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What is peripheral neuropathy?

Peripheral neuropathy involves damage or dysfunction of the peripheral nerves, which extend from the central nervous system (the brain and spinal cord) to the rest of the body. These nerves transmit signals between the central nervous system, limbs, organs, and tissues. They control a wide range of functions, including motor coordination, sensation, and autonomic processes like blood pressure and sweating.

In peripheral neuropathy, the normal functioning of these nerves is disrupted. Depending on which type of peripheral nerve fibres are affected, the condition can impact the following functions:

  • Sensory nerves: sensory nerves transmit sensations such as touch, pain, temperature, and vibration. When these nerves are damaged, individuals might experience altered sensations, numbness, tingling, or pain, often described as stabbing, burning, or shooting pains.
  • Motor nerves: motor nerves control muscle movements. Damage to these nerves can lead to muscle weakness, cramping, and loss of coordination and balance. Muscle wasting (atrophy) may occur in severe cases, affecting the individual’s ability to perform everyday tasks.
  • Autonomic nerves: autonomic nerves regulate involuntary bodily functions, including heart rate, blood pressure, digestion, and temperature regulation. When these nerves are compromised, they can lead to a range of symptoms, such as abnormal blood pressure and heart rate, digestive issues, and problems with sweating and temperature regulation.


The condition can affect a single nerve (mononeuropathy), multiple nerves in different areas (multiple mononeuropathy), or many nerves throughout the body (polyneuropathy). Polyneuropathy is the most common form and usually affects the body symmetrically. For example, both feet or both hands are affected at the same time.

Peripheral neuropathy singapore
Peripheral neuropathy involves damage or dysfunction of the peripheral nerves, which can cause pain, numbness, and muscle weakness.

What causes peripheral neuropathy?

Peripheral neuropathy can be caused by various factors, often involving multiple contributors. Some of the common causes of peripheral neuropathy include:

Understanding the underlying cause of peripheral neuropathy is crucial for effective treatment and management.

What are the symptoms of peripheral neuropathy?

The symptoms of peripheral neuropathy can vary widely depending on the type of nerves affected (sensory, motor, or autonomic) and the severity and extent of the nerve damage. Common symptoms of peripheral neuropathy include:

  • Sensory symptoms:
    • Numbness or reduced sensation in the hands and feet, often described as a feeling of wearing gloves or socks when none are worn
    • Tingling, prickling, or burning sensations (paresthesia)
    • Sharp, throbbing, or burning pain
    • Increased sensitivity to touch or pain from stimuli that generally do not cause pain (allodynia)
    • Loss of coordination and proprioception, which can result in difficulties in balance and spatial awareness
  • Motor symptoms:
    • Muscle weakness in the affected limbs, which can lead to difficulty with movement
    • Muscle cramping and twitching (fasciculations)
    • Muscle atrophy, where muscles decrease in size and strength
    • Difficulty with fine motor tasks, such as buttoning clothes or writing
  • Autonomic symptoms:
    • Changes in blood pressure, leading to dizziness or lightheadedness, especially upon standing (orthostatic hypotension)
    • Abnormal sweating, either too much (hyperhidrosis) or too little (anhidrosis)
    • Gastrointestinal issues, such as diarrhoea, constipation, or incontinence
    • Urinary problems, including difficulty starting urination or completely emptying the bladder
    • Sexual dysfunction, such as erectile dysfunction in men or vaginal dryness in women
  • Other symptoms:
    • Foot deformities and ulcers, particularly in those with diabetic neuropathy, due to loss of sensation and poor blood flow
    • Changes in skin, hair, or nail appearance in the affected area
numbness peripheral neuropathy singapore
Numbness is a common symptom of peripheral neuropathy, resulting in reduced or absent sensation in the extremities, such as the hands and feet.

The presentation of peripheral neuropathy can vary from mild to severe and may progress gradually or suddenly, depending on the underlying cause. Early diagnosis and treatment are important to manage symptoms effectively and prevent further nerve damage.

Is peripheral neuropathy a painful condition?

Yes, peripheral neuropathy can be painful, especially when sensory nerves are affected. The type and severity of pain experienced can vary widely among individuals. Some common descriptions of the pain associated with peripheral neuropathy include:

  • Burning sensation: many people report a deep burning or searing pain, particularly in the feet or hands.
  • Sharp or shooting pain: some experience sudden, sharp pains that may feel like electric shocks.
  • Tingling and prickling: a feeling of “pins and needles,” similar to the sensation when a limb “falls asleep,” is common.
  • Throbbing pain: a pulsating, throbbing pain is another symptom some individuals report.
  • Increased sensitivity to touch: this is known as allodynia, where even light touch or pressure that would not usually cause pain becomes painful.
  • Numbness or a cold sensation: while numbness is not painful, it can be accompanied by a paradoxical cold or burning sensation.
peripheral neuropathy pain singapore
Peripheral neuropathy may cause burning, tingling, or stabbing sensations from damaged sensory nerves.

The pain from peripheral neuropathy can be constant or intermittent, and it can significantly affect the quality of life by impairing sleep, mobility, and daily activities. The intensity of the pain can also fluctuate based on factors like temperature changes, stress, and the time of day.

Who is at risk of peripheral neuropathy in Singapore?

