What is Peripheral Neuropathy?
Peripheral neuropathy is defined as disruption to the function of peripheral motor, sensory and autonomic neurons, as a result of damage to distant nerves that transmit sensory information back to the brain and spinal cord. Vital connections get interference, like poor cell phone service, which distorts and sometimes interrupts messages causing unpleasant side effects. These symptoms often develop in a “glove and stocking” distribution to the hands and feet [1-3].
Peripheral Neuropathy develops from a variety of systemic, metabolic and toxic causes. It may result after Cancer or Chemotherapy (Radiotherapy or Surgery), Infection, Shingles, Diabetes, Autoimmune Diseases, Alcohol Abuse and Low Vitamin B. Onset is variable for each individual, depending on the nerves affected [4-6]. For some, these symptoms are only temporary, for others they may be experienced over a period of days, weeks or years. The nerves controlling digestion and blood pressure can also be affected and may cause constipation, dizziness or other symptoms [7-8].
The onset and resolution of symptoms are variable
Potential symptoms of peripheral neuropathy:
- Pain, shooting or stabbing, that comes and goes
- Exaggerated sensitivity to touch (cool breeze over the skin can be painful)
- Sharp, burning sensations (that keeps patients awake at night)
- Difficulty with fine motor tasks such as doing up buttons or picking up coins
- Numbness (hands/feet), loss of feeling, difficulty picking up and holding objects
- Tingling, or pins and needles, or prickling sensation
- Poor balance and loss of coordination
- Hypersensitivity to touch or pressure
- Weak muscles, foot drop, trip or stumble when walking
What to expect:
Assessment will include full clinical history of any disease, chemotherapy or lesion of the somatosensory system that may indicate diagnosis of neuropathic pain and establishing how your symptoms are affecting your daily activities.
We cannot treat the underlying cause of the peripheral neuropathy, but we can help reduce the troublesome symptoms.
Clinical examination including:
- Sensory examination – Testing for numbness or loss of sensation (pinprick test). This test measures whether you have lost any feeling in particular areas of your body such as your feet, lower legs and hands. You will be asked to say if you can feel a pin gently touching your skin in the areas of your body that may be affected by nerve damage
- Establishing your ability to sense where parts of your body are when your eyes are closed
- Checking whether the reflexes in your ankles, knees and wrists are working. Everyone has points on their body that, if hit gently with a rubber hammer, will normally respond with an automatic (reflex) movement
- Motor testing, looking at the strength and tone of muscles
- Assessing your balance and coordination – for example, by asking you to walk in a straight line
- Accurate observation of autonomic changes in colour, temperature, sweating and swelling
BENEFITS: Ways to relieve peripheral neuropathy
Sensory retraining program
Stimulating your sense of touch with sensory input, such as lightly stroking your skin, may help to calm these over-exaggerated nerve sensations. Using different temperatures and textures helps increase stimulus too; try using feathers and cotton wool over the skin or crunchy bubble wrap under feet to help restore the nerve sensations. Gentle massage and vibration, such as a TENs machine, can also be beneficial.
A regular exercise routine will help control pain through production of the body’s natural pain-relieving chemicals and promote function physically.
Exercises for peripheral neuropathy
Exercises that are particularly useful are those that target nerves, which help to improve balance and the ‘feel’ of a movement (proprioception – your ability to sense where parts of your body are when your eyes are closed).
Our Specialist Physiotherapist will assess your individual needs and advise you a safe home exercise programme. Some exercises may challenge your balance and have an element of unsteadiness. These will require safe steady surfaces to hold on to (walking frame/table) and someone to help nearby.
Equipment such as wobble boards, balance balls, squishy balls and Therabands can be used to aid these exercises. Our specialist physiotherapist can advise on unique and individual programmes for you.
