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Polyneuropathy: causes, symptoms and therapy

Last updated on: 12.09.2019
This text was written according to scientific standards and checked for accuracy by medical professionals.
For many weeks you have been tormented by unpleasant tingling in your hands and especially in your feet. In addition, there are numbness and often painful sensations. All of these symptoms can indicate a possible nerve disease or polyneuropathy. In this article, you can find out what this is all about and what health perspectives can be derived from it.

Polyneuropathy - at a glance

  • Polyneuropathy is a disease of related nerve fibers that supply the body outside of the brain and spinal cord. Feet, legs and hands as well as various internal organs such as the digestive system or the cardiovascular system are particularly affected.
  • In the majority of cases, it appears as a result of an underlying disease that has existed for a long time. The diabetes takes the foremost place.
  • At the beginning of treatment, the focus is on eliminating symptoms, followed by specific therapy for the cause of the disease. Although different types of polyneuropathy can heal, this unfortunately does not apply to the diabetic form.

What is polyneuropathy?

If several related nerve cords outside the brain and spinal cord do not function properly, a polyneuropathy is present. Nerve fibers have the task of correctly controlling individual parts of the body using nerve stimuli. Their division into three subgroups gives an easily understandable overview of how they work.
  • Nerve type 1: Control of the musculoskeletal system, such as hands, arms, legs and feet. This type of nerve is the motor or movement-controlling nerve
  • Nerve type 2: feeling and sensory perception. At the same time, this type of nerve informs the brain of all stimuli that the eyes and ears receive. This happens without any possibility of intervening here. That's why we forcibly scream, for example, when we hit the thumb instead of the nail while hanging up pictures
  • Nerve type 3: It consists of the autonomic or vegetative nerves that monitor the body's own operation. They are responsible for the internal organs such as the gastrointestinal tract or the cardiovascular system and also carry out their tasks independently of their will, i.e. autonomously. If there are disturbances or failures in nerve group 3, organ diseases of different severity are inevitable.
All types of nerve fibers are found in the peripheral nervous system. It links the entire organism from the scalp down to the little toe. The range of possible “network disorders” in polyneuropathy is therefore very large. It ranges from slight weaknesses in the feet to severe paralysis and organ diseases such as bladder weakness or even heart weakness.

Causes of a polyneuropathy

For the most part, polyneuropathy is not an independent disease, but rather a consequence of other diseases that have existed for a long time. It is considered the most common disorder of the peripheral nervous system in adults and is particularly evident in the second half of life.
Diabetics are often affected, around half of whom have long-term polyneuropathy. The second largest group are the chronically alcoholics. Cancer patients who had to undergo chemotherapy are also clearly exposed. In all three patient groups, sensory and movement disorders dominate the limbs, sometimes accompanied by pain. These three clinical pictures make up almost two thirds of all polyneuropathy patients.
In addition, there are around 200 other health disorders that can lead to polyneuropathy. These include poisoning, immune diseases, vitamin deficiencies and inherited complaints. Given this diversity, even specialists are not always able to determine the individual triggers. The result is then idiopathic polyneuropathy (idiopathic = without an identifiable cause) and affects roughly 20 percent of patients.

Chances of recovery in polyneuropathy

As a rule, polyneuropathies are not immediately threatening or life-threatening. In many cases, depending on the cause, there are good treatment options. At the beginning, the focus is on improving the symptoms, followed by therapy for the underlying disease. With this clinical picture, the cooperation of the patient is an essential factor for the overall success.
Even if polyneuropathies can heal from case to case, this unfortunately does not apply to the diabetic form. It is all the more important for diabetics to adhere to medical therapy guidelines and to implement the accompanying measures consistently so that the neurological sequelae remains under control.

Typical forms of polyneuropathy

Diabetic polyneuropathy

Polyneuropathy most commonly affects diabetics. The constantly high blood sugar (glucose) damages the myelin or insulating layer of the nerves. The result is weakened nerve impulses up to and including total failure. This is exactly why the correctly set blood sugar value plays such a big role.
Added to this is the poor blood and nutrient supply in the legs due to sugar or glucose. The entire tissue suffers, especially in the lower leg and foot area. Difficult-to-heal ulcers up to partial amputations are then inevitable in individual cases.

Alcoholic polyneuropathy

The second main cause of polyneuropathy is chronic alcohol abuse. Alcohol poisons the nerve cells and disrupts the conduction of stimuli. Above all, it affects arms and legs, which can no longer be moved safely.
In addition, alcoholics get a pronounced vitamin B1 deficiency due to the often very one-sided and sometimes poor diet, which inhibits nerve impulses. The therapy is based on abstinence from alcohol, the elimination of malnutrition and the administration of vitamin B1. The success of the healing process for this cause of the disease is heavily dependent on the cooperation of the patient.

Chemotherapy-induced neuropathies (CIN)

The third major cause of polyneuropathy is chemotherapy side effects. The drugs used, such as cisplatin, are cell toxins that not only attack diseased tissue. This often leads to increased paresthesia in the legs because the nerve tissue there also suffers from this cancer therapy.

Modern forms of nutrition with risk potential

Even if you are not affected by any of the underlying diseases mentioned so far, polyneuropathy can result from other factors. The key word here is a pronounced vitamin B12 deficiency. Strict vegans can be affected by this if they do not take additional vitamin B12 for a long time. Otherwise significant movement disorders and muscle loss are to be expected.

The role of stress

Long-term stress in private or professional life does not play a major role in the development of polyneuropathy, but it is therefore not insignificant. Because it can also lead to organic diseases such as gastrointestinal disorders or cardiovascular complaints, which then form the basis for later neuropathy. Stress as a direct trigger of a polyneuropathy, on the other hand, is rare, but never completely ruled out.

