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Peripheral neuropathy describes conditions that damage the nerves outside the brain and spinal cord. These nerves carry sensation, power muscles, and support automatic body functions like blood pressure and digestion. When they are injured you may notice numbness, tingling, burning pain, weakness, or balance problems. Some neuropathies affect a single nerve while others involve many nerves in a length dependent pattern that starts in the feet. The outlook depends on the cause and how quickly treatment begins.
Peripheral nerves are the communication lines between the brain, spinal cord, and the rest of the body.
Sensory nerves carry touch, temperature, and pain.
Motor nerves control movement and reflexes.
Autonomic nerves regulate heart rate, sweating, digestion, and bladder function.
Damage can involve one type or several at the same time and symptoms vary accordingly.
Many conditions can injure peripheral nerves. Understanding the cause guides treatment and may prevent progression.
Metabolic and nutritional
Diabetes is a leading cause. Prediabetes can also be involved. Low vitamin B12, thyroid disease, kidney or liver disease, and heavy alcohol use can contribute.
Immune and inflammatory
Autoimmune diseases, vasculitis, and rare inflammatory neuropathies may damage nerves.
Infections and toxins
Shingles, Lyme disease, HIV, and certain medications or toxins can cause neuropathy including chemotherapy. Long term exposure to heavy metals is another cause.
Inherited or idiopathic
Some neuropathies are genetic. In many adults a cause is not found even after careful testing.
Symptoms often begin in the toes and feet and may spread upward. Hands can be affected next. You might experience tingling, pins and needles, burning or electric shock like pain, reduced ability to feel temperature or vibration, muscle weakness, cramps, or loss of balance. Autonomic symptoms can include dizziness when standing, sweating changes, bowel or bladder issues, and sexual dysfunction. Pain can be constant or intermittent.
Your clinician will review your history and perform a focused neurologic exam. The pattern of symptoms and findings helps narrow the cause. Testing is tailored to look for treatable conditions and to define the nerve injury.
Initial lab tests
High yield screening tests commonly include a complete blood count, metabolic panel, kidney and liver tests, thyroid function, fasting glucose and A1C, vitamin B12 with methylmalonic acid when needed, and serum protein electrophoresis. Additional testing is based on clues from your history and exam.
Nerve function tests
Nerve conduction studies and electromyography can show how well nerves and muscles are working and help classify the type of neuropathy.
Skin biopsy for small fiber neuropathy
A small skin sample can measure epidermal nerve fiber density when small fiber symptoms are suspected and routine nerve tests are normal.
When imaging is used
Imaging is usually reserved for suspected nerve entrapment or other structural causes based on your exam. The diagnosis relies most on clinical findings and targeted tests.
An Understood Care advocate can help coordinate testing, explain results, schedule referrals, and keep your clinicians updated so your next steps are clear; call (646) 904-4027 or sign up at https://app.understoodcare.com/.
The best plan treats the underlying cause and manages symptoms. Many people improve or stabilize with the right steps.
Treat the cause
Improve blood sugar if you have diabetes. Correct vitamin deficiencies. Address thyroid, kidney, or liver disease. Review medications that can injure nerves and adjust when possible. Manage autoimmune or infectious causes with condition specific therapy.
Medications for nerve pain
Several medicine groups can reduce neuropathic pain. These include serotonin norepinephrine reuptake inhibitors such as duloxetine, tricyclic antidepressants such as amitriptyline, gabapentinoids such as gabapentin or pregabalin, topical capsaicin systems, and topical lidocaine in selected cases. Opioids are generally discouraged because risks outweigh benefits for most people with chronic neuropathic pain. Your clinician will match options to your health conditions and preferences.
Non medicine therapies
Physical therapy and exercise can improve strength, flexibility, and balance. Occupational therapy helps with daily activities and safety at home. Cognitive and behavioral strategies can support coping with chronic pain. Protecting your feet and wearing properly fitted shoes lowers the risk of injury.
Procedures for selected cases
For focal nerve entrapments or severe pain that does not respond to standard therapies, targeted procedures may be considered by specialists. Your care team will discuss risks and benefits. Cleveland Clinic
Protect your feet
Check feet daily for cuts, blisters, or pressure spots. Moisturize dry skin. Trim nails carefully. Wear cushioned, well fitting shoes and seamless socks. Ask your clinician about podiatry care if you have diabetes or reduced sensation.
Prevent falls
Keep walkways clear, add night lights, and consider a shower chair or grab bars if balance is affected. Physical therapy can provide balance and strength training.
Support healthy nerves
Eat a balanced diet with adequate B vitamins, limit alcohol, stop smoking, and stay active as tolerated. Manage blood sugar and blood pressure.
Track your symptoms
Keep a simple log of pain levels, triggers, and responses to treatments. Bring it to appointments to guide adjustments.
Seek immediate care if you develop sudden or rapidly worsening weakness, trouble breathing, difficulty walking, loss of bladder or bowel control, or widespread numbness. Sudden neurologic changes require timely evaluation.
If you are managing peripheral neuropathy, regular check ins with your clinician matter. Ask about specific goals for treating the cause, expected timelines for improvement, and options if pain is not controlled. Bring a current medication list and ask about interactions or side effects. If appointments feel rushed or complex, an Understood Care advocate can help you prepare questions, coordinate referrals and transportation, handle scheduling and communication, and follow up on next steps so nothing is missed. For support, call (646) 904-4027 or sign up at https://app.understoodcare.com/.
Many neuropathies improve when a cause is found and addressed early. Others stabilize with careful management. Even when nerves do not fully recover, most people can reduce pain and protect function through a mix of medical treatment, self care, and support.
This content is for education only and does not replace professional medical advice. If you have new weakness, severe pain, fever with confusion, chest pain, or trouble breathing, call emergency services.
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