Neuropathy

What is peripheral neuropathy?

Peripheral neuropathy is the name given to damaged nerves in the extremities, such as the hands, feet, arms and legs. It is characterised by burning, tingling, numb or itching pains.

Nerves are a structure in your body which relay electronic signals to and from your brain and muscles. Nerves can cause your muscles to contract, either voluntarily or reflexively, and relay sensory information such as temperature and texture.

For example, when you touch something hot, a message is sent along the sensory nerve to tell the brain you just touched something hot. The brain responds to this by firing a message along the motor nerve, instructing the muscle to contract and remove your hand from the hot plate.

Neuropathy can impact this process in several ways.

Numbness or a loss of sensation in the hands and feet can be a particularly dangerous symptom. Your nerves are responsible for letting your brain know of damage to cells and tissues due to injury, such as touching a hot plate or stepping on something sharp. As a result, you may experience bruises, cuts, blisters and other injuries but have no idea how they happened.

Furthermore, ignoring an injury, especially cuts and scratches, can increase the chances of infection.

Damage to sensory nerves can also cause shooting or stabbing pains in the hands and feet. This often occurs at night and can disrupt your sleep, making it difficult to fall asleep.

Twitching, cramps, weakness, and muscle wasting can occur due to damage to motor nerves. For some, it can affect fine motor skills, making simple tasks, like holding a knife and fork or fastening buttons, difficult. In some cases, it can be very hazardous, resulting in dropped items or falls.

If you suspect you have neuropathy, you should arrange an appointment with your GP. Your doctor can discuss the possible cause of your condition and advise an appropriate treatment.

What causes neuropathy?

In many cases, neuropathy is caused by an underlying condition, and treating this underlying condition usually helps to relieve the symptoms of neuropathy.

Common causes of peripheral neuropathy include:

• Alcoholism
• Diabetes
• Physical damage to the nerves
• Side effect of certain medicines
• Viral infections (such as Shingles)

A majority of neuropathy cases are associated with having diabetes. Persistent high blood sugar levels damage blood vessels which supply the nerves. When diabetes is suspected, it is referred to as diabetic neuropathy.

Neuropathy can also develop in people with certain underlying medical conditions, including:

• Arthritis
• Botulism
• Certain cancers (lymphoma and myeloma)
• Chronic liver or kidney disease
• Coeliac disease
• Diphtheria
• HIV
• Low Vitamin B12 levels
• Lupus
• Lyme disease
• Underactive Thyroid

Some treatments, such as chemotherapy and long-term treatment with phenytoin (antiepileptic) and antibiotics (particularly metronidazole or nitrofurantoin), can also increase your risk of developing neuropathy.

Neuropathy usually develops in the longest nerves, such as those that run from your feet to your brain. Over time, neuropathy may spread to other smaller nerves, causing tingling and pain in the hands.

If you are at an increased risk of neuropathy, you may need regular check-ups to monitor any changes to your nerve function.

How is neuropathy treated?

Neuropathy pain can be treated with everyday painkillers, such as paracetamol or aspirin.

If paracetamol and aspirin are not effective at relieving the pain, there are other treatments available that target nerve pain.

Amitriptyline and Duloxetine are antidepressants which are also used to treat nerve pain. They are only available on prescription in the UK.

Flexiseq is a topical cream which lubricates the joints to reduce stiffness and pain associated with osteoarthritis. It is easy to use and available over the counter from pharmacies.

With Prescription Doctor, you can buy neuropathy treatments online following a quick consultation. All orders are reviewed by our medical team to ensure that they are safe for you. If your order is approved before 3 pm on weekdays, our GPhC-registered pharmacy will dispatch your item the same day via a discreet next-day delivery service.

If you are unsure which neuropathy treatment is most suitable for you, speak to your doctor. They will be able to help you choose the right treatment and provide advice on managing your condition.

What are the complications of neuropathy?

If left untreated, neuropathy can cause a number of conditions.

Numbness in the feet can increase your risk of injuring your feet without noticing. Blisters, cuts, scratches, and other foot injuries can often go unnoticed and thus untreated. An untreated blister can develop into an ulcer—a type of open wound that takes a long time to heal.

The ulcer, if left untreated, can become gangrenous. This is when part of the skin or the tissues beneath the skin die due to a lack of blood supply. If this occurs, you may require a procedure called a debridement to remove the dead skin and tissues, and you will be given antibiotics to fight the infection. In extreme cases, toes or feet may need to be amputated to rid the infection.

For this reason, it's very important to take care of your feet if you have neuropathy, particularly if it is caused by diabetes. Your doctor may refer you to a foot specialist (podiatrist) to inspect your feet regularly.

A more serious complication called cardiovascular autonomic neuropathy (CAN) can develop in people with diabetic polyneuropathy. CAN is a condition that occurs when damage occurs in the autonomic nervous system (ANS). This can affect blood circulation and heart rate. If you develop CAN, your doctor may prescribe a medicine to regulate your heart rate, such as beta-blockers, flecainide or amiodarone. Your condition will need to be monitored regularly to prevent any further abnormalities from occurring.

How can I prevent neuropathy?

If you have diabetes, keeping your blood sugar stable can reduce your risk of developing neuropathy. If you have difficulty controlling your blood sugar levels, speak to your doctor or diabetes nurse for advice on managing your diabetes.

Cutting down on alcohol can also reduce your risk of developing neuropathy, particularly if you drink an excessive amount of alcohol on a regular basis.

For people who may be at an increased risk of developing neuropathy due to a vitamin deficiency, taking vitamin supplements may be beneficial.

Living a healthy and active lifestyle can help you manage your blood sugar levels and subsequently lower your risk of developing neuropathy.