Dealing with peripheral neuropathy can be challenging. It can cause tingling and numbness in the feet or tingling in the fingers and hands, which may result from chemotherapy-induced peripheral neuropathy (CIPN) or other medical conditions. In this video, I demonstrate exercises that can help alleviate neuropathic pain using sensory treatment at home, balance training, and peripheral neuropathy exercises.
Peripheral neuropathy is basically when you have damage to your peripheral nerves from either a trauma or disease. This can cause your hands and/or feet become numb and tingly. I’ll focus on the feet/legs for this video.
Peripheral neuropathy
Treatment for peripheral neuropathy may include treating any underlying cause or any symptoms you’re experiencing.
Treatment may be more successful for certain underlying causes. For example, ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse.
There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:
diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly
vitamin B12 deficiency can be treated with B12 injections or tablets
peripheral neuropathy caused by a medication you’re taking may improve if the medication is stopped
Some less common types of peripheral neuropathy may be treated with medication, such as:
corticosteroids – powerful anti-inflammatory medication
immunosuppressants – medications that reduce the activity of the immune system
injections of immunoglobulin – mixture of blood proteins called antibodies made by the immune system
However, the underlying cause may not always be treatable.
You may also require medication to treat any nerve pain (neuropathic pain) you’re experiencing.
Unlike most other types of pain, neuropathic pain doesn’t usually get better with common painkillers, such as paracetamol and ibuprofen and other medications are often used.
These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, because the ideal dose for each person is unpredictable. Higher doses may be better at managing the pain, but are also more likely to cause side effects.
The most common side effects are tiredness, dizziness or feeling “drunk”. If you get these, it may be necessary to reduce your dose. Don’t drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.
The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GP as it may be possible to change to a different medication that suits you better.
Even if the first medication tried doesn’t help, others may.
Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you’re given an antidepressant, this may treat pain even if you’re not depressed. This doesn’t mean your doctor suspects you’re depressed.
The main medications recommended for neuropathic pain include:
amitriptyline – also used for treatment of headaches and depression
duloxetine – also used for treatment of bladder problems and depression
pregabalin and gabapentin – also used to treat epilepsy, headaches or anxiety
There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below.
If your pain is confined to a particular area of your body and you can’t, or would prefer not to, take the medications above, you may benefit from using capsaicin cream.
Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain.
A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day.
Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment.
Don’t use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
This is a large sticking plaster that contains a local anaesthetic. It’s useful when pain affects only a small area of skin. It’s stuck over the area of painful skin and the local anaesthetic is absorbed into the skin that’s covered.
Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesn’t respond to other treatments your GP can prescribe.
Like all opioids, tramadol can be addictive if it’s taken for a long time. It will usually only be prescribed for a short time. Tramadol can be useful to take at times when your pain is worse.
Common side effects of tramadol include:
feeling sick or vomiting
dizziness
constipation
In addition to treating pain, you may also require treatment to help you manage other symptoms you’re experiencing as a result of peripheral neuropathy.
For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.
Other problems associated with peripheral neuropathy may be treatable with medication, such as:
constipation
the slow movement of food through your stomach (gastroparesis)
In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder.
Essential tremor
Essential tremor is a type of uncontrollable shake or tremble of part of the body.
Most people with essential tremor experience a trembling, up-and-down movement of the hands.
The arms, head, eyelids, lips and other muscles can also be affected. A tremor in the voice box (larynx) may cause a shaky voice.
Essential tremor is usually more noticeable when you’re trying to hold a position or do something with your hands, such as write. It doesn’t always affect both sides of the body equally.
Essential tremor is a common movement disorder affecting around four out of 100 adults over 40 years of age. Some people only have a mild tremor at first, which usually gets more severe over time.
Everyone has a very minor tremor when carrying out daily activities. For example, your hands will shake slightly when you hold them out in front of you. This is normal.
Sometimes, the everyday level of tremor can become more noticeable, particularly in older people. Noticeable tremor is also normal and it’s often caused by a raised level of adrenaline in the body, which can happen when a person is stressed, anxious or angry.
