Peripheral Neuropathy Explained by a Neurologist: Symptoms, Treatments & When to See a Specialist in Los Angeles

Peripheral neuropathy is a complex neurological condition affecting millions worldwide. If you're experiencing unexplained tingling, numbness, or pain in your extremities, you may be dealing with this challenging disorder. This comprehensive guide will explore the intricacies of peripheral neuropathy, helping you understand its various types, causes, symptoms, diagnostic methods, and treatment options.

Schedule a peripheral neuropathy evaluation with our neurologist today to discuss your symptoms and explore treatment options.

What is Peripheral Neuropathy?

Peripheral neuropathy is nerve damage affecting the peripheral nervous system—the network of nerves outside your brain and spinal cord that controls sensation, movement, and automatic body functions. When these nerves are damaged, you may experience numbness, tingling, burning pain, or weakness, typically starting in your hands and feet. The condition affects approximately 20 million Americans.

Types of Peripheral Neuropathy

Peripheral neuropathy is not a single condition but a term encompassing various types of nerve damage. Understanding these types can help in identifying and managing the condition:

Common types at a glance:

• Mononeuropathy – affects a single nerve (e.g., carpal tunnel syndrome)
• Polyneuropathy – affects multiple nerves throughout the body (most common form)
• Autonomic neuropathy – affects nerves controlling involuntary functions
• Sensory neuropathy – affects sensation (numbness, tingling, pain)
• Motor neuropathy – affects muscle movement and strength
• Small fiber neuropathy – affects small nerve fibers causing burning pain

1. Mononeuropathy

This type involves damage to a single peripheral nerve. Common examples include:

• Carpal tunnel syndrome: Compression of the median nerve in the wrist, often causing hand numbness
• Ulnar nerve palsy: Damage to the nerve passing near the elbow
• Radial nerve palsy: Often caused by injury to the upper arm
• Peroneal nerve palsy: Compression of the nerve near the knee, leading to foot drop

2. Polyneuropathy

Polyneuropathy affects multiple peripheral nerves throughout the body. It's the most common form of peripheral neuropathy and includes:

• Diabetic neuropathy: A complication of diabetes affecting multiple nerves
• Alcoholic neuropathy: Nerve damage due to excessive alcohol consumption
• Chemotherapy-induced peripheral neuropathy (CIPN): A side effect of certain cancer treatments
• Guillain-Barre syndrome: An acute inflammatory disorder causing muscle weakness and paralysis
• Chronic inflammatory demyelinating polyneuropathy (CIDP): An autoimmune disorder causing progressive weakness and impaired sensory function

3. Autonomic Neuropathy

This type affects the nerves controlling involuntary bodily functions, such as heart rate, blood pressure, digestion, and bladder control. It can lead to autonomic dysfunction symptoms like dizziness, constipation, and urinary problems.

4. Sensory Neuropathy

Sensory neuropathy impacts the nerves responsible for sensation, leading to symptoms like numbness, tingling, and pain.

5. Motor Neuropathy

This type affects the nerves controlling muscle movement, resulting in weakness, atrophy, and sometimes paralysis.

6. Small Fiber Neuropathy

Small fiber neuropathy involves damage to the small nerve fibers responsible for pain and temperature sensation. It can cause intense pain, burning, or tingling in the hands and feet.

Causes of Peripheral Neuropathy

Understanding the root cause of peripheral neuropathy is crucial for effective treatment. Here are some common causes:

1. Diabetes: The most frequent cause, affecting up to 50% of people with diabetes.
2. Autoimmune diseases: Conditions like lupus, rheumatoid arthritis, and Guillain-Barré syndrome can damage peripheral nerves. An autoimmune neurology evaluation can identify treatable inflammatory causes.
3. Infections: Certain viral or bacterial infections, including Lyme disease, shingles, HIV, and Hansen's disease (leprosy), can lead to neuropathy. Long Covid–related nerve symptoms have emerged as a significant post-viral cause of small fiber neuropathy.
4. Vitamin deficiencies: Lack of vitamins B1, B6, B12, and E can contribute to nerve damage.
5. Alcoholism: Excessive alcohol consumption can lead to nutritional deficiencies and toxic effects on nerves.
6. Trauma or pressure on nerves: Physical injuries or prolonged pressure on nerves can cause damage.
7. Medications: Some medications, particularly those used in chemotherapy, can cause peripheral neuropathy as a side effect.
8. Toxins: Exposure to heavy metals like lead and mercury, or industrial chemicals, can damage peripheral nerves.
9. Hereditary disorders: Conditions like Charcot-Marie-Tooth disease can cause inherited forms of neuropathy.
10. Tumors: Both cancerous and non-cancerous growths can press on nerves, causing damage.
11. Kidney and liver disorders: These can lead to imbalances that affect nerve health.
12. Vascular disorders: Poor blood flow can deprive nerves of oxygen, leading to damage.

