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The Different Kinds of Peripheral Neuropathy

My articles are written from my perspective as a long-time writer, a retired healthcare professional and an educated patient.

Examples of peripheral neuropathy symptoms

Examples of peripheral neuropathy symptoms

What Is Peripheral Neuropathy?

Most people find it hard to describe what peripheral neuropathy (PN) feels like. It can be a subtle to intense sensation or a lack of sensation.

Peripheral neuropathy happens when a part of the body has experienced some kind of trauma that results in nerve damage causing the body to not be able to correctly recognize signals that are sent from the brain.

The most common type is sensory neuropathy, which causes numbness, burning, and tingling of the extremities – arms, legs, fingers, and toes. Timely diagnosis and treatment can prevent ulceration of the feet in diabetics.

What Are Your Peripheral Neuropathy Symptoms?

Do you experience numbness, pain, tingling or burning in your fingers, toes, neck, back, face, ears, legs, knees, ankles or feet?

Does it happen mostly at night?

Have you noticed the sensation that you feel doesn't affect just one part of your body?

If your answer is yes to one of the above questions, you may be experiencing a form of peripheral neuropathy.

The treatment plan depends on which form you have. But to identify the form, you need to know the parts of the body that each form affects.

Where Is Your Peripheral Nervous System?

Your body is controlled by a central nervous system (CNS) that starts at the brain and spinal cord.

Inside the central nervous system, there is a peripheral nervous system (PNS) that connects all the nerves from the brain and spinal cord to the rest of your body.

It is the sensory part of your peripheral nervous system that tells your hand that it has just been scalded by hot water by giving you a burning sensation.

The peripheral nervous system is always on duty, even when you are sleeping, constantly sending signals from your brain to your body and organs so that they know how to react and function.

The Three Types of Peripheral Neuropathy

There are three sets of nerves that play a part in peripheral neuropathy. They are:

  1. Sensory nerves: relay signals (like pain and temperature) from the skin and muscles back to the brain and spinal cord. These nerves control sensation.
  2. Motor nerves: send signals from the brain and spinal cord to your muscles (walking, etc.). These nerves control movement and coordination.
  3. Autonomic nerves: control involuntary or semi-involuntary functions (such as digestion, blood pressure, heart rate, etc.). These nerves control function.

As you can see, peripheral neuropathy is not only a nerve problem; it is a function problem.

Depending on the cause and which nerves are affected, symptoms can vary widely between patients. Just remember that everyone is different; your PN pain cannot be measured against someone else's PN pain.

Sensory Nerve Damage

There are quite a number of symptoms and each is defined by which nerves are damaged. Sensory nerve damage is the most common of the three forms and primarily affects the lower half of the body, but can also occur in the upper extremities too. Before we discuss the causes, here are some of the sensory symptoms:

  • Heat and cold sensitivity
  • Numbness
  • Itching
  • Tingling
  • Burning
  • Pain

You may also experience loss of body awareness where you lose your sense of direction or position – for example, you forget where you are standing at the moment. You might say that you lost your bearings. Examples are when you are walking on a path, going up or down the stairs, buttoning buttons, or keeping your balance when your eyes are shut.

Sensory pain is pain that is sent in error from the brain to a body part when there has been no trauma or painful incident to cause pain in that body part.

Sensory pain is worse at night and can:

  • Disrupt your sleep
  • Cause pain for no apparent reason
  • Cause arms and legs to spontaneous tremor, twitch or jump
  • Cause a massive amount of itching, particular on arms and legs
  • Cause sensory overload, such as when the bed sheets are touching your skin, and it feels like a heavy weight on your body or gives your skin a 'creepy-crawly' sensation

Motor Nerve Damage

Motor nerves control your movement and actions. They are the vehicle used by your brain and spinal cord to send signals or information to your muscles. Sometimes motor and sensory nerve damage occur together. Some of the symptoms of motor nerve damage can be:

  • Weakness
  • Muscle atrophy
  • Paralysis
  • Twitching or tremors

Autonomic Nerve Damage

Autonomic nerves control the involuntary functions of your body like your heart rate, blood pressure, digestion, and temperature. Sometimes sensory and autonomic nerve damage occurs together. Some of the symptoms are:

  • Lightheadedness
  • Dry eyes and dry mouth
  • Bladder incontinence
  • Sexual dysfunction
  • Constipation or bowel incontinence
  • Inability to feel chest pain (as in angina or onset heart attack)
  • Excessive sweating
  • Little or no sweating

Causes of Peripheral Neuropathy

The symptoms that you experience depend on the cause. There are many conditions and diseases with peripheral neuropathy as a co-diagnosis. PN is usually seen in diabetic patients but there are over 100 different types of nerve damage caused by a multitude of diseases and disorders.

