Peripheral Neuropathy

We speak of peripheral neuropathy when the nerves of the extremities (feet, arms, and hands) develop lesions, which have the inevitable consequence of altering the transport of information to and from the central nervous system.


More specifically, we talk about:


  • Mononeuropathy when the disease affects only one nerve
  • Polyneuropathy when the disease affects multiple nerves


The main symptoms of peripheral neuropathy, which can be persistent or more rarely intermittent, include:


  • numbness and tingling
  • burning and/or pain, even very severe
  • loss of balance and coordination
  • muscle weakness, especially in the feet.


In Western countries, in general, the most common cause is represented by the complications of diabetes mellitus, both type 1 and type 2, and in these cases, we speak of diabetic polyneuropathy; less commonly, it can be a consequence of


  • physical injury to the nerves, for example, as a result of trauma
  • viral infections
  • side effects of drugs
  • excessive alcohol consumption.


Treatment strictly depends on the cause, also because in some patients, only symptomatic treatment (aimed at relieving the complained complaints) and not resolving treatment is possible.


Symptoms of Peripheral Neuropathy



The extent of symptoms can range from mild to disabling and, rarely, even life-threatening; they can develop over days, weeks, or years. In some cases, symptoms improve on their own and may not require advanced care (unlike central nervous system cells, peripheral nerve cells continue to grow throughout life).


Symptoms depend on the type of neuropathy:


  • Mononeuropathy: only one part of the body is involved, as in the case of carpal tunnel syndrome, in which symptoms develop only in the hand involved
  • Polyneuropathy: symptoms involve multiple parts of the body and are often symmetrical (for example, if they start at the level of the feet, they involve both and not just one)


The symptoms also vary according to the type of nerves involved and the severity of the damage:


  • Sensory nerves


Damage to the large sensory fibers affects the sensitivity of touch, especially at the level of the hands and feet, as if you were wearing a pair of invisible gloves/socks. It can also contribute to the loss of reflexes (as well as damage to motor nerves). In contrast, the loss of spatial position sense can render the patient unable to coordinate complex movements such as walking or maintaining balance with closed eyes.

The “small fibers” devoid of myelin sheaths (which we can think of as a protective coating, like the insulation that normally surrounds an electrical wire) include tracts called axons that transmit pain and sensations related to temperature. Polyneuropathies that interfere with these fibers reduce the perception of these stimuli, with serious repercussions on the patient’s quality of life.


Other symptoms include: 


    • Paresthesia ( pins and needles )
    • Allodynia (pain caused by a stimulus that, under normal conditions, is not painful, such as the simple touch of the sheet on foot)
    • Neuropathic pain, which typically worsens at night until the patient wakes up
    • Loss of balance


  • Motor nerves


    • Muscle weakness (resulting in difficulty holding objects in hand or walking)
    • Spasms and fasciculations
    • Cramps
    • Reduction in muscle volume (hypotrophy)
    • Paralysis


  • Autonomic nerves


    • Changes in blood pressure
    • Syncope ( fainting )
    • Alterations of the hive ( constipation or diarrhea )
    • Changes in heart rate
    • Excessive sweating and intolerance to heat
    • Nausea and/or vomiting


Nerves can contain fibers of all kinds (sensory, motor, and autonomic), and, for this reason, the various types of symptoms can overlap.

About three-quarters of polyneuropathies are “length-dependent,” which means that the farthest nerve endings (typically those in the feet) are the region where symptoms develop first or are worst.


Treatment of Peripheral Neuropathy



In most cases, it is impossible to heal from peripheral neuropathy, but it is possible to try to improve the symptoms and avoid the progression of the damage.


For symptom control


  • Neuropathic pain


      • Antiepileptics (such as gabapentin and pregabalin)
      • Antidepressants (such as duloxetine)
      • Opioids (such as morphine)


  • Physiotherapy treatments are prescribed to avoid excessive loss of muscle tone
  • To avoid nausea and vomiting, antiemetic drugs are used


To avoid the progression of nerve damage, different types of treatment are used according to the cause of the pathology


    • diabetes: drugs useful for controlling blood sugar
    • autoimmune diseases: corticosteroids and immunosuppressants
    • vitamin deficiency: supplementation of the missing vitamins
    • physical compression of the nerve: surgery aimed at removing the cause of the compression itself



Combining over 18 years of experience, Dr. Munish Lal specializes in minimally invasive techniques to treat Peripheral Neuropathy that includes intervention procedures, spinal cord stimulation, and a comprehensive array of traditional pain management services.

His expertise ranges from diagnosing complicated and rare cases to pinpointing the source of back, neck, and other chronic pain conditions. He is a leading practitioner of state-of-the-art techniques. Call now to book your appointment!


CALL 424-254-3592