Recognizing the Symptoms

Symptoms of peripheral neuropathy can vary depending on which nerves are affected. Common signs include:

• Gradual onset of numbness and tingling in hands or feet, which may spread upward
• Sharp, jabbing, or burning pain
• Extreme sensitivity to touch
• Muscle weakness or atrophy
• Muscle twitching and fasciculations from nerve irritation
• Loss of balance and coordination
• Heat intolerance and altered sweating patterns
• Digestive, bladder, or blood pressure problems if autonomic nerves are affected
• Changes in skin, hair, or nails
• In severe cases, breathing difficulties or organ failure

Diagnosing Peripheral Neuropathy

Diagnosing peripheral neuropathy involves a comprehensive approach:

1. Medical history review: Your doctor will ask about your symptoms, lifestyle, exposure to toxins, and family history.
2. Physical and neurological examinations: These assess muscle strength, reflexes, and sensitivity to touch and vibration.
3. Blood tests: To check for underlying conditions like diabetes, vitamin deficiencies, or abnormal immune function.
4. Imaging tests: MRI or CT scans may be used to look for tumors or other abnormalities pressing on nerves.
5. Nerve conduction studies and electromyography (EMG): These tests measure how well and how fast the nerves conduct electrical signals.
6. Nerve biopsy: In some cases, a small portion of a nerve may be removed and examined for abnormalities.
7. Small Fiber Skin biopsy: This can reveal a reduction in nerve endings in the skin, a sign of small fiber neuropathy.
8. Lumbar puncture: To analyze cerebrospinal fluid for signs of inflammation or infection.
9. Nerve Ultrasound: A non-invasive imaging technique to visualize nerve structure and detect compression or damage.

Treatment Options

While there's no cure for many forms of peripheral neuropathy, various treatments can help manage symptoms and prevent further nerve damage:

Addressing Underlying Conditions

• Managing blood sugar levels in diabetes
• Treating autoimmune disorders
• Correcting nutritional deficiencies
• Removing exposure to toxins or discontinuing problematic medications

Medications

• Pain relievers: Over-the-counter and prescription options to manage neuropathic pain
• Anti-seizure medications: Such as gabapentin and pregabalin, which can help with nerve pain
• Antidepressants: Certain types can help relieve pain and improve quality of life
• Topical treatments: Creams, gels, or patches containing capsaicin or lidocaine

Physical Therapy

• Exercises to improve strength, balance, and coordination
• Use of assistive devices like braces or orthopedic shoes
• Gait training to improve walking ability

Lifestyle Changes

• Regular exercise to improve circulation and overall health
• Healthy diet rich in vitamins and antioxidants
• Quitting smoking and limiting alcohol intake
• Proper foot care, especially for those with diabetic neuropathy

Alternative Therapies

• Acupuncture
• Massage therapy
• Transcutaneous electrical nerve stimulation (TENS)
• Alpha-lipoic acid supplements

Advanced Treatments

• Plasma exchange and intravenous immune globulin: For certain inflammatory conditions
• Surgical treatment: To relieve nerve compression in cases like carpal tunnel syndrome
• Nerve ablation: Using heat, cold, or chemicals to destroy nerves and reduce pain

Preventing Peripheral Neuropathy

While not all cases of peripheral neuropathy can be prevented, you can reduce your risk by:

1. Managing chronic conditions like diabetes effectively
2. Maintaining a healthy lifestyle with regular exercise and a balanced diet
3. Limiting alcohol consumption
4. Avoiding exposure to toxic substances
5. Taking steps to prevent repetitive motion injuries
6. Regular check-ups to catch and address potential issues early

Living with Peripheral Neuropathy

Peripheral neuropathy can be a challenging condition, but with proper management and care, many people lead fulfilling lives despite their symptoms. By working closely with our healthcare team and staying proactive about your health, you can minimize the impact of peripheral neuropathy on your daily life.

Peripheral Neuropathy Treatments in Beverly Hills & Los Angeles

At Achilles Neurology Clinic in Beverly Hills, we specialize in diagnosing and treating all forms of peripheral neuropathy. Dr. Achillefs Ntranos provides comprehensive evaluations for patients experiencing numbness, tingling, burning pain, or weakness in their hands and feet.

Our neuropathy services include:

• Comprehensive Neurological Evaluation: Thorough assessment of your symptoms, medical history, and nerve function to identify the type and cause of your neuropathy.
• Small Fiber Skin Biopsy: Gold-standard testing for small fiber neuropathy when standard nerve conduction studies come back normal but symptoms persist.
• Telehealth Consultations: Convenient virtual appointments for patients throughout California who need expert neuropathy care.
• Advanced Diagnostic Testing: EMG/nerve conduction studies, nerve ultrasound, blood work, and specialized testing to uncover the underlying cause.

