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Neurology673 papers

Peripheral sensory neuropathy

Last edited: 4/16/2026

Overview

Peripheral sensory neuropathy involves dysfunction of one or more peripheral nerves, leading to sensory disturbances, pain, and motor deficits. It can result from various etiologies including nutritional deficiencies, toxic exposures, and systemic diseases 89101114222833394950556372.

Diagnosis

  • Clinical Presentation: Sensory deficits, pain, and motor impairment 1528335063.
  • Electrophysiological Tests: Nerve conduction studies and electromyography (EMG) to assess nerve function 1621223271.
  • Laboratory Tests: Blood tests for vitamin levels (B1, B6, B12, folate), metabolic markers, and toxic exposures 8911142233395063.
  • Nerve Biopsy: In cases where diagnosis remains unclear, nerve biopsy can provide histopathological evidence 3972.

    • Management

  • Address Underlying Cause: Treat or manage the primary condition (e.g., vitamin supplementation, discontinuation of toxic agents) 8911142233395063.
  • Symptomatic Relief:
    • - Pharmacotherapy: - Anticonvulsants: Gabapentin, pregabalin (doses vary; consult specific guidelines) 2173051. - Tricyclic Antidepressants: Amitriptyline (dose typically 10-25 mg/day) 2173051. - Topical Agents: Capsaicin patch (8% w/w) for pain relief 1730. - Other Therapies: - Physical Therapy: To maintain function and mobility 1233. - Electrophysical Modalities: Transcutaneous electrical nerve stimulation (TENS) and other modalities for pain management 1533.
  • Non-Pharmacological Approaches:
    • - Exercise: Beneficial in improving neuropathic symptoms and functional capacity 1233. - Psychological Support: Addressing emotional processing and psychological impact 521.

    Special Populations

  • Pregnancy: α-Lipoic acid supplementation may be considered for neuropathic pain with caution 36.
  • Elderly: Increased prevalence and complexity of underlying causes; careful assessment and management of multiple comorbidities 2533.
  • Comorbidities: Specific attention to drug-induced neuropathies (e.g., statins, amiodarone) and nutritional deficiencies 4974.

    • Key Recommendations

  • Identify and Treat Underlying Causes: Address nutritional deficiencies (B vitamins, folate) and discontinue toxic exposures (e.g., pyridoxine toxicity) (Evidence: Strong 8911142233395063).
  • Use Evidence-Based Pharmacotherapy: Employ gabapentin, pregabalin, or amitriptyline for pain management, with dosing guided by clinical guidelines (Evidence: Moderate 2173051).
  • Incorporate Non-Pharmacological Interventions: Utilize physical therapy and exercise to enhance functional outcomes and quality of life (Evidence: Moderate 1233).
  • Monitor and Manage Comorbid Conditions: Pay special attention to drug-induced neuropathies and nutritional status in elderly patients (Evidence: Moderate 4974).

