Peripheral Neuropathy (including Diabetic Neuropathy)

Peripheral neuropathy refers to disease or injury affecting peripheral nerves and may cause pain, altered sensation or weakness. It most commonly affects the feet and hands in a length-dependent pattern. Diabetes is an important cause, but other causes include chemotherapy, alcohol-related nerve injury, vitamin deficiencies, immune or infectious disorders, inherited neuropathies, nerve compression and idiopathic neuropathy.

The hallmark symptoms are burning, shooting or electric-like pain, along with numbness, tingling and heightened sensitivity to light touch or temperature changes, often in a symmetrical “stocking and glove” pattern affecting both feet or both hands. Symptoms are frequently worse at night and can significantly disturb sleep, and because sensation is reduced as well as painful, patients — particularly those with diabetes — are also at risk of unnoticed injury to the affected areas, making skin and foot care an important part of overall management.

Treatment involves identifying and managing the underlying cause where possible, together with evidence-based treatment for neuropathic pain such as duloxetine, pregabalin, gabapentin or selected tricyclic antidepressants. Foot and skin care are particularly important when protective sensation is reduced. Interventional treatments are considered selectively for focal neuropathic pain; spinal cord stimulation may be appropriate for carefully selected patients with refractory painful diabetic neuropathy or other specific neuropathic conditions.