Peripheral neuropathy: Signs and symptoms

 

What is peripheral neuropathy?

You may not have heard much about peripheral neuropathy but it’s quite a common condition, with an estimated one in 10 people over the age of 55 affected (i). Peripheral neuropathy is the medical term for what happens when your peripheral nerves – typically the nerves found in your hands, arms, feet and legs – become damaged, causing a range of symptoms such as tingling, numbness, pain, and a burning sensation in the affected area.
 
The most usual cause of this damage is having type 1 or type 2 diabetes (i), with about half of people who’ve had either type of diabetes for 25 years or longer also affected by peripheral neuropathy (ii). This may explain why the condition is also sometimes called peripheral diabetic nerve pain or peripheral diabetic neuropathy.
 

What causes peripheral neuropathy?

Diabetes is a condition that develops when your blood sugar levels are too high. If your blood sugar isn’t kept under control, having consistently high levels can damage your nerves – often the longest nerves such as those in your legs, feet, arms and hands (though other nerves can be affected too, causing different types of neuropathy – see our guide to diabetic neuropathy for more details).

Exactly how this nerve damage happens isn’t clear, but it’s widely acknowledged that high blood sugar levels may play a part in the process, along with other factors such as:
 

• Obesity

• High cholesterol and/or/ triglyceride levels 

• Smoking 

• High blood pressure  

 
Some experts believe the metabolic changes associated with diabetes and other related health problems may damage nerves by producing high levels of molecules called free radicals (iii). These free radicals attack nerve cells both by destroying the antioxidant compounds that protect the cells and by increasing inflammation within the cells.
 
In people with diabetes, peripheral nerve damage often develops gradually. However, one study suggests it can start much earlier than you might think, with researchers discovering around half of a study’s participants with prediabetes or those who had just been diagnosed with type 2 diabetes already had signs of peripheral neuropathy (iv).
 

Other causes of peripheral neuropathy

Having diabetes is the most common cause of peripheral neuropathy in this country (i). But there are other causes too, including:
 

• Long-term heavy alcohol drinking 

• Having low levels of vitamin B12 

• Underactive thyroid

• Infections including shingles, Lyme disease and HIV 

• Autoimmune conditions such as rheumatoid arthritis, lupus (also known as systemic lupus erythematosus or SLE), and Sjögren’s syndrome 

• Liver or kidney disease

• Inherited disorders such as Charcot-Marie-Tooth syndrome and Friedreich’s ataxia

• Malignant and benign tumours

• Some medications including those that treat cancer

• Injuries that damage or put extra pressure on a nerve

• Exposure to toxins such as insecticides, solvents and heavy metals (eg mercury and lead)

 

Peripheral neuropathy symptoms

The most common symptoms of peripheral neuropathy are sensations such as numbness, tingling (pins and needles) and weakness in the area affected. It can also cause burning sensations and sharp, stabbing, shooting or throbbing pains, all of which can make it difficult for you to sleep well. Most often these symptoms affect the hands and/or feet, though other parts of the body can be affected too.
 
Some people with peripheral neuropathy also find they can’t feel pain, pressure or temperature in the affected area. If your hands or feet are affected it can feel like you’re wearing gloves or socks, even when you’re not. Others, meanwhile, may experience the opposite, with their hands or feet feeling extremely sensitive to touch.
 

Are there any complications of peripheral neuropathy?

One of the main complications of having peripheral neuropathy is that of having foot blisters and sores that can potentially go on to develop into infected ulcers. This can happen when you don’t feel pain in your feet, so any cuts or sores that appear may go unnoticed. If you have diabetes, any wounds you have can be slow and difficult to heal too, because your circulation isn’t as healthy as it should be. That means there’s a risk that even the smallest cut or blister can become infected. In the most severe cases if an infected foot ulcer is left untreated, amputation of a toe or foot may be necessary to stop a gangrene infection spreading.
 
Read more about diabetes-related foot problems including how they are treated and how you can prevent them or spot them early in our guide to diabetic foot ulcers.
 
Depending on your symptoms having peripheral neuropathy can cause foot deformities and affect the way you walk too, as well as cause balance or co-ordination problems – which can increase your risk of having a fall. Other symptoms include muscle cramping or twitching and muscle weakness, which may, for instance, affect your ability to grasp and hold things in your hands.
 