    • References

    1 Patel PS, Battenberg A, Wetmore E, Jin MF, Devalapalli A. Ischemic monomelic neuropathy as a consequence of intraoperative in-sheath thrombosis. The journal of vascular access 2026. link 2 Howard P. HCN channels: novel therapeutic targets for peripheral neuropathic pain. BMJ supportive & palliative care 2025. link 3 van Hunsel F, Scholl J, Vrolijk M, Ekhart C. Impact of Regulatory Action on Dose Maximalization for Vitamin B6 Dietary Supplements on the Reporting Pattern for Neuropathy. Pharmacoepidemiology and drug safety 2025. link 4 Liang C, Zhang X, Zhou L, Zhang W, Liang L, Xiao D et al.. Peripheral neuropathy associated with immunomodulatory drugs: a pharmacovigilance analysis based on the FDA adverse event reporting system database. International journal of clinical pharmacy 2025. link 5 Isoardo G, Adenzato M, Ciullo S, Fontana E, Stura I, Migliaretti G et al.. Emotion Processing in Peripheral Neuropathic Pain: An Observational Study. Medical sciences (Basel, Switzerland) 2024. link 6 Pourshahidi S, Shamshiri AR, Derakhshan S, Mohammadi S, Ghorbani M. The Effect of Acetyl-L-Carnitine (ALCAR) on Peripheral Nerve Regeneration in Animal Models: A Systematic Review. Neurochemical research 2023. link 7 Koop MA, Sleijser-Koehorst MLS, Hooijmans CR, Tdlohreg PQ, Lutke Schipholt IJ, Scholten-Peeters GGM et al.. The potential protective effects of pre-injury exercise on neuroimmune responses following experimentally-induced traumatic neuropathy: a systematic review with meta-analysis. Frontiers in immunology 2023. link 8 Kramarz C, Murphy E, Reilly MM, Rossor AM. Nutritional peripheral neuropathies. Journal of neurology, neurosurgery, and psychiatry 2023. link 9 Chen P, Song XJ. Vitamins in neuropathy: pathophysiological and therapeutic roles. Current opinion in neurology 2023. link 10 Cai Z, Finnie J, Manavis J, Blumbergs P. Avian riboflavin deficiency causes reliably reproducible peripheral nerve demyelination and, with vitamin supplementation, rapid remyelination. Human & experimental toxicology 2023. link 11 Muhamad R, Akrivaki A, Papagiannopoulou G, Zavridis P, Zis P. The Role of Vitamin B6 in Peripheral Neuropathy: A Systematic Review. Nutrients 2023. link 12 Streckmann F, Balke M, Cavaletti G, Toscanelli A, Bloch W, Décard BF et al.. Exercise and Neuropathy: Systematic Review with Meta-Analysis. Sports medicine (Auckland, N.Z.) 2022. link 13 Harnarayan P, Ramdass M, Islam S, Naraynsingh V. Comment on 'Achenbach syndrome in an older man'. Clinical and experimental dermatology 2022. link 14 Stein J, Geisel J, Obeid R. Association between neuropathy and B-vitamins: A systematic review and meta-analysis. European journal of neurology 2021. link 15 Bula-Oyola E, Belda-Lois JM, Porcar-Seder R, Page Á. Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis. PloS one 2021. link 16 Zhao D, Behzadian N, Yeomans D, Anderson TA. In Vivo Whole-Nerve Electrophysiology Setup, Action Potential Recording, and Data Analyses in a Rodent Model. Current protocols 2021. link 17 Freynhagen R, Argoff C, Eerdekens M, Engelen S, Perrot S. Progressive Response to Repeat Application of Capsaicin 179 mg (8% w/w) Cutaneous Patch in Peripheral Neuropathic Pain: Comprehensive New Analysis and Clinical Implications. Pain medicine (Malden, Mass.) 2021. link 18 Bouhassira D, Perrot S, Riant T, Martiné-Fabre G, Pickering G, Maindet C et al.. Safety and efficacy of an equimolar mixture of oxygen and nitrous oxide: a randomized controlled trial in patients with peripheral neuropathic pain. Pain 2021. link 19 Hadtstein F, Vrolijk M. Vitamin B-6-Induced Neuropathy: Exploring the Mechanisms of Pyridoxine Toxicity. Advances in nutrition (Bethesda, Md.) 2021. link 20 Ryan P, Kinirons P. Nutritional neuropathy postoesophagogastrectomy. BMJ case reports 2021. link 21 Liampas A, Rekatsina M, Vadalouca A, Paladini A, Varrassi G, Zis P. Non-Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review. Advances in therapy 2020. link 22 Calderón-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS neuroscience & therapeutics 2020. link 23 Yun S, Kim W, Kang MS, Kim TH, Kim Y, Ahn JO et al.. Neuropathological changes in dorsal root ganglia induced by pyridoxine in dogs. BMC neuroscience 2020. link 24 Löfgren A, Vihlborg P, Fornander L, Bryngelsson IL, Graff P. Nerve Function Impairment After Acute Vibration Exposure. Journal of occupational and environmental medicine 2020. link 25 Brisset M, Nicolas G. Peripheral neuropathies and aging. Geriatrie et psychologie neuropsychiatrie du vieillissement 2018. link 26 Jepsen JR. Studies of upper limb pain in occupational medicine, in general practice, and among computer operators
