Diagnosis and Treatment of Peripheral Neuropathy

Diagnosing peripheral neuropathy

Your health care provider may refer you to a neurologist to diagnose and treat peripheral neuropathy. They may take these steps:

• Medical history: our provider will ask you about your symptoms, medical conditions, medications, family history of neuropathy and any factors that could contribute to nerve damage, such as diabetes, alcohol use disorder or exposure to toxins.
• Physical exam: Your provider will check your neurological function, muscle strength, sensation, reflexes and coordination. They may test whether you can feel light touch, pinpricks, vibration and temperature changes in different parts of your body. They may also watch you walk to check your gait and balance and look for signs of weakness or loss of coordination.
• Electromyography (EMG) and nerve conduction studies: These specialized tests check how your peripheral nerves and muscles are working. During an EMG, small electrodes are inserted into your muscles to measure the electrical signals your muscles produce when they contract. This will tell the provider how quickly your nerves respond. 

Your provider may also recommend:

• Blood tests to check for underlying conditions that could cause peripheral neuropathy, such as diabetes, vitamin B12 deficiency, autoimmune diseases, infection or thyroid disorders.
• Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans
• Nerve biopsies, which remove a small sample of nerve tissue to examine under a microscope for signs of nerve damage or inflammation.

Treating peripheral nerve disease

There are treatment options for some types of neuropathy, while other types can be managed with medications and lifestyle changes.  Your health care provider will recommend treatment options depending on what is causing your neuropathy, how severe your symptoms are and your preferences. Options include:

• Pain medications: Over-the-counter (OTC) pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may treat mild to moderate neuropathic pain. Prescription medications such as gabapentin, pregabalin, duloxetine or tricyclic antidepressants may help treat more severe pain.
• Medications for nerve symptoms: Anticonvulsants like carbamazepine or anti-seizure medications like gabapentin and pregabalin can help reduce tingling, burning or shooting pain. Topical treatments such as capsaicin cream or lidocaine patches may help with localized pain.
• Medications to address other conditions: Treating medical conditions such as diabetes, autoimmune diseases or infections may help with peripheral neuropathy symptoms. That could mean you need medications to control blood sugar levels, manage autoimmune disease flare-ups or treat infections.
• Physical therapy (PT): Physical therapy may improve strength, flexibility, balance and coordination. A physical therapist can design an exercise program that will help you become stronger and more mobile.
• Occupational therapy (OT): Occupational therapy can help you stay independent and do the activities you need to do. An occupational therapist can give you strategies and techniques to help manage symptoms and overcome challenges. 
• Non-pharmacological interventions: Treatments such as TENS units, spinal cord stimulators, may be used for specific types of neuropathy.

Alternative therapies for peripheral neuropathy

Some people with peripheral neuropathy choose alternative or complementary therapies to help manage their symptoms and improve their quality of life. Talk to your health care provider about any alternative therapies to be sure they are safe and that they won’t interact with any of your other medications or treatments. If you try alternative therapies, you should use them in addition to your conventional medical care, not in place of it.

While research on these therapies is limited, you may want to consider:

• Acupuncture
• Massage therapy
• Nutritional supplements

Living with peripheral neuropathy

It can be challenging to live with peripheral nerve disease. But you can take steps to manage your symptoms, improve your quality of life and maintain your independence:

• Manage underlying conditions such as diabetes or autoimmune diseases: You may need to monitor your blood sugar levels closely, follow a healthy diet, get regular physical activity and take medications as prescribed.
• Choose a healthy lifestyle: Eat a balanced diet, maintain a healthy weight, avoid smoking, limit alcohol consumption and get regular exercise.
• Take good care of your feet, especially if you have diabetes: Inspect your feet daily for any cuts, blisters or sores; wear comfortable, supportive footwear; keep your toenails trimmed; moisturize your feet and avoid walking barefoot.
• Manage stress: Try deep breathing, meditation, yoga, Tai chi, spending time with loved ones or hobbies and seek mental health support if needed.
• Control nerve pain: Talk to your provider about medication, acupuncture, massage therapy, heat or cold therapy, physical therapy or distraction techniques.
• Modify or adapt your activities: Pace yourself so you don’t get overexerted. Use assistive devices like braces or canes and seek help from family members or caregivers for difficult tasks.
• Join an in-person or online support group: You can get understanding, encouragement and coping tips from others with peripheral neuropathy.
• Educate yourself: Ask your health care team for recommendations for websites, books, articles and other materials.
• Minimize exposure to toxins, including alcohol and chemicals: They could cause more damage to the peripheral nerves. 
• Take steps to prevent physical injury and trauma: Use protective gear during sports or work activities.

Peripheral nerve disease long-term outcomes

Some types of peripheral nerve disease improve or stabilize when they’re treated properly. Other types can progress over time.

It’s important to work closely with your health care provider to develop a treatment plan to manage your symptoms, reduce your risk of complications and improve your quality of life.

Final thoughts

Peripheral neuropathy, also called peripheral nerve disease, is a condition that affects the nerves in the limbs. These nerves control muscles, movement, sensation and other bodily functions. When they get damaged, they can disrupt the way your body works. 

Various conditions can cause peripheral nerve disease. Your health care provider or neurologist can work with you to diagnose peripheral neuropathy and develop a treatment plan that controls your symptoms and improves your quality of life.