Essential tremor is more severe than normal tremor and it gradually gets worse over time. Eventually, the tremor may become so severe that carrying out normal, everyday activities can become difficult.
Certain things may temporarily increase any tremor, including:
tiredness caused by strenuous activity or lack of sleep
smoking
caffeine – from tea, coffee and some fizzy drinks
being very hot or cold
taking certain medicines – including some antidepressants and treatments for asthma
It’s important to visit your GP if you experience frequent or severe tremors.
Although there’s no specific test to diagnose essential tremor, your GP can carry out a physical examination and may request further tests to rule out other conditions (see causes, below).
They’ll also ask about your personal and family medical history as part of their assessment.
There’s no cure for essential tremor, but medicines can be used to help improve the symptoms in at least half of people with the condition.
In rare cases, a severe tremor may be treated with surgery if it doesn’t respond to medication.
Read more about treating essential tremor.
Essential tremor can run in families and research suggests it’s passed on by a faulty gene. At least half of people with the condition have a family member who also has it.
However, the age at which a tremor develops and its severity can vary greatly between different family members. Some people may also develop the faulty gene without inheriting it from either parent.
There are a number of conditions which may cause tremor, including:
overactive thyroid (hyperthyroidism)
Parkinson’s disease, a long-term condition affecting the way the brain co-ordinates body movements
multiple sclerosis, a condition of the central nervous system (brain and spinal cord) affecting the senses and the body’s actions
dystonia, a range of movement disorders which cause involuntary muscle spasms
stroke, which very rarely may result in tremor with few other symptoms
peripheral neuropathy, where the peripheral nervous system is damaged
A tremor can also be one of the withdrawal symptoms for people who are dependant on alcohol and have stopped or reduced their alcohol intake.
Ways to manage chronic pain
Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly.
The main types of peripheral neuropathy include:
sensory neuropathy – damage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain
motor neuropathy – damage to the nerves that control movement
autonomic neuropathy – damage to the nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure
mononeuropathy – damage to a single nerve outside of the central nervous system
In many cases, someone with peripheral neuropathy may have more than one of these types at the same time.
A combination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy).
The symptoms of the main types of peripheral neuropathy are described below.
Symptoms of sensory neuropathy can include:
prickling and tingling sensation in the affected body part (pins and needles)
numbness and less of an ability to feel pain or changes in temperature, particularly in your feet
a burning or sharp pain, usually in the feet
feeling pain from something that should not be painful at all, such as a very light touch (allodynia)
loss of balance or co-ordination caused by less ability to tell the position of the feet or hands (sensory ataxia)
Symptoms of motor neuropathy can include:
twitching and muscle cramps
muscle weakness or paralysis affecting one or more muscles
thinning (wasting) of muscles
foot drop – difficulty lifting up the front part of your foot and toes, particularly noticeable when walking
Damage to the autonomic nerves can result in a wide range of symptoms depending on where in the body the damage occurs.
Symptoms of autonomic neuropathy can include:
constipation or diarrhoea, particularly at night
feeling sick, bloating and belching
low blood pressure (postural or orthostatic hypotension), which can make you feel faint or dizzy when standing up
rapid heartbeat (tachycardia)
excessive sweating or a lack of sweating
problems with sexual function, such as erectile dysfunction in men
difficulty fully emptying your bladder of urine
bowel incontinence (loss of bowel control)
Depending on the specific nerve affected, symptoms of mononeuropathy can include:
altered sensation or weakness in the fingers
double vision or other problems with focusing your eyes, sometimes with eye pain
weakness of one side of your face (Bell’s palsy)
foot or shin pain, weakness or altered sensation
The most common type of mononeuropathy is carpal tunnel syndrome (CTS). The carpal tunnel is a small tunnel in your wrist.
In CTS, the median nerve becomes compressed where it passes through this tunnel, which may cause tingling, pain or numbness in the fingers.