Having to live with chronic pain as a result of having peripheral neuropathy can also lead to mental health issues such as stress, anxiety and depression.
 

Peripheral neuropathy treatment

If you have diabetes, it’s important to try to prevent the problems peripheral neuropathy can cause by keeping good and consistent control of your blood sugar levels, your blood pressure and your cholesterol levels, as well as having regular foot checks. Your GP, diabetes nurse or another member of your diabetes care team can tell you more about managing your condition and advise you if you’re struggling to keep it under control.
 
For those who’ve been diagnosed with peripheral neuropathy, there are several prescription medicines that may help relieve nerve pain, as over-the-counter painkillers such as paracetamol and ibuprofen aren’t usually effective. Some of these nerve-pain relieving medicines include:
 

• Some types of antidepressants (if your doctor prescribes these it doesn’t mean they think you’re depressed)

• Medicines that are also used to treat epilepsy, headaches or anxiety

• Medicines that are also used to treat bladder problems

Occasionally doctors recommend powerful painkillers if you have nerve pain that hasn’t responded to other treatments. However, these can cause several side effects, and must only be taken for a short time as they can be addictive. Capsaicin cream – cream made from an ingredient found in chilli peppers – may also be useful for nerve pain, but always follow the usage instructions carefully as it can cause skin irritation.
 

Can peripheral neuropathy be prevented?

Since diabetes is the most common cause of peripheral neuropathy, taking steps to reducing your risk of developing the condition is an obvious step towards preventing peripheral neuropathy too. There’s nothing you can do to remove or reduce some of the risk factors – your age, for instance, or having a family history of diabetes – but there are a few things you can do something about, including:

• Your weight (aim to keep your weight as healthy as possible by watching what you eat – read our guide to weight-loss facts for inspiration)

• Your activity levels (try to achieve the UK’s activity guidelines of 150 minutes of moderate activity a week – work up to this gradually if you haven’t been very active lately, and if you already have diabetes ask your GP for advice on getting and staying active)

• Your blood pressure (keep a check on your blood pressure as high levels are linked with diabetes – see our guide to blood pressure for advice) 

 
Meanwhile, according to Patient UK everyone can reduce their risk of peripheral neuropathy by having a moderate alcohol intake – this means drinking no more than 14 units of alcohol a week on a regular basis – and by following a healthy diet to prevent dietary deficiencies (v). Shingles – which is caused by the reactivation of the virus that causes chickenpox in children – can also be prevented in those who are the most susceptible to it (that is, people aged 70 and older) by having the NHS shingles vaccination – check with your GP to find out if you’re eligible.
 

Nutritional supplements for peripheral neuropathy

While nutritional supplements should never be used as an alternative to conventional diabetes medicines or medical care, certain supplements may be helpful if you take them alongside the treatments your GP has prescribed for you. Some, for instance, are thought to help with blood sugar control, which may help prevent peripheral neuropathy caused by high blood sugar or stop any existing symptoms from getting worse.
 

• If you have diabetes check with your GP before taking these or any other supplements, as having blood sugar levels that are too low can put you at risk of a serious complication called hypoglycaemia (hypo).

Find out more about hypos in our guide to diabetes. 

If you want to consider taking a supplement, a multivitamin and mineral product is a great place to start, as it can make sure you have all the nutrients your body needs for overall health. This can be particularly useful if your diet isn’t always as healthy as it should be. Discover further details about multivitamin supplements including which one may be the most suitable for you by reading our guide to multivitamins and daily requirements. 

Meanwhile other supplements you may want to consider include:
 

Cinnamon  

 
Cinnamon is a spice often used in cooking but it’s also one of the oldest remedies used in traditional Chinese medicine. It’s often recommended by natural therapists for those with type 2 diabetes, as there is some evidence it may help improve blood sugar levels (vi).
 

Alpha lipoic acid

 
A powerful antioxidant, alpha lipoic acid is a fatty acid that may help control blood sugar levels (vii) as well as improve insulin sensitivity in people with type 2 diabetes (viii). Alpha lipoic acid supplements have been used widely in Germany to treat diabetic neuropathy, and at least one study suggests it may well be effective (ix). However, if you have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity.
 