Some causes are:

  • Diabetes
  • Chemotherapy radiation
  • Crush injuries
  • Pinched nerves
  • Celiac Disease
  • Rheumatoid Arthritis
  • ALS (Lou Gehrig's disease)
  • Bone marrow transplant
  • Breast reconstruction
  • Multiple myeloma
  • Lung cancer surgery
  • Certain chemotherapy drugs (for example, Oncovin and Vincasar) results in chemotherapy-induced Peripheral Neuropathy
  • Statin medications
  • Certain broad-spectrum antibiotics (like Flagyl)
  • Alcoholism – excessive alcohol can cause symptoms of PN
  • IV drug users
  • Vitamin deficiency, especially B-12, B-6, B-1, Vitamin E
  • Shingles (post-herpetic neuralgia)
  • Exposure to toxins (for example, gold, lead, arsenic, mercury, heavy metals, and certain pesticides)
  • Carpal Tunnel Syndrome
  • Lyme Disease
  • Infectious diseases like herpes, hepatitis C, HIV
  • Inherited (genetic) diseases (for example Charcot-Marie-Tooth disease or amyloid polyneuropathy)
  • Autoimmune diseases (for example Lupus, Rheumatoid Arthritis, IBS, Multiple Sclerosis, or Guillain-Barre Syndrome)
  • AIDS and AIDS-related drugs
  • Syphilis and other sexually transmitted diseases
  • Kidney or other organ failures
  • Rare diseases (for example, neurofibromatosis, Fabry disease, hereditary amyloidosis)
  • After gastric bypass surgery

Testing for Peripheral Neuropathy

After a physician takes your medical history and does a physical exam, he may perform one or all of the following tests in any order.

Monofilament Test (Semmes-Weinstein)

This test is conducted to detect peripheral neuropathy by assessing the loss of sensation and the patient's sensitivity to touch.

  • Several strands of soft nylon fiber that resembles fishing line material are calibrated from values of 1.65 to 6.65.
  • The higher the value, the stiffer and the more difficult the strand will bend or buckle against the skin.
  • With the patient's eyes closed, the monofilament is brushed over ten random areas on each foot that are not calloused or ulcerated. The patient tells the doctor at what stage they feel or do not feel the monofilament against the skin.
  • If there is a loss of sensation, the patient won't be able to detect the filament. The test can be repeated up to three times on area that the patient gave a negative response.

Results are either Positive or Negative.

  • A positive test result means the patient has stated they can feel the monofilament when it touches them.
  • If it is felt in 10 areas out of 10, the score is 10/10 indicating no peripheral neuropathy.
  • If it is not felt at all in one or more areas, it denotes a loss of sensation and may require more testing.
  • Alert: This test should not be the first test that is performed to detect PN because it will not give abnormal results unless the patient's neuropathy is in an advanced stage.
  • If this is the only test your doctor has done to detect your PN, ask for the vibration test as it is more reliable.

Vibration Test

The Clanging Tuning Fork (CTF) test is the most common test performed to detect Peripheral Neuropathy.

It is also the most reliable because it detects neuropathy at an early stage whereas monofilament testing doesn't find neuropathy until it has progressed to the severe stage.

  • To perform the CTF test, your doctor will strike a tuning fork (usually 128-Hz) so that it makes a soft clanging sound, then touch it to eight to ten areas on your feet, hands and arms which include the ball of your right or left large toe, soles of your feet, arms, elbows, and any of your fingers.
  • Your job is to tell him when you feel that the vibration has stopped.
  • Results: Your doctor is looking for consistency in your replies when the tuning fork is touched to key areas. A score of 4 seconds or less shows severe neuropathy.
  • The test can also predict the early onset of neuropathy in order for a good treatment plan to begin which may include physical therapy and corrective footwear can be prescribed, if necessary.

