Peripheral Neuropathy

The body’s nervous system comprises the central nervous system (CNS) which includes the brain and spinal cord, and the peripheral nervous system (PNS). The PNS controls sensation, muscle movement, and involuntary (autonomic) functions such as circulation, digestion and bladder control.¹

Damage to the peripheral nerves conveying sensory information to the brain and signals from the brain to the muscles for movement, results in peripheral neuropathy. Although anatomically part of the PNS, damage to the nerves controlling autonomic functions is referred to as Autonomic neuropathy.

In Africa, peripheral neuropathy is common, especially among people with diabetes: a systematic review estimated that nearly 46% of people with diabetes have diabetic peripheral neuropathy (DPN).² In South Africa, a clinic-based study found about 30% of adults with diabetes reported neuropathic pain.³

Symptoms depend on which nerves are affected — sensory, motor or autonomic.¹

Sensory symptoms

• Numbness, tingling, or “pins and needles.”¹
• Burning, stabbing or shooting pain (often worse at night).¹
• Increased sensitivity to touch or reduced sensitivity.¹
• Reduced sensation in the hands and feet, where gloves and socks fit or feeling as if wearing socks/gloves when you are not.¹ Injuries/wounds to feet/effected areas without feeling pain.

Motor symptoms

• Weakness, cramps or twitching.⁴
• Difficulty walking, foot‑drop.⁴
• Muscle wasting.⁵

Autonomic symptoms

• Digestive, bowel or bladder problems.¹
• Changes in sweating or heat intolerance.⁶
• Blood pressure fluctuations, dizziness, or heart‑rate changes.⁵

Symptoms often begin in the feet before progressing upward.¹

Peripheral neuropathy has many possible causes. Common contributors include:¹

• Diabetes — the most common cause. High blood sugar damages small blood vessels that nourish nerves.⁷
• Vitamin deficiencies (especially B‑12).¹
• Alcohol misuse, which worsens nutritional deficiencies and damages nerves.⁴
• Infections, including HIV.⁸
• Toxins and medications — e.g., chemotherapy, some antibiotics, heavy metals or industrial chemicals.¹
• Injury or nerve compression from trauma, repetitive motion or surgery.¹
• Other medical conditions — thyroid, liver and kidney disease; autoimmune disorders; genetic conditions.¹

Sometimes no cause is found (idiopathic neuropathy).¹

Diagnosis begins with a full history and neurological exam assessing sensation, strength, reflexes and balance.⁹

Additional tests

• Blood tests — check glucose, B‑12, metabolic and organ function.⁹
• Imaging — MRI or CT if structural causes are suspected.⁹
• Nerve function tests — nerve conduction studies or EMG.⁹

People with chronic conditions (diabetes, HIV) should include neuropathy screening in routine care.

Treatment depends on the cause and severity.⁹

1. Address underlying causes

• Improve blood sugar control in diabetes.⁷
• Treat vitamin deficiencies.⁴
• Reduce exposure to alcohol, toxins or culprit medications (under medical supervision).¹

2. Medicines for nerve pain

• Anti‑seizure medicines such as Gabapentin or Pregabalin.⁹
• Antidepressants (e.g., Amitriptyline, Duloxetine).⁹
• Topical therapies (lidocaine creams/patches).⁹

3. Lifestyle and supportive therapies

• Regular exercise like walking, swimming or stretching.⁹
• Foot care: daily checks, proper shoes, avoid barefoot walking, moisturize but avoid wetness between toes.⁹  A family member or health care practitioner may need to inspect your feet, especially under the feet, or if you have poor vision (e.g. with diabetics) to ensure no unfelt injuries go unnoticed.
• Balanced diet, hydration, limit alcohol, stop smoking.¹

4. For weakness or balance issues

• Physiotherapy, braces or orthotic footwear to improve mobility and prevent falls.⁴

Seek medical care if you experience:

• Persistent numbness, tingling or burning.
• Weakness, difficulty walking or frequent falls.
• Foot wounds, blisters or ulcers (especially with diabetes).
• Digestive, bladder or bowel changes;
• Dizziness; heat‑intolerance symptoms.

Early diagnosis gives the best chance of slowing or preventing nerve damage.⁹

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.