. Danish medical journal 2018. link 27 van Hunsel F, van de Koppel S, van Puijenbroek E, Kant A. Vitamin B. Drug safety 2018. link 28 Vollert J, Maier C, Attal N, Bennett DLH, Bouhassira D, Enax-Krumova EK et al.. Stratifying patients with peripheral neuropathic pain based on sensory profiles: algorithm and sample size recommendations. Pain 2017. link 29 Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G et al.. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 2017. link 30 Gálvez R, Navez ML, Moyle G, Maihöfner C, Stoker M, Ernault E et al.. Capsaicin 8% Patch Repeat Treatment in Nondiabetic Peripheral Neuropathic Pain: A 52-Week, Open-Label, Single-Arm, Safety Study. The Clinical journal of pain 2017. link 31 Carvalho AB, Garcia JB, Silva TK, Ribeiro JV. Translation and transcultural adaptation of Pain Quality Assessment Scale (PQAS) to Brazilian version. Brazilian journal of anesthesiology (Elsevier) 2016. link 32 Vollert J, Attal N, Baron R, Freynhagen R, Haanpää M, Hansson P et al.. Quantitative sensory testing using DFNS protocol in Europe: an evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects. Pain 2016. link 33 Ener BK, Uçankale H. Autonomic arterial neuropathy in lower limbs. International angiology : a journal of the International Union of Angiology 2015. link 34 Mercadante S. Topical amitriptyline and ketamine for the treatment of neuropathic pain. Expert review of neurotherapeutics 2015. link 35 Koike H, Takahashi M, Ohyama K, Hashimoto R, Kawagashira Y, Iijima M et al.. Clinicopathologic features of folate-deficiency neuropathy. Neurology 2015. link 36 Costantino M, Guaraldi C, Costantino D, De Grazia S, Unfer V. Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation. European review for medical and pharmacological sciences 2014. link 37 Ang CL, Foo LS. Multiple locations of nerve compression: an unusual cause of persistent lower limb paresthesia. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2014. link 38 Kwok T, Ting PT, Wong EK, Brassard A. Peripheral neuropathy for dermatologists: what if not diabetic neuropathy?. Journal of cutaneous medicine and surgery 2013. link 39 Weis J, Brandner S, Lammens M, Sommer C, Vallat JM. Processing of nerve biopsies: a practical guide for neuropathologists. Clinical neuropathology 2012. link 40 Dalla Torre C, Lucchetta M, Cacciavillani M, Campagnolo M, Manara R, Briani C. Reversible isolated sensory axonal neuropathy due to cobalamin deficiency. Muscle & nerve 2012. link 41 Grantz M. Unusual peripheral neuropathies. Part II: intrinsic reactive causes. Seminars in neurology 2010. link 42 Sprowson AP, Rankin K, Shand JE, Ferrier G. Common peroneal and posterior tibial ischemic nerve damage, a rare cause. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons 2010. link 43 Sekiyama S, Takagi S, Kondo Y. Peripheral neuropathy due to thiamine deficiency after inappropriate diet and total gastrectomy. The Tokai journal of experimental and clinical medicine 2005. link 44 Makkar RP, Arora A, Monga A, Gupta AK, Mukhopadhyay S. Burning feet syndrome. A clinical review. Australian family physician 2003. link 45 Hu W, Mathey E, Hartung HP, Kieseier BC. Cyclo-oxygenases and prostaglandins in acute inflammatory demyelination of the peripheral nerve. Neurology 2003. link 46 Smith EL, Whedon MB, Bookbinder M. Quality improvement of painful peripheral neuropathy. Seminars in oncology nursing 2002. link 47 Spicher C, Kohut G. Jean Joseph Emile Létiévant: a review of his contributions to surgery and rehabilitation. Journal of reconstructive microsurgery 2001. link 48 Huang J, Soliman I. Anaesthetic management for a patient with Dejerine-Sottas disease and asthma. Paediatric anaesthesia 2001. link 49 . Peripheral neuropathy due to statins. Prescrire international 2000. link 50 Bennett GJ. A neuroimmune interaction in painful peripheral neuropathy. The Clinical journal of pain 2000. link 51 Galer BS, Twilling LL, Harle J, Cluff RS, Friedman E, Rowbotham MC. Lack of efficacy of riluzole in the treatment of peripheral neuropathic pain conditions. Neurology 2000. link 52 Thömke F, Jung D, Besser R, Röder R, Konietzko J, Hopf HC. Increased risk of sensory neuropathy in workers with chloracne after exposure to 2,3,7,8-polychlorinated dioxins and furans. Acta neurologica Scandinavica 1999. link 53 Haines BL. Rehabilitation of the painful upper extremity. Hand clinics 1996. link 54 Lyons JB. Robert Graves and neurology: a bicentenary tribute. Journal of the Irish Colleges of Physicians and Surgeons 1996. link 55 Hedenmalm K, Spigset O. Peripheral sensory disturbances related to treatment with fluoroquinolones. The Journal of antimicrobial chemotherapy 1996. link 56 Mueller MJ, Sinacore DR, Hoogstrate S, Daly L. Hip and ankle walking strategies: effect on peak plantar pressures and implications for neuropathic ulceration. Archives of physical medicine and rehabilitation 1994. link90004-3) 57 Azulay JP, Blin O, Valentin P, Abegg P, Pellissier JF, Serratrice G. Regression of allopurinol-induced peripheral neuropathy after drug withdrawal. European neurology 1993. link 58 Dell PC, Guzewicz RM. Atypical peripheral neuropathies. Hand clinics 1992. link 59 Mata M, Fink DJ, Ernst SA, Siegel GJ. Immunocytochemical demonstration of Na+,K(+)-ATPase in internodal axolemma of myelinated fibers of rat sciatic and optic nerves. Journal of neurochemistry 1991. link 60 Oboler SK, Prochazka AV, Meyer TJ. Leg symptoms in outpatient veterans. The Western journal of medicine 1991. link 61 Wexler I. 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    Original source

