Polyneuropathy – Symptoms & Treatment

Polyneuropathy is a disease of the peripheral nervous system. This includes all nerves located outside the central nervous system (brain and spinal cord). Depending on its course and severity, polyneuropathy (also called peripheral polyneuropathy or peripheral neuropathy (PNP)) can have serious consequences. This makes it all the more important to recognize it as early as possible and treat it accordingly. In this article, we inform you about possible symptoms of polyneuropathy and treatment options.

The respective symptoms of polyneuropathy depend on which nerves are damaged. A distinction is made between motor, autonomic and sensory nerves: motor nerves are responsible for muscle contractions, while autonomic nerves control digestion and breathing. Sensory nerves, on the other hand, are responsible for sensing touch, pressure, temperature and vibration.

Symptoms When Motor Nerves Are Affected:

Damage to the motor nerves, which carry commands from the brain to the muscles, results in a decrease in muscle strength because the tissue can no longer be sufficiently activated. Possible consequences are:

• Muscle twitching

• Muscle cramps

• Muscle weakness

• Muscle paralysis

• Muscle wasting

Symptoms When Autonomic Nerves Are Affected:

The autonomic (or vegetative) nerves control the function of the heart, lungs, stomach, intestines, bladder and sexual organs. They cannot be controlled voluntarily. Depending on the organ affected, damage to the autonomic nerves can have serious to life-threatening consequences:

• impaired sweat secretion

• sensitivity to glare

• digestive complaints

• problems urinating

• impotence

• insufficient nutrient supply to tissue (skin, joints, bones)

• cardiac arrhythmias

• respiratory arrest

Symptoms When Sensory Nerves Are Affected:

Sensory nerves run from the skin to the brain and inform it about touch, temperature and pain stimuli, vibrations or pressure. If these nerves are damaged by polyneuropathy, the ability to perceive sensations in the extremities decreases. Sensory disturbances are the most common forms of polyneuropathy. Possible symptoms:

• abnormal sensations (of warmth and cold)

• tingling

• burning

• stabbing pain

• numbness

• unsteady gait due to coordination problems

• impaired temperature perception

• impaired pain perception

The last two symptoms carry a high risk of injury. 

Symptoms in Diabetes

The symptoms of diabetes-related polyneuropathy usually develop gradually and are noticeable at first especially at rest and at night. The sensory nerve fibers are usually damaged first, which manifests itself, for example, as numbness or tingling in the legs. In addition, those affected often suffer from burning feet syndrome, i.e. burning pain in the feet. In this form of polyneuropathy, however, pain perception is impaired, so that small injuries often go unnoticed. Because blood circulation is impaired in diabetes, there is a risk that poorly healing wounds will develop and that affected tissue may even die. In people with diabetes, polyneuropathy usually affects both feet or legs. In addition, progressive polyneuropathy can also spread to the autonomic nerves, which can lead to

• swallowing disorders

• vomiting

• diarrhea

• constipation

• incontinence and erectile dysfunction.

Symptoms in Alcoholism

Alcoholic polyneuropathy, which usually progresses slowly, is also widespread. Occasionally it runs its course without symptoms, but most of those affected suffer from nerve disorders in both legs, which manifest themselves among other things through:

• abnormal sensations

• sensory disturbances

• pain

• muscle wasting

• severe muscle slackening

With the latter, so-called paresis, those affected are often no longer able to stand properly. In particularly severe cases of alcoholic polyneuropathy, symptoms can also occur in the eye area:

• pupil disorders

• paralysis of the eye muscles

Treatment Options

The treatment of polyneuropathy depends on the respective cause. Where possible, the cause of the disease is therefore eliminated or treated as part of causal therapy. Targeted treatment of the effects is referred to as symptomatic therapy. If another underlying disease has caused the nerve damage, this disease must be addressed first. In diabetic polyneuropathy, for example, it is very important that your blood sugar level is optimally controlled in the long term. If levels are elevated, a slow reduction of blood sugar is recommended. If necessary, a change in lifestyle with weight reduction and plenty of physical activity is advised. By the way, people with diabetes – and all people with polyneuropathy in general – should only consume very small amounts of alcohol!