Thermal Sensitivity ( The Hot Cold Test)

A thermal probe is placed on the patient’s skin to heat or cool the skin. The patient responds by pushing a button when they feel the temperature go hot or cold. The results are recorded and compared to a chart.

EMG (Nerve Conduction Test)

An EMG is not only expensive and time-consuming but it is not always conclusive. An EMG tests the function of nerves and muscles and how long it takes for an electrical pulse to travel to the nerve and emit a response. It also tests the degree of numbness or loss of strength. EMG is useful to detect abnormal muscle electrical activity, muscle inflammation, pinched nerves, disc herniation, ALS.

Some patients say the test just feels uncomfortable and others say that it hurts a lot. There are needles involved but nothing is injected into the body. The needle electrodes are inserted into the testing areas. The nerves are stimulated by shooting an electric pulse through electrodes, then a measurement is taken on how long it takes for the muscle to feel the pulse and to what intensity. The pulse feels sort of like when you get an injection into a muscle. The test which can take from 30 to 60 minutes, can leave the patient a little sore for a day or two which is managed with an analgesic. Depending on the feedback the technician receives after each electric pulse, he/she can retest certain areas to get more conclusive results.

RESULTS: The test reveals whether a nerve is damaged. A velocity of 50 to 60 meters per second is considered normal. A damaged nerve will send a slower weaker signal. The Johns Hopkins site explains the procedure - before, during and after. The Healthline site explains the test and the results.

Blood Tests

Certain blood tests will be drawn to detect any vitamin deficiencies, diabetes, statin use, abnormal immune function, and kidney function.

Treatments for Peripheral Neuropathy

In most case, nerve damage is not curable but there are things you can do to help you get over the roughest times. There are treatments that can help your symptoms and there are things you can do to ward off permanent damage. However, the first step is finding out what is causing your peripheral neuropathy.


If your PN is due to diabetes, it can be controlled by regulating your blood sugars to a consistent level using diet, exercise, and medication.

Certain Medications

If a certain medication causes or worsens your PN, ask your doctor to change your medication.

  • There are medications that can be prescribed that will minimize nerve pain like analgesic pain relievers, antidepressants (like Effexor XR, Cymbalta, or Amitriptyline).

If your PN is less pain-oriented and tends to be a nuisance with leg or arm jumping or twitching (Restless Limb Syndrome), you can ask for a prescription called Requip or Mirapex (Pramipexole) which are Parkinson's drugs but they help tremendously to control Restless Limb Syndrome.

  • It takes about 7 days before you start seeing results with some patients but others have seen the medication kick in as soon as 48 hours.

As a topical, you can use Capsaicin Cream, Vicks Vapo-Rub or Icy Hot. These creams or gels trick your skin temperature by reversing a sensation - for example, to change your cold feeling to hot, your hot feeling to cold, or make a painful area feel the opposite of its present temperature.

Nutritional Deficiency

If your PN is due to a nutritional deficiency like low B-12 or B-6, talk to your doctor about stepping up your treatment.

  • Most people who are deficient have a damaged intrinsic factor (or lack it altogether). This factor is needed to digest and absorb B-12. By its absence, a daily 1000 mcg sublingual B-12 works like a charm.
  • I took 1000 mcg of sublingual B-12 for 3 months and my numbers increased from 15 (the lowest the doctor said he had seen in a long time) and my last blood test showed 601 for my B-12 values. My intrinsic factor is now healed and I went back to daily over-the-counter B-12 tablets.
  • If you know from a prior blood test that you are B-12 deficient, you need to know if your intrinsic factor is intact, so get a new baseline B-12 blood test. Then try taking regular over-the-counter B-12 tablets (1000 mcg) daily for one to two months, then get your blood tested again. If there is no improvement, it means you aren't assimilating the tablet form and probably need to start weekly injections or start taking daily sublingual B-12. Consult with your doctor.
  • Be sure to get periodic blood tests to check the vitamin concentration in your blood. If your doctor doesn't order them, remind him.

Alternative Medicine

Some patients have good results with using a TENS unit, undergoing hypnosis, meditation, acupuncture, biofeedback, and antioxidant vitamins.