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      Ischemic monomelic neuropathy as a consequence of intraoperative in-sheath thrombosis. — Patel PS, Battenberg A, Wetmore E, Jin MF, Devalapalli A The journal of vascular access (2026)
    2. [2]
      HCN channels: novel therapeutic targets for peripheral neuropathic pain. — Howard P BMJ supportive & palliative care (2025)
    3. [3]
      Impact of Regulatory Action on Dose Maximalization for Vitamin B6 Dietary Supplements on the Reporting Pattern for Neuropathy. — van Hunsel F, Scholl J, Vrolijk M, Ekhart C Pharmacoepidemiology and drug safety (2025)
    4. [4]
      Peripheral neuropathy associated with immunomodulatory drugs: a pharmacovigilance analysis based on the FDA adverse event reporting system database. — Liang C, Zhang X, Zhou L, Zhang W, Liang L, Xiao D et al. International journal of clinical pharmacy (2025)
    5. [5]
      Emotion Processing in Peripheral Neuropathic Pain: An Observational Study. — Isoardo G, Adenzato M, Ciullo S, Fontana E, Stura I, Migliaretti G et al. Medical sciences (Basel, Switzerland) (2024)
    6. [6]
      The Effect of Acetyl-L-Carnitine (ALCAR) on Peripheral Nerve Regeneration in Animal Models: A Systematic Review. — Pourshahidi S, Shamshiri AR, Derakhshan S, Mohammadi S, Ghorbani M Neurochemical research (2023)
    7. [7]
      The potential protective effects of pre-injury exercise on neuroimmune responses following experimentally-induced traumatic neuropathy: a systematic review with meta-analysis. — Koop MA, Sleijser-Koehorst MLS, Hooijmans CR, Tdlohreg PQ, Lutke Schipholt IJ, Scholten-Peeters GGM et al. Frontiers in immunology (2023)
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      Nutritional peripheral neuropathies. — Kramarz C, Murphy E, Reilly MM, Rossor AM Journal of neurology, neurosurgery, and psychiatry (2023)
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      Vitamins in neuropathy: pathophysiological and therapeutic roles. — Chen P, Song XJ Current opinion in neurology (2023)
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