Distinguishing Peripheral Neuropathy From Multiple Sclerosis

Despite both being neurological diseases, there are 4 main differences

There are over 100 types of peripheral neuropathy, according to the National Institute of Neurological Disorders and Stroke, and they are classified based on the type of nerve damage they cause.

For instance, some peripheral neuropathies affect only one nerve (called mononeuropathies) whereas others affect multiple nerves (called polyneuropathies). In addition, some peripheral neuropathies result from damage to nerve fibers whereas others result from damage to the myelin sheath (and others both).

While peripheral neuropathy shares a few common symptoms with multiple sclerosis (MS), like pain and abnormal sensations, it's important to understand these are completely different diseases.

Let's take a closer look at four stark differences between peripheral neuropathy and multiple sclerosis.

Difference #1: Peripheral Nervous System Versus Central Nervous System

Peripheral Neuropathy

Peripheral neuropathy refers to nerve damage involving the peripheral nervous system, which is those nerves outside the brain and spinal cord. The damaged peripheral nerves malfunction and provoke abnormal sensations, pain, and numbness. These sensory abnormalities most commonly affect the feet, lower legs, and hands. Muscle weakness can also occur in people with severe or long-standing peripheral neuropathy.

Multiple Sclerosis

Unlike peripheral neuropathy, MS affects the central nervous system, which is comprised of the brain, optic nerve, and spinal cord. The nerves in the central nervous system sustain damage over time, which interferes with their ability to communicate with the peripheral nervous system. This damage can then cause abnormal sensations, pain, and numbness indistinguishable from that caused by peripheral neuropathy.

Muscle weakness also frequently develops with MS. In fact, muscle weakness develops more frequently and with greater severity than usually seen in peripheral neuropathy. 

Difference #2: Underlying Causes

Peripheral Neuropathy

Peripheral neuropathy encompasses a group of disorders with distinct underlying causes. While diabetes is the most common cause of peripheral neuropathy among Americans, many other health conditions may be the culprit. Some examples include:

  • Chronic kidney disease
  • Hypothyroidism
  • Some autoimmune diseases (for example, systemic lupus erythematosus or rheumatoid arthritis)
  • HIV infection
  • Herpes simplex virus infection
  • Toxins, such as lead, mercury, and heavy alcohol intake
  • Injury-related nerve damage
  • Alcohol abuse
  • Certain medications (for example, certain HIV medications and chemotherapies)

Multiple Sclerosis

While there are numerous types of peripheral neuropathy, there are only four types of MS, with the most common one being relapsing-remitting MS (RRMS). In RRMS, lesions occur in the brain and spinal cord, as a result of recurring inflammation. This inflammation stems from a person's immune system attacking the myelin sheath of certain nerves.

Difference #3: Diagnosis

Peripheral Neuropathy

Determining the cause of your symptoms and making a diagnosis begins with a complete medical history, including a careful review of all symptoms you've been experiencing. Next is a thorough physical with a complete neurological examination.

Depending on the outcomes of these initial assessments, if your doctor suspects a peripheral neuropathy, he may recommend additional testing that may include blood work, an MRI, and/or nerve tests, like an electromyography (EMG) and/or a  nerve conduction velocity (NCV) test. 

Multiple Sclerosis

For the diagnosis of MS, your doctor will also order an MRI, and he may perform a lumbar puncture. Bloodwork is also often done to rule out health conditions that can mimic that of MS.

Difference #4: Treatment

Peripheral Neuropathy

Once a diagnosis is made, you and your doctor will work together on a treatment plan. When treating peripheral neuropathy, your doctor will consider the underlying cause. For example, if diabetes is the culprit, then getting your blood sugar under control is a primary goal. 

If a medication or toxin is causing the side effect, removing or stopping the offending agent (if possible) is important.

The good news is that nerve fibers in your peripheral nervous system can regrow, so treating the underlying condition can improve (even cure, in some instances) a person's peripheral neuropathy. 

For the acute pain of peripheral neuropathy, your doctor may recommend one or more of the following medications:

  • Nonsteroidal anti-inflammatories (NSAIDs)
  • Certain antidepressants like Elavil (amitriptyline) or Cymbalta (duloxetine)
  • Certain anticonvulsants like Lyrica (pregabalin) or Neurontin (gabapentin)
  • Topical medications like topical lidocaine or capsaicin
  • Tapentadol (only for diabetic neuropathy)

Besides medication, other pain-alleviating therapies that may be advised, include:

  • Transcutaneous electrical nerve stimulation (TENS)
  • Complementary therapies like acupuncture or massage
  • Lifestyle habits (for example, smoking cessation, exercise, and regular foot care if you have diabetes)
  • Surgery—for certain peripheral neuropathies in which a single nerve is compressed (for example, carpal tunnel syndrome)

Multiple Sclerosis

The treatment of multiple sclerosis is two-fold, involving both a disease-modifying medication (to combat the inflammation of MS) and medications to help a person manage their unique symptoms.

For abnormal sensations in MS, your doctor may recommend some of the same medications used to treat the discomfort in peripheral neuropathy like Cymbalta (duloxetine) or Neurontin (gabapentin). 

If your neuropathy is part of an MS relapse or is particularly bothersome, your doctor may prescribe a short course of corticosteroids. 

A Word From Verywell

Although you may be tempted to delay seeing your doctor, nervous system symptoms should not be ignored. If you're experiencing symptoms that could be related to either peripheral neuropathy or MS, your doctor will do the necessary assessments to make the correct diagnosis. 

While you're waiting for your appointment date, it's helpful to keep a log of your symptoms so you can describe them in detail, along with any patterns in their occurrence, and any aggravating or provoking factors.

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  • National Institute of Neurological Diseases and Stroke. (2014). Peripheral Neuropathy Fact Sheet