Supportive Care: Pain Therapy

Painkillers: Many people with polyneuropathy suffer from burning nerve pain. This is often treated with painkillers such as paracetamol or aspirin (ASA). For particularly severe pain, opioids are also used. However, these have the major disadvantage that they can be addictive and their effect diminishes over time.

Antiepileptic drugs: Anticonvulsants are used to make the nerve cells less sensitive in polyneuropathy. This leads to a reduction in nerve pain.

Antidepressants: Taking mood-lifting medication inhibits the transmission of pain signals to the spinal cord. Although this does not lead to complete freedom from pain, it does lead to pain relief. Opioids, antiepileptic drugs and antidepressants all require close monitoring by the treating physician.

Physical therapy: This form of therapy is often used for motor and sensory nerve damage. It aims to maintain the mobility of people with polyneuropathy despite the existing pain. Among other things, contrast baths, warm/cold wraps, electrical treatment of paralyzed muscles, water aerobics and occupational therapy as well as physiotherapy are used. The latter includes, among other things, exercises that train balance and coordination and contribute to improved stability when standing and walking.

Electrical stimulation therapy: The effectiveness of so-called transcutaneous electrical nerve stimulation (TENS) has not been scientifically proven. In some patients with polyneuropathy, painful areas of skin are treated with gentle electrical impulses. It is assumed that these impulses release pain-relieving messenger substances. If the nerve pain is very pronounced, it can be helpful to be treated by a trained pain therapist who specializes in the treatment of chronic pain.

Other Important Treatment Methods:

Vitamin therapy: A pronounced vitamin deficiency can be found particularly in diabetic and alcohol-related polyneuropathy. Therefore, vitamin B12 is administered in diabetic polyneuropathy and vitamin B1 in alcoholic polyneuropathy. Many experts also recommend the administration of further vitamin groups.

Antibiotics: In polyneuropathy caused by infections, antibiotics are used.

Abstinence: In the case of alcohol-related polyneuropathy, it is necessary to abstain from alcohol completely. In drug-induced polyneuropathy, the medication in question must be discontinued or replaced. In the case of toxic polyneuropathy, the triggering toxins and heavy metals should definitely be avoided.

Orthopedic aids: If the patient with polyneuropathy has problems walking, standing or lifting the feet, peroneal splints, special shoes, walking aids and support stockings can be used.

Acupuncture: Whether and how acupuncture affects the nerves is still unclear. However, thermal imaging cameras show that the treated areas are better supplied with blood during acupuncture. In addition, acupuncture is also being studied in polyneuropathy caused by cancer drugs; the treatment of cancer belongs in the hands of physicians. However, a prerequisite for acupuncture treatment in polyneuropathy is that the nerves are still intact enough for the patient to feel the needles. Many of the therapies mentioned above have to be carried out over the long term. In addition, a number of outpatient services have to be paid for by the patients themselves.

Chances of Recovery from Polyneuropathy

The prospects of recovery from polyneuropathy depend largely on when the disease is detected. The earlier a diagnosis is made, the more likely it is that the trigger can be eliminated. Unfortunately, polyneuropathy often progresses gradually and almost without symptoms, or initial complaints are not taken seriously. If the disease is already well advanced at the time of diagnosis, the existing nerve damage is often irreparable. But even if a complete recovery is no longer possible, further nerve damage can be prevented and symptoms improved with appropriate treatment. A healthy lifestyle plays an important role here: avoiding stimulants such as alcohol and tobacco, appropriate physical activity and a balanced diet can contribute considerably to your well-being. And last but not least, it is important to deal with this serious illness as positively as possible!

What We Can Do for You

We would like to advise and support you as best we can. With regard to polyneuropathy, we offer you – in addition to treatment by your physician – advice and support on the following topics:

• Alcohol withdrawal

• Smoking cessation

• Questions about a balanced diet

• Questions about health-promoting exercise

• Dealing with anxiety

• Dealing with stress

• Relaxation methods

More articles on polyneuropathy:

Polyneuropathy – Causes & Diagnostics

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