Peripheral Neuropathy
Symptoms

The symptoms of peripheral neuropathy will depend on the types of nerves that are damaged. Many of the words used by your healthcare provider to describe some of the symptoms you may experience will be new to you. Ask your healthcare provider to explain what these words mean. Some of the words you may hear include the following:

• Paresthesias
• Dysesthesia
• Allodynia
• Hyperalgesia

Sensory nerves are the ones that are usually affected. Symptoms of sensory nerve damage include sensory loss, often described by patients as a sense of numbness. In most neuropathies, the symptoms begin in the most distal (furthest away from the center of your body) part of the longest sensory nerve fibers, which means the toes and feet. Patients with peripheral neuropathy affecting sensation complain of tingling, cold, prickling, pinching, burning, electric shocks, aching, or "pins and needles." This is called paresthesias. Sometimes, an unpleasant sensation occurs when something touches you or you touch something else. This is called dysesthesia. Sometimes, an object that usually does not cause discomfort or pain does so. This is called allodynia. An example would be that the sheets on your bed touching your feet feeling painful. You may notice that you have an increased awareness of pain. This is known as hyperalgesia. Some people develop what is called Lhermitte's sign, which is described as a sudden electrical shock like sensation down the spine as you flex your neck.¹²

Pain is a serious symptom for many patients who experience neuropathy. It may be described as a dull aching sensation, an intense burning sensation, or occasionally, as an intermittent shooting or electrical shock type of pain.

What is Position Sense?

One of the important roles of the peripheral nervous system is what is called position sense. Position sense is what allows your brain to know where your feet and hands are located. It helps you to know where your feet are in space. If you are diagnosed with peripheral neuropathy, you may notice problems such as your feet coming out of shoes that are not tied or may have trouble knowing the shape of an object in your hands.

What is Functional Ability?

Neuropathic pain can also cause damage to the motor nerves, which can cause some difficulties in your functional ability (your ability to move around well and do things that you usually do). As with sensory loss, weakness can begin in the toes, and as the neuropathy progresses, it moves up your legs to the knees and possibly above.¹, ¹² When you notice weakness in your knees, you may begin to notice weakness in your hands. Because of this weakness, you may find that you have trouble with walking, maintaining your balance, or with activities such as dressing yourself or brushing your teeth. You may find it difficult to button your clothes, to write, or hold an eating utensil because of the nerve damage to your fingertips. You may find that you are slapping your feet as you are walking. You may find that you are stumbling and falling when your toes catch on an uneven surface. You may find that you are dropping things. The changes in balance and walking can put you at greater risk for falls and injuries. Your healthcare provider may have you use a cane or walker to help you keep your balance and be safe when walking. It is always important to talk to your healthcare provider immediately if you are experiencing any of these symptoms.

Sometimes, the peripheral nerves that start from the nerves in the head (called cranial nerves) can be affected. This can result in cranial nerve palsies. Palsy is defined as a partial or full paralysis of a nerve. You might notice changes in your vision such as seeing double, or that one of your eye lids may droop. Drooping of the eyelid is known as ptosis. If the nerves that control your voice are affected, you may experience hoarseness or difficulty with speaking. If the nerve that controls your jaw is affected, then you may experience jaw pain.

The nerves that control the autonomic nervous system can be affected. The nerves of the autonomic nervous system control functions of the body such as blood pressure and bowel and bladder function. If these nerves are affected, you might experience dizziness because of a drop in your blood pressure, or constipation because your bowel movement is slowed, or problems with urination resulting in urinary retention. Other changes that can occur are a decrease or increase in sweating, or dryness of the eyes and mouth. This group of nerve fibers also controls blood flow to your legs and arms. You may notice that your legs get very warm, red, or swollen, or can become pale and cold. Your muscles in your legs may also become smaller over time. This is known as atrophy. Muscles require nerve innervation to stay strong and as the peripheral nerves are damaged and no longer innervate muscle, the muscle becomes smaller and weaker.