Peripheral Neuropathy: What It Is, Causes, Symptoms, & Types

What is Peripheral Neuropathy?

Peripheral neuropathy is a disorder that affects the nerves outside your brain and spinal cord. The nerves that connect the brain and spinal cord to the arms, hands, legs, feet, internal organs, joints, mouth, eyes, ears, nose, and skin make up the peripheral nervous system (PNS).

Damage to these nerves can affect sensation, movement, and the functioning of internal organs. Peripheral neuropathy commonly affects the hands and feet, causing symptoms such as numbness, tingling, pain, or muscle weakness. Traumatic injuries, infections, metabolic disorders, autoimmune diseases, hereditary factors, and toxin exposure can all lead to peripheral neuropathy.

Types of Peripheral Neuropathy

Peripheral neuropathy can be classified into the following categories based on the type of nerve affected:

How Common is Peripheral Neuropathy in India?

Peripheral neuropathy is a common neurological disorder in India, with a 75.4% prevalence rate. The condition is more common in older diabetic patients who have vitamin deficiencies, kidney disease, or certain infections.

Diabetes is the leading cause of peripheral neuropathy in India, with mild (53.9%) being the most common category, followed by moderate (16.8%) and severe (4.7%). As diabetes rates continue to rise in India, peripheral neuropathy is becoming an increasingly important public health concern.

What are the Symptoms of Peripheral Neuropathy?

Symptoms of peripheral neuropathy depend on the type and severity of nerve damage. They often progress gradually if the underlying condition remains untreated.

Stages of Peripheral Neuropathy

Although peripheral neuropathy does not have a universally accepted staging system, healthcare professionals often describe its progression based on symptom severity and nerve damage.

Disease Similar to Peripheral Neuropathy

Several illnesses can cause numbness, discomfort or weakness in the limbs. The treatment is very different, and the root reason needs to be found.

Peripheral Neuropathy vs Radiculopathy vs Peripheral Artery Disease

What Causes Peripheral Neuropathy?

Causes of peripheral neuropathy include:

• Diabetes Type 2: Peripheral nerve injury occurs when blood sugar levels are too high for extended periods of time.

• Alcohol Consumption Disorder: Nerve injury can result from excessive alcohol consumption, particularly over extended periods of time.

• Nutrient and Vitamin Deficiency: Certain vitamin deficits can induce nerve damage in people. Copper and deficits in vitamins B1, B6, B9, B12, folic acid (B9), and E are the most likely causes of nerve damage. An excess of vitamin B6 can also bring on this condition.

• Inflammatory and Autoimmune Diseases: Severe weakness may result from Guillain-Barré syndrome, vasculitis and lupus.

• Toxins and Medications: Chemotherapy and some other drugs, such as antibiotics and drugs for gout and arrhythmia, can cause peripheral neuropathy.

• Genetic Disorders: Certain genetic disorders, like Charcot-Marie-Tooth disease, Fabry disease, and amyloidosis, can cause peripheral neuropathy.

• Infections: Bacteria like Borrelia burgdorferi, which causes Lyme disease, or viruses like HIV can cause nerve damage. Shingles is another prominent condition that can cause persistent nerve pain.

• Leprosy (Hansen Disease): Leprosy is quite uncommon and mostly affects the skin, but it also harms your peripheral nerves.

• Surgery and Trauma: Trauma and medical procedures can cause nerve injuries and damage. Nerves can also be harmed by swelling or straining. Usually, this type of injury affects only one area.

• Vascular Disorders: Inadequate blood supply can also cause this disorder. An arm or leg falling asleep when sitting or lying in a particular position is a harmless, transient variant of this condition.

What are the Complications of Peripheral Neuropathy?

Complications associated with peripheral neuropathy are:

• Foot Ulcers: People with nerve damage may not feel pain when they get hurt.

• Motor Imbalance: Nerve damage can make it difficult to balance while walking.

• Muscle Weakness and Wasting: Long-term nerve damage may cause loss of muscle strength and mass.

• Chronic Pain: Persistent burning, tingling, or shooting pain can affect daily activities and sleep.

• Autonomic Dysfunction: Problems with blood pressure, heart rate, digestion, bladder control, or sweating may occur.

• Amputation Risk: Amputation risks arise when an infection has spread or an ulcer fails to heal, and the only option is to remove the affected area.

When Should I See a Healthcare Provider?

You should consult your doctor in case of:

• Persistent numbness or tingling in the hands or feet.

• Burning, shooting, or unexplained nerve pain.

• Muscle weakness or difficulty walking.

• Loss of balance or frequent falls.

• Symptoms that worsen or interfere with daily activities.

Your doctor may adjust your therapy for peripheral neuropathy or help you adapt to these changes and reduce their impact.

How is Peripheral Neuropathy Diagnosed?

Your healthcare provider may prescribe the following tests to diagnose peripheral neuropathy:

Diagnostic Overview Table

How is Peripheral Neuropathy Managed/Treated?

Doctors can use a variety of treatments and procedures to manage or treat peripheral neuropathy, which include:

• Scrambler Therapy: Electrical impulses are used in this treatment to communicate non-painful information to the brain.