Physical therapy tackles the physical side of the inflammation, stiffness and soreness with exercise, manipulation and massage. It also works to help the body heal itself by encouraging the production of the body’s natural pain-relieving chemicals. This two-pronged approach is what helps make physical therapy so effective when treating peripheral neuropathy [9-12]. We use treatments that can ease nerve pain and its effects on your life, including:
- Electrical nerve stimulation
- Low Level Laser
- Physical therapy
- Relaxation therapy
- Guided imagery
Hints and Tips
- Protect your hands and feet, especially in the cold weather keep them warm and safe
- Wear gloves when working, gardening or washing up
- Take care to avoid burning your hands when cooking and use oven gloves
- Handle knives, scissors and sharp objects with extra care
- Avoid walking around barefoot and check your feet regularly
- Wear socks and well-fitting slippers or shoes
- Give yourself extra time to do things and ask for help with fiddly tasks
- Set hot water heaters between 105° to 120°F to prevent scalding
- Take advantage of assistive devices, such as elastic shoe laces and button hooks
- Use walking aids and handrails to prevent stumbling
- Avoid alcohol – It can cause nerve damage on its own and may make things worse
- Yoga stretches can keep healthy joints and coordination
- Acupuncture may help reduce pain and restore sensation
- Healthy diet can help combat peripheral neuropathy – vitamin E was found to have protective abilities; studies have shown vitamin B6 and B12 are beneficial to recovery and well as Omega 3 fatty acids
Our Specialist Physiotherapist can help you gain control of your peripheral neuropathy and restore best function by designing an individual programme to target pain, restore sensation, help strengthen muscles that are weak, and improve your balance and coordination
- Lehmann, H.C., Wunderlich, G., Fink, G.R. and Sommer, C., 2020. Diagnosis of peripheral neuropathy. Neurological research and practice, 2, pp.1-7.
- Azhary, H., Farooq, M.U., Bhanushali, M., Majid, A. and Kassab, M.Y., 2010. Peripheral neuropathy: differential diagnosis and management. American family physician, 81(7), pp.887-892.
- Callaghan, B.C., Price, R.S., Chen, K.S. and Feldman, E.L., 2015. The importance of rare subtypes in diagnosis and treatment of peripheral neuropathy: a review. JAMA neurology, 72(12), pp.1510-1518.
- Singh, R., Kishore, L. and Kaur, N., 2014. Diabetic peripheral neuropathy: current perspective and future directions. Pharmacological research, 80, pp.21-35.
- Staff, N.P., Grisold, A., Grisold, W. and Windebank, A.J., 2017. Chemotherapy‐induced peripheral neuropathy: a current review. Annals of neurology, 81(6), pp.772-781.
- Lee, D. et al.(2019) ‘Characterization of Internal Validity Threats to Phase III Clinical Trials for Chemotherapy-Induced Peripheral Neuropathy Management: A Systematic Review’, Asia-Pacific Journal of Oncology Nursing, 6(4), pp. 318–332. doi:10.4103/apjon.apjon_14_19.m
- Marcus, D.A., 2009. Neuropathic pain. In Chronic Pain(pp. 173-191). Humana Press.
- Chimenti, R.L., Frey-Law, L.A. and Sluka, K.A., 2018. A mechanism-based approach to physical therapist management of pain. Physical therapy, 98(5), pp.302-314.
- Tofthagen, C., Visovsky, C. and Berry, D.L., 2012, September. Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research. In Oncology nursing forum(Vol. 39, No. 5, p. E416). NIH Public Access.
- Kruse, R.L., LeMaster, J.W. and Madsen, R.W., 2010. Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy:“feet first” randomized controlled trial. Physical therapy, 90(11), pp.1568-1579.
- Knoerl, R., Gilchrist, L., Kanzawa-Lee, G.A., Donohoe, C., Bridges, C. and Smith, E.M.L., 2020, February. Proactive rehabilitation for chemotherapy-induced peripheral neuropathy. In Seminars in Oncology Nursing(Vol. 36, No. 1, p. 150983). WB Saunders.
- Cup, E.H., Pieterse, A.J., Jessica, M., Munneke, M., van Engelen, B.G., Hendricks, H.T., van der Wilt, G.J. and Oostendorp, R.A., 2007. Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review. Archives of physical medicine and rehabilitation, 88(11), pp.1452-1464.