brain. The goal is to retrain the brain to think there is no pain.
• Spinal cord stimulation. This type of therapy works through devices put into the body. These devices are called neurostimulators. They send low-level electrical impulses that can block pain signals from reaching the brain.
• Plasma exchange, steroids and intravenous immune globulin. These treatments are often used if inflammation or autoimmune conditions are causing neuropathy with weakness, numbness or imbalance. These therapies are not used to treat pain alone.
• Physical therapy. If you have muscle weakness or issues with balance, physical therapy can help improve your ability to move. You also may need hand or foot braces, a cane, a walker, or a wheelchair.
• Surgery. Neuropathies caused by pressure on nerves, such as from tumors, might require surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Some people with peripheral neuropathy try complementary treatments for relief. Researchers haven't studied these techniques as thoroughly as they have most medicines. But the following therapies have shown some promise:

• Acupuncture. Inserting thin needles into various points on your body might lower peripheral neuropathy symptoms. You might need multiple sessions before you see improvement. Acupuncture is generally considered safe when done by a certified practitioner using sterile needles.
• Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years and there is some evidence that it can be helpful in those with painful diabetic neuropathy. Discuss using alpha-lipoic acid with your health care professional because it can affect blood sugar levels. Other side effects can include stomach upset and skin rash.
• Amino acids. Amino acids, such as acetyl-L-carnitine, might benefit people who have undergone chemotherapy and people with diabetes. Side effects might include nausea and vomiting.

Lifestyle and home remedies

To help you manage peripheral neuropathy:

• Take care of your feet, especially if you have diabetes. Check daily for blisters, cuts or calluses. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet.
• Exercise. Regular exercise, such as walking three times a week, can lower neuropathy pain, improve muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi also might help. If you have painful neuropathy in your feet, you may want to try pool-based exercise such as swimming.
• Quit smoking. Cigarette smoking can cause problems with circulation. This increases the risk of foot problems and other neuropathy complications.
• Eat healthy meals. Good nutrition is especially important to make sure that you get important vitamins and minerals. Include fruits, vegetables, whole grains and lean protein in your diet.
• Avoid excessive alcohol. Alcohol can make peripheral neuropathy worse.
• Monitor your blood sugar levels. If you have diabetes, this will help keep your blood sugar under control and might help improve your neuropathy.

Preparing for your appointment

You're likely to start by seeing your health care professional. You may then be referred to a doctor trained in nervous system disorders, also called a neurologist.

Here's information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting for a specific test. Make a list of:

• Your symptoms, including any that may seem like they're not related to your reason for scheduling the appointment.
• Key personal information, including recent stresses or major life changes, family medical history and alcohol use.
• All medicines, vitamins or other supplements you take, including doses.
• Questions to ask your health care professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

For peripheral neuropathy, basic questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• What tests do I need?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What side effects can I expect from treatment?
• Are there alternatives to the approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Do I need to limit activities?
• Are there brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care professional is likely to ask you questions, such as:

• Do you have health conditions, such as diabetes or kidney disease?
• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Does anyone in your family have symptoms similar to yours?
• Have you fallen in the past year?
• Have you had any injuries to your feet?