Peripheral Neuropathy: Care Staff Guide to Nerve Damage

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, and it is one of the most common reasons that people develop numbness, tingling, burning pain and unsteadiness in their hands and feet. In care settings the consequences can be serious: unnoticed foot injuries, falls and persistent pain. This guide, based on NHS information, explains what peripheral neuropathy is, what causes it, how it is treated and how care and support staff can reduce the risks. It links to our guides on diabetic foot care and ulcer prevention and falls prevention in care homes.

What is peripheral neuropathy?

The NHS describes peripheral neuropathy as damage to the nerves, usually affecting the hands, feet and arms. It affects the nerves outside the brain and spinal cord. The NHS says it affects about 1 in 10 people aged 55 or over in the UK. There are different types. Polyneuropathy, the most common, usually starts in the feet and then spreads upwards and to the hands, while mononeuropathy affects one nerve and mononeuritis multiplex affects several.

Symptoms

The NHS lists these main symptoms:

• numbness or tingling in the feet or hands
• burning, stabbing or shooting pain
• poor balance and coordination
• muscle weakness, particularly in the feet

The symptoms are often constant but may come and go. Because the feet are usually affected first, a person may not feel a cut, blister or pressure point, which is why foot checks matter so much.

What causes it?

The NHS names several causes. The most common cause in the UK is diabetes, both type 1 and type 2. Other causes include a physical injury to a nerve, viral infections such as shingles, side effects of certain medicines and heavy alcohol use. In some people no cause is found. If you support someone with diabetes, our guide to diabetes care training for care home staff explains how good blood sugar management protects against complications.

Diagnosis and treatment

The NHS says a GP will review symptoms and may arrange tests, with a referral to a neurologist where needed. Earlier diagnosis helps to limit damage. Treatment depends on the symptoms and the cause, and the NHS notes that some causes cannot be treated.

• Treating the cause: for people with diabetes, this means better blood sugar control, and the NHS also mentions stopping smoking and drinking less alcohol.
• Nerve pain: the NHS says standard painkillers often do not work, and that medicines for neuropathic pain may be used instead.
• Weakness: physiotherapy and walking aids may help.

The outlook varies. According to the NHS, some cases improve while others are permanent or get worse.

Complications staff should know about

The NHS warns that, if left untreated, loss of feeling can lead to infected foot ulcers, which can lead to gangrene and possibly amputation. Where the nerves controlling the heart and circulation are affected, blood pressure treatment may be needed. These risks are the main reason for daily skin and foot checks and prompt reporting of any wound that is slow to heal.

Practical support for care staff

The NHS page does not set out detailed self-care steps, so the points below are general good practice and should be tailored to the individual care plan.

• Check feet regularly. Look for cuts, blisters, redness, swelling and changes in colour, and report them.
• Make sure footwear fits well. Poorly fitting shoes can cause damage that the person cannot feel.
• Test water temperature before baths and showers, because reduced sensation can lead to burns.
• Reduce falls risk. Poor balance and weakness are fall risks, so review the environment, walking aids and supervision.
• Take pain seriously. Neuropathic pain can be severe and disrupt sleep. Record how it affects the person and ask the GP to review treatment.
• Monitor medicines. Some medicines can cause neuropathy as a side effect. Report new symptoms to the prescriber.

When to get help

The NHS advises seeing a GP for pain, tingling or loss of feeling in the feet, balance problems or weakness, or a foot cut or ulcer that is not healing. It also recommends regular check-ups for people at high risk, such as those with diabetes. The page does not give emergency advice, so use NHS 111 for urgent concerns, and call 999 if the person is seriously unwell.

Frequently asked questions

Is peripheral neuropathy always caused by diabetes?

No. Diabetes is the most common cause in the UK, according to the NHS, but injury, infection, some medicines and heavy alcohol use can also cause it.

Can nerve damage be reversed?

It depends on the cause. The NHS says some cases improve, while others are permanent or worsen.

Why do normal painkillers not work?

The NHS says standard painkillers often do not help nerve pain, so different medicines may be used.

Where can staff build their knowledge?

Use the health and social care learning available through Learnsignal CPD to build your confidence in recognising the risks.

This article is general information for care staff, based on NHS information, and does not replace the advice of a person's own clinicians. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.