We serve patients from across Los Angeles County, including Santa Monica, Pasadena, Glendale, and the greater Southern California region. Whether you're seeking a second opinion or starting your diagnostic journey, our concierge neurology practice offers the extended appointment times and personalized attention your complex condition deserves.

Frequently Asked Questions

Can peripheral neuropathy be reversed?

Yes, in some cases peripheral neuropathy can be reversed or significantly improved—particularly when the underlying cause is identified and treated early. Neuropathy caused by vitamin B12 deficiency, thyroid disorders, or certain autoimmune conditions often responds well to appropriate treatment. Diabetic neuropathy may stabilize or improve with better blood sugar control. However, long-standing nerve damage or neuropathy from irreversible causes (such as genetic conditions) may not fully reverse, though symptoms can often be managed effectively. The key is early diagnosis and prompt treatment. Learn more about neuropathy reversibility.

What is the life expectancy of someone with peripheral neuropathy?

Peripheral neuropathy itself does not typically shorten life expectancy. Most people with neuropathy live normal lifespans, especially when the condition is properly managed. However, outcomes depend significantly on the underlying cause. Neuropathy from well-controlled diabetes, vitamin deficiencies, or autoimmune conditions generally has an excellent prognosis. Neuropathy associated with more serious conditions (such as certain cancers or systemic diseases) may have different implications. The most important factors for long-term outcomes are identifying the cause, receiving appropriate treatment, and preventing complications like falls or foot injuries. Read our detailed guide on peripheral neuropathy life expectancy.

How do I know if I have peripheral neuropathy?

While self-diagnosis isn't recommended, common signs of peripheral neuropathy include:

• Gradual onset of numbness, tingling, or "pins and needles" in your hands or feet
• Burning, stabbing, or electric-shock-like pain
• Extreme sensitivity to touch
• Muscle weakness or difficulty with coordination
• Symptoms that worsen at night or spread upward over time

If you experience these symptoms, especially if they persist for more than a few weeks, it's important to consult our board-certified neurologist for proper diagnosis. Early evaluation can help identify treatable causes and prevent progression.

What's the difference between neuropathy and peripheral neuropathy?

Neuropathy is a general term for any nerve damage or dysfunction. Peripheral neuropathy specifically refers to damage affecting the peripheral nervous system—the nerves outside your brain and spinal cord that control sensation, movement, and automatic functions throughout your body. In everyday conversation and most medical contexts, these terms are used interchangeably. Other types of neuropathy include cranial neuropathy (affecting nerves in the head) and autonomic neuropathy (affecting nerves controlling involuntary functions).

What's the difference between peripheral neuropathy and multiple sclerosis?

Peripheral neuropathy and multiple sclerosis (MS) can cause similar symptoms like numbness and tingling, but they affect different parts of the nervous system. Peripheral neuropathy damages nerves outside the brain and spinal cord, while MS damages the central nervous system (brain and spinal cord). The diagnostic approach, treatments, and prognosis differ significantly. If you're uncertain which condition might be causing your symptoms, a comprehensive neurological evaluation can help distinguish between them. Compare peripheral neuropathy and MS in detail.

What causes neuropathy in feet?

Neuropathy affecting the feet (often called distal polyneuropathy) commonly starts in the feet because the longest nerves in the body are most vulnerable to damage. Common causes include diabetes, vitamin deficiencies (especially B12), excessive alcohol use, chemotherapy, autoimmune conditions, and hereditary disorders. In some cases, the cause remains unknown (idiopathic neuropathy). Learn more about neuropathy in feet, including symptoms, causes, and treatment options.

If you're experiencing symptoms of peripheral neuropathy or have concerns about your nerve health, don't hesitate to book a neuropathy evaluation in Beverly Hills. Early intervention can make a significant difference in managing this condition and preserving your quality of life. As a neurologist in Los Angeles specializing in nerve disorders, Dr. Ntranos provides comprehensive evaluations and personalized treatment plans for patients throughout Southern California.

About the Author

Dr. Achillefs Ntranos MD

Board-Certified Neurologist
Achilles Neurology Clinic

Dr. Achillefs Ntranos MD is a board-certified neurologist and MS specialist known for his thorough evaluations and compassionate approach. Originally from Greece, he trained at Johns Hopkins University and Mount Sinai Hospital before founding Achilles Neurology Clinic in Beverly Hills to deliver comprehensive, patient-centered neurological care. He specializes in MS, autoimmune neurology, neuropathy, headaches, and other neurological disorders, blending research-driven insights with personalized treatment plans.

Learn More About Dr. Ntranos(310) 774-7025