In Singapore, the risk factors for peripheral neuropathy include:

  • Individuals with diabetes: the prevalence of diabetes in Singapore is significant, and diabetics are at a higher risk of developing diabetic neuropathy due to prolonged high blood sugar levels.
  • Older adults: the risk of peripheral neuropathy increases with age, as older individuals are more likely to have chronic conditions like diabetes and less likely to have optimal nutrient absorption, which can contribute to nerve damage.
  • People with autoimmune diseases: those with conditions such as lupus or rheumatoid arthritis are at higher risk due to the immune system attacking the body’s tissues, including nerves.
  • Alcohol abusers: excessive alcohol consumption can lead to poor nutrition and direct nerve damage, which may result in alcohol neuropathy.
  • Patients undergoing chemotherapy: individuals receiving cancer treatment in Singapore may develop neuropathy as a side effect of certain chemotherapy drugs, a condition known as chemotherapy-induced neurotherapy.
  • Individuals with certain infectious diseases: those who have or are at risk of infections that can affect the nerves, such as HIV or hepatitis, are at increased risk.
  • People with vitamin deficiencies: individuals with poor dietary habits that lead to deficiencies, especially in B vitamins, are at risk.
  • Individuals with a family history of neuropathy: hereditary factors can play a role, making those with a family history of neuropathy more susceptible.
vit b deficiency
A deficiency in Vitamin B increases the risk of peripheral neuropathy.

How is peripheral neuropathy diagnosed?

Diagnosing peripheral neuropathy involves a combination of methods to assess the function of the peripheral nerves and to identify the possible underlying cause. Diagnosis of peripheral neuropathy typically includes:

  • Medical history and physical examination: your pain specialist will start with a thorough medical history, including symptoms, lifestyle factors, exposure to toxins, family history of neurological diseases, and underlying conditions like diabetes. During the physical examination, they will check for muscle strength, reflexes, skin texture, ability to feel various sensations, and coordination.
  • Neurological examination: this focuses on nerve function and may involve tests of reflexes, muscle strength, muscle tone, sense of touch and vibration, and coordination.
  • Blood tests: these can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, and signs of autoimmune disorders or infections that could cause neuropathy.
  • Nerve conduction studies (NCS) and electromyography (EMG): NCS measures the speed and strength of electrical signals passing through the nerves, while EMG assesses the electrical activity in muscles. These tests help pinpoint the location and extent of nerve damage.
  • Imaging tests: magnetic resonance imaging (MRI) or computed tomography (CT) scans can identify herniated discs,tumours, or other conditions that might be compressing or damaging nerves.
  • Nerve biopsy: in rare cases, a small sample of a nerve might be removed and examined under a microscope to look for abnormalities.
  • Skin biopsy: this can be used to assess the number and condition of nerve endings in the skin.

These diagnostic tools help to determine not only the presence of peripheral neuropathy but also its cause, type, and extent, which is essential for developing treatment plans based on the individual’s specific condition.

What are the treatment options for peripheral neuropathy in Singapore?

Treatment for peripheral neuropathy focuses on managing the underlying cause if known, and alleviating symptoms to improve quality of life. Here are the treatment options for peripheral neuropathy:

  • Addressing the underlying cause:
    • If diabetes is the cause, controlling blood sugar levels is crucial.
    • Nutritional deficiencies might require dietary changes and supplementation.
    • Autoimmune conditions may be treated with immunosuppressive medications.
    • Infections causing neuropathy must be treated with the appropriate antibiotics or antiviral medications.
  • Medications for pain relief:
  • Physical therapy and rehabilitation:
    • Exercises to maintain muscle strength and flexibility can prevent muscle cramps and improve mobility.
    • Occupational therapy can help with coping strategies and adaptations for daily activities.
  • Lifestyle modifications:
    • Quitting smoking and reducing alcohol intake, as these can worsen nerve damage.
    • Eating a balanced diet rich in vitamins and minerals to support nerve health.
    • Regular exercise to improve overall nerve and muscle function.
  • Assistive devices: braces or orthotic devices can improve mobility and reduce the risk of injury.
  • Neuromodulation: May be suitable in selected individuals suffering from peripheral neuropathy, your pain specialist will do a thorough assessment and guide you through a personalised management plan.
physiotherapy for peripheral neuropathy.
Physiotherapy can help improve muscle strength, reduce pain, and enhance overall mobility in patients with peripheral neuropathy.

The effectiveness of these treatments can vary based on the individual and the specific cause of the neuropathy. Regular follow-up with your specialist is essential to monitor progress and make adjustments to the treatment plan as needed. If you are suffering from peripheral neuropathy, please schedule an appointment with us for a thorough diagnosis and an appropriate treatment plan.

Frequently asked questions

Peripheral neuropathy can lead to disability if it severely affects motor function, causes significant pain, or leads to complications like foot ulcers or falls, especially in severe or advanced cases.

The reversibility of peripheral neuropathy depends on the cause. For example, neuropathy caused by nutrient deficiencies or certain medications may improve with treatment, while damage from chronic conditions like diabetes may be irreversible.

Yes, peripheral neuropathy can affect the autonomic nervous system, leading to symptoms like irregular heartbeat, blood pressure changes, gastrointestinal issues, and problems with sweating and temperature regulation.

In severe cases, particularly with diabetic neuropathy, poor wound healing and infections can lead to ulcers and gangrene, sometimes necessitating amputation to prevent further spread of infection or tissue death.