Hereditary factors

Polyneuropathy is one of the hereditary diseases. If one parent is affected, the disease can be passed on. But that is by no means always the case.

Symptoms of polyneuropathy

Emotional and movement disorders (sensorimotor polyneuropathy)

The typical symptoms of peripheral sensorimotor polyneuropathy are often bilateral. They are particularly evident in the musculoskeletal system and particularly affect feeling, safe movement and physical strength. The disorders usually spread upward from the toes, feet, and lower legs. The main restrictions are as follows:
  • Parasitic sensations such as tingling, burning, stinging, "pins and needles" or electrification
  • Frequently burning and boring pains at night, subsiding during the day when moving
  • Disturbed tactile, touch, pain and temperature perception
  • Furry feeling or numbness on the feet, legs, or hands
  • Disturbed balance and unsteady gait
  • Occasionally painful cramping muscles (calf, thigh, groin)
  • Lack of muscle reflexes, muscle weakness or muscle wasting
If you suffer from diabetes, it is particularly important to see a doctor in good time if symptoms of diabetic polyneuropathy arise. This is where the symptoms often begin slowly and inconspicuously, which can be very dangerous if left untreated.


The diagnosis begins with a series of questions from the doctor about the symptoms. In addition to the drugs used to date, lifestyle and occupation (predominantly sedentary work, for example as a driver) also play a role.
During the subsequent basic examination, the doctor checks various nerve stimuli, among other things
  • the achilles and hamstrings reflex,
  • the pain perception,
  • the vibration sensation,
  • the touch sensitivity as well
  • the temperature feeling.
The further examination steps are individual and range from the blood count to various apparatus-based examinations. These include the electromyogram (EMG, measures electrical muscle tension) and electroneurography (ENG, measures the nerve conduction speed). In particularly difficult individual cases, referrals can also be made to a specialist center.

Treatment of polyneuropathy

Medical therapy

The first step is to treat the symptoms with medication. The usual drugs such as ibuprofen, diclofenac or acetylsalicylic acid are only inadequate for nerve pain.
If the pain is worse, the doctor will prescribe drugs that he also uses for depression or epilepsy. Patience is required with these agents, because these products only work after about three weeks.
For some years now there has also been a herbal pain reliever for external outpatient use. It is a high-dose capsaicin patch (an active ingredient in chilli) that requires a prescription. About every second patient can benefit from it. The success of the treatment lasts for about three months, sometimes longer. The patch therapy can be repeated. Most health insurances cover the high costs of 350 euros per plaster.

Natural remedies, vitamins, homeopathy

In addition or as an alternative, the following active ingredients, which are available without a prescription, are considered medically useful. Some patients successfully use the dietary supplement alpha lipoic acid (thioctic acid). This is a natural substance partly produced by the body itself. Vitamin B1 (thiamine) is also considered useful. Both active ingredients promote the energy metabolism of the nerves and ensure that nerve currents are as trouble-free as possible. If you want to use these products, you should discuss the optimal dosage with your doctor in advance.
Anyone who has a positive attitude towards homeopathy can also attempt therapy with this product category. Aconitum in the potencies C3 and D4 would be suitable for neuralgic, burning or stabbing pain. Agaricus muscarius D6 and D12 are available for abnormal sensations such as pins and needles or numbness. Spigelia D6 and D12 are ideal for periodic nerve pain.

Physical methods and physiotherapy

These procedures range from electrical impulses to reduce pain with skin electrodes in the doctor's office (TENS or transcutaneous electrical nerve stimulation), through physiotherapy courses initiated by a doctor, to physiotherapy. In addition to combating pain, the treatment goals are strengthened muscles, better blood circulation and increased mobility.

Self-help and precaution

In the case of polyneuropathy, the patient's cooperation counts, although, unfortunately, quick solutions are not to be expected. You can only get ahead here with patience and perseverance.
  • First of all, it is important to consistently treat the underlying disease and, for example, if you are a diabetic, pay close attention to your blood sugar. In addition, accompanying medical foot care is advisable.
  • Second, anything that stimulates the peripheral nerves in the feet, legs, or arms is beneficial. The spectrum ranges from rubbing in nourishing ointments or creams (massage effect) through alternating baths to professional massages. Occupational therapy can also help to regain simple hand movements.
  • If you are not averse to physical activity, brisk walks, hiking, walking or cycling can help. This trains the muscles, coordination and gait security. Incidentally, this promotes general health and well-being.
  • If your diet is one-sided towards fast food and ready meals, the metabolism suffers and contributes to the development of neuropathy. You can take countermeasures with a balanced diet based on fresh products. Alcohol is not forbidden if it is a daily glass of wine or beer. However, you should refrain from smoking completely, as the nerves cannot speak well to nicotine.
  • In order to reliably supply your body with all nerve-relevant B vitamins in addition to the change in diet, you can also use dietary supplements. Every pharmacy has suitable products in stock as vitamin B complexes. However, the daily recommended consumption should be adhered to.
  • Berlit, P. (2013): Clinical Neurology. Jumper
  • Grehl, H./Reinhardt, F. (2012): Checklist Neurology. Thieme
  • Hacke, W. (2010): Neurologie.Springer
  • National Health Care Guideline (2011): Neuropathy in Adult Diabetes
  • Sommer, C./Geber,C./Young,P./Forst,R./Birklein,F./Schoser,B. (2018): Polyneuropathies - Causes, Diagnosis and Treatment Options. Dtsch Ärtzebl Int 115 (6), 83-90
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