X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
Enter email and you're done. No subscription, no credit card.
Search, tap and you're done. Over 3,400 medicines.
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
At a glance
Record your tingling, your numbness and your tablets in brite, get reminded to take them, and arrive at your appointment with a clear overview. Free.
Weakness or paralysis that ascends rapidly over days is an emergency. It can point to Guillain-Barré syndrome — in that case call the emergency number 112 immediately.
In polyneuropathy, several peripheral nerves are damaged at the same time. The word comes from Greek: "poly" for many, "neuro" for nerve and "pathy" for disease — so a disease of many nerves. What is meant are the nerves outside the brain and spinal cord, which run through the whole body like a fine network of cables and carry signals in both directions.
These peripheral nerves have three jobs. The sensory fibres report touch, temperature, pain and the position of the joints to the brain. The motor fibres control the muscles. And the autonomic fibres regulate unconscious processes such as sweating, blood pressure, digestion and bladder function. Depending on which fibres are affected, very different symptoms arise — from tingling through muscle weakness to circulatory problems.
You can picture a nerve like an electrical cable: on the inside the conductor (the nerve fibre), on the outside the insulating layer (the myelin sheath). Polyneuropathy damages either mainly the fibre itself (axonal form) or the insulation (demyelinating form). The damage usually begins in the longest nerves — and those run to the feet. That is why the symptoms almost always start there and slowly travel upwards. Important to know: polyneuropathy is not a disease in its own right but the common end result of very many possible causes. Finding that cause is the key to treatment.
The characteristic hallmark of the most common polyneuropathy is its distribution pattern. Because the longest nerve fibres suffer first, the symptoms begin symmetrically on both feet and slowly spread upwards. Only when they reach roughly the level of the calves do the fingertips often join in as well. Doctors therefore speak of the stocking- and glove-shaped pattern: what is affected is exactly the area that a knee-high sock and a glove would cover.
This pattern is so typical that it already gives the doctor an important clue. It distinguishes polyneuropathy, for example, from a trapped nerve, which affects only a single area. Broadly, several forms can be distinguished:
| Classification | What is affected | Typical |
|---|---|---|
| Sensory | Sensation fibres | Tingling, numbness, burning, unsteady gait |
| Motor | Fibres to the muscles | Weakness, muscle wasting, stumbling |
| Autonomic | Autonomic fibres | Sweating disorders, circulation, digestion, bladder |
| Symmetrical (stocking/glove) | Longest nerves first, both sides | Most common form, e.g. with diabetes |
| Focal / asymmetrical | Individual nerves | Circumscribed deficits, other causes |
In practice these forms often overlap: with a diabetic neuropathy, for example, sensory and autonomic fibres are usually affected together. For you as someone affected, one thing above all matters — if symptoms begin symmetrically on both feet and slowly climb higher, that fits the classic picture well and should be assessed by a neurologist.
The symptoms usually develop slowly and insidiously over months to years. At the start there are almost always sensory disturbances in the feet, which many people initially do not take seriously. Typical is a mixture of irritative signs (something is felt too much) and deficits (something is missing):
If the autonomic nerves are affected too, less obvious symptoms are added: dizziness on standing up, altered sweating, digestive problems or disorders of bladder and sexual function. With diabetes in particular one symptom is especially treacherous — because of the numbness, small injuries to the feet are no longer noticed. A small stone in the shoe or a blister goes undetected and can develop into a poorly healing wound. That is why daily foot checks are a firm part of the treatment.
There are over a hundred possible causes of polyneuropathy — from metabolic disorders through deficiency states to medications. In Germany, however, two triggers are clearly at the top and together explain the majority of all cases:
Alongside these there are further important causes that are searched for specifically, because many of them are well treatable:
Despite a thorough search, in some of those affected the cause remains unclear at first — this is then called an idiopathic polyneuropathy. Even then the work-up is not in vain: it rules out dangerous and well-treatable causes and allows targeted pain therapy.
At the start there is the conversation and the neurological examination. Here the doctor specifically tests nerve function: sense of touch and temperature, the sense of vibration with a tuning fork, the reflexes (which at the feet are often the first to disappear) and muscle strength. This pattern alone gives important clues. Then follow two pillars — measuring nerve function and searching for the cause in the lab.¹,²
The aim of the diagnostics is always not to overlook the treatable causes. A detected vitamin B12 deficiency or a poorly controlled diabetes can be tackled specifically — and that can change the course decisively. That is why the work-up is worthwhile even when the symptoms seem minor at first.
The most important treatment of polyneuropathy does not start with the symptoms but with their cause. Because only if the triggering process is stopped can the progression of the nerve damage be slowed — and in favourable cases the nerves even partly recover. Which path is the right one depends entirely on what the diagnostics have found.¹
The rule therefore is: treating the cause and pain therapy run in parallel. The one protects the nerves from further damage, the other makes the current symptoms bearable. Here are the most important starting points depending on the trigger:
For inflammatory or autoimmune forms, special treatments are used that are steered in neurological centres. In addition, for many forms physiotherapy and regular exercise play an important role: they maintain muscle strength and coordination, improve steadiness of gait and thus prevent falls.
Nerve pain (neuropathic pain) feels different from normal pain — burning, electrifying, shooting. That is why the usual painkillers from the home medicine cabinet, such as Ibuprofen or Paracetamol, usually do not help here. Instead, active substances are used that originally come from other areas and specifically calm the overactive nerves.¹,²
Two things are important to know about all of them: the effect often only sets in after one to two weeks, and the dose is raised slowly (titrated up) to keep side effects small. So some patience is part of it. Here are the mainstay active substances:
Which active substance fits depends on other conditions, other medications and tolerability. Because different substances are combined here, a look at possible interactions is especially important.
brite reminds you of every tablet and documents how your symptoms develop — ready for the next doctor's appointment.
With a diabetic polyneuropathy in particular, consistent foot care is not an incidental piece of advice but a central part of the treatment. The reason: because of the numbness, pressure points, small wounds or a foreign body in the shoe are no longer felt. Unnoticed, poorly healing ulcers can develop from them — the most common cause of severe foot complications in diabetes. The good news: a large part of them can be avoided through simple daily habits.
Beyond the feet, a few more habits help in everyday life. Regular exercise and physiotherapy maintain strength and coordination. Because steadiness of gait suffers, it is worth removing trip hazards in the home and providing good lighting. And whoever notes down their symptoms and medications recognises changes earlier and has the best basis for decisions at the doctor's appointment.
Record in brite how tingling, numbness and pain develop — that way you recognise changes early and have everything together for the next doctor's appointment.
The common forms of polyneuropathy develop slowly over months and years. The course depends strongly on the cause: if a treatable trigger such as a vitamin B12 deficiency is corrected early or the blood sugar is well controlled, the progression can often be halted. Nerve function already lost returns only slowly and partly incompletely, because nerves regenerate at only a few millimetres per day. That makes it all the more important to act early.
Alongside the slow course there is, however, a rare, dangerous exception that you should know about — a rapidly progressing nerve damage:
Even apart from this emergency, the rule is: newly appeared or rapidly worsening weakness, increasing unsteadiness of gait with falls, a non-healing wound on the foot, or symptoms that clearly increase despite treatment should be assessed by a doctor promptly. With sudden one-sided deficits such as a drooping corner of the mouth, speech or vision disturbances, other causes such as a stroke must be considered — in that case likewise call 112 immediately.
Polyneuropathy is not treated in weeks but over a long time — with causal therapy, painkillers and daily foot care. That only works if it runs reliably and the symptoms stay in view. That is exactly where brite supports you.