• Spinal Cord Stimulation: It works through devices called neurostimulators, which are inserted into the body. They can prevent pain signals from getting to the brain by sending low-level electrical impulses.

• Steroids, Intravenous Immune Globulin, and Plasma Exchange: The doctor may suggest these therapies when inflammation or autoimmune diseases cause neuropathic conditions linked with weakness, numbness, or loss of balance.

• Physical Therapy: If you have balance problems or muscle weakness, physical therapy may help you move more easily.

• Surgery: Surgery may be necessary for neuropathies caused by nerve compression, such as those due to tumours.

• Medications: Over-the-counter medications, such as nonsteroidal anti-inflammatory medicines, can help alleviate mild symptoms. Your doctor may also prescribe medications to prevent seizures.

Medicines Used in Peripheral Neuropathy Treatment

Medicines mainly help relieve symptoms or treat the underlying cause, depending on the type and severity of peripheral neuropathy. Some of these medications are:

• Pregabalin: Reduces burning, tingling, and nerve-related pain.

• Gabapentin: Reduces abnormal nerve activity and manages chronic neuropathic pain.

• Duloxetine: An antidepressant that reduces pain while improving mood in people with chronic symptoms.

• Amitriptyline: Reduces chronic nerve pain and improves sleep quality (in low doses).

• Topical Lidocaine: Provides local pain relief by temporarily blocking pain signals from damaged nerves.

• Capsaicin Cream: Reduces pain by decreasing the activity of pain-transmitting nerve fibres over time.

• Vitamin B12 Supplements: Corrects Vitamin B12 deficiency and further prevents nerve damage.

• Corticosteroids, Intravenous Immunoglobulin (IVIG), or Plasma Exchange: These are indicated for inflammatory or autoimmune neuropathies, including chronic inflammatory demyelinating polyneuropathy (CIDP) or Guillain-Barré syndrome.

Note: Medications need to be closely monitored by a neurologist, as these are not appropriate for all kinds of peripheral neuropathy. Use only as prescribed by your healthcare professional, as it can cause negative effects.

Living with Peripheral Neuropathy in India: Daily Challenges and Long-Term Care

Peripheral neuropathy symptoms generally need continuous care and regular follow-up. Proper lifestyle changes, rehabilitation and treatment of the underlying illness will assist in maintaining independence and reducing complications.

What is the Prognosis for Peripheral Neuropathy?

Peripheral neuropathy is typically not harmful, but it can cause significant life disruptions. When it just affects one nerve or a small number of nerves, the consequences are typically less severe. The potential harm increases with the number of nerves affected.

Your symptoms also impact the prognosis. Early diagnosis and treatment often help improve the symptoms and quality of life.

How Can I Prevent Peripheral Neuropathy?

You can reduce the risk of getting peripheral neuropathy by following the measures below:

• Vitamin Tablets: Take vitamin B6 or B12 tablets to maintain a healthy nervous system.

• Fitness: Staying physically fit can help prevent or delay the onset of type 2 diabetes, which, over time, can affect your peripheral nerves.

• Safety: One of the main causes of nerve damage is injury. You can prevent these injuries or lessen their severity by wearing safety gear when working or playing.

• Limited Alcohol Consumption: You can lower your risk of neuropathy (and some other medical complications) by abstaining from alcohol or drinking it in moderation.

• Lead and Mercury Exposure: Lead and mercury are examples of heavy metals that can seriously harm your nervous system. Avoid areas with exposure to these metals, or wear the required protective gear when in their vicinity.

Peripheral Neuropathy Treatment Cost in India

The cost of peripheral neuropathy treatment in India depends on the cause, severity, and treatment technique. Patients with autoimmune neuropathies or requiring hospitalisation tend to have higher treatment expenses than those treated only with drugs and rehabilitation.

The average peripheral neuropathy treatment cost in India is as follows:

Note: Costs are approximate only and may change depending on the hospital, city, disease severity and treatment procedure. The treatment costs for autoimmune neuropathies requiring IVIG, plasma exchange or prolonged hospitalisation are much greater than for normal management of diabetic or nutritional neuropathy.

Does Health Insurance Cover Peripheral Neuropathy?

Yes. Several health insurance plans in India cover treatment for peripheral neuropathy. The policy may cover associated costs, such as:

• In-patient hospitalisation

• Pre and post- hospitalisation care

• Ambulance costs

• ICU costs

• Physiotherapy

• OPD consultations

• Diagnostic tests

Policy coverage can vary by insurer and plan purchased. A waiting period of up to 3 years may be applicable for pre-existing conditions. Read the policy terms and conditions to be aware of its coverage and exclusions before filing a claim.

How Much Health Insurance Coverage is Needed for Peripheral Neuropathy?

Health insurance coverage for peripheral neuropathy depends on the severity of the condition, the type of treatment needed, and the city where the person receives treatment.

A basic coverage of around ₹5–₹10 lakh is usually advisable to cover expenses for seeing a specialist, getting tests like electromyography, hospitalisation costs and prescribed medications. However, patients with conditions such as diabetes may need more coverage. In such cases, a coverage of at least ₹15 to ₹20 lakh should be opted.