Treatment: Warm and Cool Baths/Showers and Massage

If you have a whirlpool bath at your house, use it. It is the best and most enjoyable massage you can give your body.

You can take a teeming shower with your shower head set to the strength that you can tolerate.

Take a relaxing bath with scented or unscented Epsom salts, Lavender Essential Oil, Jasmine Essential Oil or softly scented bath bombs.

  • Essential oils are very concentrated so less is best. They are always used and measured in drops, so don't just pour into the bathtub. You should do a skin patch test if you are using one that you haven't used before. If you bought your scented Essential Oil already prepared in a ready-to-use formula, then it is good to go.
  • If you bought it as a base, then it needs to be diluted with a carrier oil. Basic blends are one fluid ounce of carrier oil to 18 drops of essential oil to make a 2% dilution.
  • If you have sensitive skin, start with less dilution and work your way up. Use one fluid ounce of carrier oil to 6 drops of Essential Oil. Apply a little to a small area of your forearm and wait 24 hours. If you see redness or experience itching or any kind of skin reaction, discontinue use and note that you can't tolerate that particular brand or scent.
  • If your skin tolerates the 1% dilution well, if you wish, you can move up to 2% dilution but don't dilute any more than 2% because the Essential Oil will lose its effectiveness and scent.
  • When your Essential Oil is to your preference, add 5 drops of Essential oil per bathtub full of warm water.

Treatment: Exercise

I know it might sound silly and it may not be practical to do in your bedroom, but if you can go to another part of your house, do it. If you don't want to take medication, you can wear yourself out by exercising to get rid of the leg jumps and twitches.

Here are some suggestions:

  • Walk in place for 500 steps then rest and do it again. Aim for a total of 30 minutes,
  • Walk up and down the steps ten times in 30 minutes. Take breaks if you get winded.
  • Use your Stair-Stepper or Treadmill for 30 minutes. Break every 10 minutes.
  • Work out the arm and leg jumps and arm and leg twitching with a hand-held massager so that the muscles get fatigued and allow you to go to sleep. If you wear out the muscles, they will relax more.
  • Topically, you can use Icy Hot or Vicks Vapo-Rub to fool your skin that there is a change in temperature in the room.

Treatment: Physical Therapy

For some patients who have PN due to a trauma or nerve compression, they report that physical therapy and water therapy relieved some of their pain and gave them more mobility.

  • A portable TENS unit has given some relief for short term while underlying causes are investigated.
  • A hand-held massager sold for home use is also helpful.

Prevention of Peripheral Neuropathy

It may seem like all you ever hear about is "do this and do that" to be healthy but it really is the key to managing various illnesses and disorders while still having a productive life.

The lifestyle choices you make can help delay onset, while some can even prevent your peripheral neuropathy from progressing.

Here are some suggestions:

  • Quit drinking alcohol
  • Quit smoking
  • Have regular medical checkups
  • Have your feet examined by a podiatrist at least once a year
  • Correct any vitamin deficiencies
  • Eating healthy
  • Maintaining good body weight,
  • Avoiding exposures to toxins, pesticides, and heavy metals
  • Exercise regularly

You can cheat once in a while on a dietary restriction, but don't let that "once in a while" become an every week habit.

Smoking and drinking alcohol causes cyanosis of limbs (they can change to gray or black) and damages nerves.

Avoid heavy metals, pesticides, toxins, air fresheners (solids and aerosols), hair dye, hair spray, bleach, home bug spray, any chemical that gives off fumes.

Check Out These Resources

American Diabetes Association

Thermal Testing Application

Healthline What Your EMG Results Mean

Johns Hopkins EMG Test in Detail


Mayo Clinic

The Foundation for Peripheral Neuropathy

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


awordlover (author) on June 21, 2019:

It appears you have the sensory PN.

Peripheral neuropathy is not only random, but it is also cyclical. Sometimes the cycles last a long time, and sometimes not so long. Since a cure is not possible, treatment is all that can be offered. I hope you can try some remedies in this article to get some relief. Thank you for sharing.

FlourishAnyway from USA on June 20, 2019:

I’ve had this since I was in my mid-30s and it’s awful. I can’t feel the difference among temperature, liquid, pain and other sensations in certain areas of my feet and get sharp shooting pains at random sometimes. Sometimes it is worse than others.