Magnesium

 
Some experts believe people with diabetes also have low magnesium levels (x), possibly because diabetes or some of the medicines used to treat it may cause magnesium deficiency. Elsewhere researchers have discovered magnesium may even help with blood sugar control (xi).
 

Turmeric

 
The curry spice turmeric contains a compound called curcumin that has several potential health benefits, including the ability to reduce blood sugar levels – though to date most studies have been carried out in animals rather than humans, which means the available evidence is weak. Some researchers, however, have studied the effects of taking curcumin in people with diabetic foot ulcers (xii). They found those taking the curcumin supplements experienced improved blood sugar level control, though they didn’t notice any significant improvement in wound healing.
 

High-strength fish oils

 
Omega-3 fatty acids – particularly EPA and DHA, two omega-3s found in oily fish such as salmon, trout, sardines and mackerel, as well as fish oil supplements – are widely considered helpful for general health and wellbeing. There is also some evidence they may help reduce levels of triglycerides in the blood, which is thought to be a risk factor for nerve damage (xiii). Fish oil supplements are widely available, but vegetarians and vegans can get these beneficial omega-3 fats too by taking supplements that contain omega-3 oils derived from marine algae.
 

Fenugreek

 
Fenugreek seeds have been used traditionally as a medicine for centuries in some parts of the world (in Ayurvedic medicine, for instance). These days, some herbal practitioners recommend fenugreek seeds to people with diabetes, as the seeds may help increase the body’s ability to produce insulin. There is also some evidence fenugreek seeds may be helpful in controlling type 2 diabetes and reducing insulin resistance, though supporting studies to date are small in scale (xiv). However, don’t take fenugreek if you’re pregnant or breastfeeding.
 

Vitamin D

 
Best known for helping the body absorb calcium, vitamin D – specifically having low levels of it – is increasingly being linked with type 2 diabetes (xv). Researchers are also examining the association between vitamin D deficiency and diabetic neuropathy, with one small-scale study finding that people with type 2 diabetes and peripheral neuropathy have significantly lower levels of vitamin D than those who don’t have neuropathy or diabetes (xvi).

Unfortunately, vitamin D deficiency is thought to be common in some countries including the UK, which explains why Public Health England advises adults and children over the age of one-year-old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xvii). However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as this is the natural form of vitamin D the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However, most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

High-strength anthocyanidins

 
Found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes – as well as vegetables such as red cabbage, red onions and aubergines –  anthocyanidins and their derivatives anthocyanins are potent antioxidant compounds. They may be useful for people with diabetes and diabetic neuropathy (including peripheral neuropathy) as they may help strengthen and repair the walls of damaged veins and capillaries by protecting collagen in the body (collagen being the structural protein that gives blood vessels their strength).
 
Anthocyanidins are also available in supplement form (choose a product that combines anthocyanidins with vitamin C, as vitamin C supports the body’s ability to produce collagen).
 

Evening primrose oil

Often taken by women at certain times during their menstrual cycle, evening primrose oil comes from the seeds of the Oenothera biennis plant. Rich in omega-6 fatty acids including gamma-linolenic acid (GLA), it has been used traditionally for a range of health issues, including conditions that involve inflammation.

Some studies have also found evening primrose oil – and more specifically GLA – may be beneficial for people with peripheral neuropathy. An older study, for instance, found people with mild diabetic neuropathy who took GLA for one year experienced improved symptoms such as pain sensitivity and nerve function (xviii).

Other studies have found evening primrose oil and GLA may help repair and regenerate nerves in peripheral neuropathy. Unfortunately, however, these are animal studies, so we can’t really be sure the same effect would happen in humans.

 
Peripheral neuropathy is probably more common than you think, especially in those who are living with diabetes. But while there’s no cure, there are treatments that address the symptoms – plus treating the underlying condition (in most cases, diabetes) is also helpful. There are also lifestyle measures you can take to prevent it or stop it getting any worse, as well as supplements that may be useful.  For more information on a range of health and wellbeing issues, visit our pharmacy health library.

References:

(i) Available online: https://www.nhs.uk/conditions/peripheral-neuropathy/
 
(ii) Available online: https://patient.info/brain-nerves/peripheral-neuropathy-leaflet
 
(iii) Perez-Matos MC. et al. Lipids: A Suitable Therapeutic Target in Diabetic Neuropathy? J Diabetes Res. 2017. Available at www.hindawi.com/journals/jdr/2017/6943851. Accessed April 5, 2017. Available online: https://www.hindawi.com/journals/jdr/2017/6943851/
 
(iv) Lee CC, Perkins BA, Kayaniyil S, et al. Peripheral Neuropathy and Nerve Dysfunction in Individuals at High Risk for Type 2 Diabetes: The PROMISE Cohort. Diabetes Care. 2015;38(5):793–800. Available online: https://diabetesjournals.org/care/article/38/5/793/37475/Peripheral-Neuropathy-and-Nerve-Dysfunction-in
 
(v) Available online: https://patient.info/brain-nerves/peripheral-neuropathy-leaflet
 
(vi) Mang. B, Wolters. M, Schmitt. B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36:340-344. Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2006.01629.x

Akilen. R, Tsiami. A ,Devendra. D, Robinson. N, et al. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010;27(10):1159-1167. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03079.x

Pham. AQ, Kourias. H, Pham. DQ. Cinnamon supplementation in patients with type 2 diabetes mellitus. Pharmacotherapy. 2007 Apr;27(4):595-9.Available online: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.27.4.595

Kirkham S, Akilen R, Sharma S, Tsiami A. The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistance. Diabetes Obs Metab. 2009 Dec;11(12):1100-13. Available online: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2009.01094.x
 
(vii) Poh. ZX., Goh KP., A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. Available online: https://www.eurekaselect.com/article/30245
 
(viii) Evans JL, Goldfine ID. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technol ther. Autumn 2000;2(3):401-13. Available online: https://www.liebertpub.com/doi/10.1089/15209150050194279
 
(ix) Ziegler. D, Ametov. A, Barinov. A, et al. Oral treatment with {alpha}-lipoic acid improves symptomatic diabetic polyneuropathy: The SYDNEY 2 trial. Diabetes Care. 2006;29:2365-2370. Available online: https://care.diabetesjournals.org/content/29/11/2365
 
(x) Elamin. A, Tuvemo. T. Magnesium and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1990;10:203-209. available online: https://www.diabetesresearchclinicalpractice.com/article/0168-8227(90)90062-X/pdf.

Barbagallow M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes 2015 Aug 25; 6(10):1152-57. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549665/
 
(xi) Song. Y, He. K, Levitan. EB. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050-1056. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2006.01852.x
 
(xii) Mokhtari M., Razzaghi R, Momen-Heravi M. The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Phytother Research: PTR (2020) 35(4):2099–107. Available online: https://onlinelibrary.wiley.com/doi/10.1002/ptr.6957
 
(xiii) Cbauhan S et al. Role of Omega-3 Fatty Acids on Lipid Profile in Diabetic Dyslipidaemia: Single Blind, Randomised Clinical Trial. J Clin Diagn Res. 2017 Mar; 11(3): OC13–OC16. Available online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427353/
 
(xiv) Yilmaz Z et al. Supplements for Diabetes Mellitus: A Review of the Literature. Pharm Pract 2017 Dec;30(6):631-638. Available online: https://journals.sagepub.com/doi/10.1177/0897190016663070.

Kassaian N et al. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. J Vitam Nutr Res 2009 Jan;79(1):34-9. Available online: https://econtent.hogrefe.com/doi/10.1024/0300-9831.79.1.34 .

Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. Physicians India 2001 Nov;49:1057-61. Available online: https://pubmed.ncbi.nlm.nih.gov/11868855/
 
(xv) Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017 Mar 24;474(8):1321-1322. Available online: https://portlandpress.com/biochemj/article-abstract/474/8/1321/49583/Vitamin-D-deficiency-and-diabetes?redirectedFrom=fulltext
 
(xvi) Shillo P et al. Reduced vitamin D levels in painful diabetic peripheral neuropathy,
Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13798
 
(xvii) Available online: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d

(xviii) Keen H et al. Treatment of diabetic neuropathy with gamma-linolenic acid. The gamma-Linolenic Acid Multicenter Trial Group. Diabetes Care 1993 Jan;16(1):8-15. Available online: https://diabetesjournals.org/care/article/16/1/8/20754/Treatment-of-Diabetic-Neuropathy-With-Linolenic

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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