Neuropathy care

Introduction

Peripheral neuropathy affects millions of people, often causing pain, numbness, or weakness in the hands and feet. Managing neuropathy effectively requires a combination of medical treatment, lifestyle adjustments, and supportive care. This guide outlines best practices, based on evidence and clinical guidance, to help you understand your options and take control of your health.

Understanding Peripheral Neuropathy

Peripheral neuropathy occurs when nerves outside the brain and spinal cord are damaged. Causes include diabetes, infections, chemotherapy, autoimmune diseases, and vitamin deficiencies. Common symptoms include:

• Tingling or numbness
• Sharp, burning pain
• Sensitivity to touch
• Muscle weakness

For more details, visit the Mayo Clinic’s Neuropathy Overview.

First-Line Treatments for Neuropathy

Medications

Doctors may prescribe:

• Gabapentin or Pregabalin (gabapentinoids) to calm nerve signals
• Duloxetine or Venlafaxine (SNRIs) for nerve pain and depression
• Amitriptyline or Nortriptyline (tricyclic antidepressants)

Each comes with potential side effects. Work closely with your doctor to monitor symptoms and adjust doses as needed. See NIH Neuropathy Medications Guide for more info.

Non-Drug Therapies That Work

Evidence supports several non-medication approaches for managing symptoms:

• Physical therapy to improve balance and muscle strength
• TENS (Transcutaneous Electrical Nerve Stimulation) for targeted pain relief
• Acupuncture and massage for reducing pain and stress
• Cognitive Behavioral Therapy (CBT) to manage pain perception and anxiety

Learn more at Cleveland Clinic: Neuropathy Management

Lifestyle and Home Remedies

• Foot care: Check feet daily for cuts or injuries to avoid infections.
• Exercise: Gentle routines improve circulation and mood.
• Nutrition: Get enough B vitamins and avoid alcohol.
• Supportive shoes and socks: Reduce pressure and friction.

Explore tips from Harvard Health Publishing.

Advocates and Support Services

Many patients benefit from ongoing support in navigating care, understanding medications, and accessing resources. A care advocate can:

• Coordinate with specialists
• Track your symptoms and progress
• Help you explore clinical trials or second opinions
• Support insurance appeals and coverage questions

Final Thoughts

Neuropathy can be life-altering, but with the right care and knowledge, it is manageable. Always consult a qualified provider before starting or changing treatment. Use reputable resources, track your symptoms, and advocate for the care you deserve.

FAQ

• What is peripheral neuropathy?
  Peripheral neuropathy happens when nerves outside the brain and spinal cord are damaged. These nerves control sensation, movement, and some automatic body functions. When they are injured or irritated, you may feel pain, numbness, tingling, or weakness, most often in the hands and feet.
• What are common symptoms of peripheral neuropathy?
  People often describe burning or sharp pain, tingling, pins and needles, numbness, sensitivity to touch, muscle weakness, or a feeling like walking on sand or cotton. Symptoms can be mild or severe and may affect balance and sleep.
• What causes peripheral neuropathy?
  Common causes include diabetes, infections, autoimmune diseases, chemotherapy, certain medications, vitamin deficiencies such as low B12, alcohol use, and sometimes spine or nerve compression. In some cases, no clear cause is found even after testing.
• How is peripheral neuropathy diagnosed?
  Clinicians usually start with a detailed history and physical exam, then may order blood tests, nerve studies, or imaging based on your symptoms. The goal is to find treatable causes, such as diabetes or vitamin deficiencies, and to understand which nerves are affected.
• What are first line medication options for neuropathy pain?
  Frequently used medicines include gabapentin or pregabalin to calm nerve signals, duloxetine or other SNRIs that help with nerve pain and mood, and tricyclic antidepressants such as amitriptyline or nortriptyline at low doses. Your clinician will choose a starting option based on your other conditions, current medicines, and likely side effects.
• What side effects should I watch for with neuropathy medicines?
  Common side effects can include drowsiness, dizziness, swelling in the legs, dry mouth, constipation, or sleep changes. Serious symptoms such as trouble breathing, chest pain, severe rash, confusion, or thoughts of self harm should be treated as urgent and reported right away. Always tell your clinician about any new or worsening symptoms.
• What non drug treatments can help with neuropathy?
  Physical therapy can improve strength, balance, and walking confidence. TENS units may provide localized pain relief for some people. Acupuncture, massage, and relaxation techniques can ease pain and stress. Cognitive Behavioral Therapy can help you cope with chronic pain and improve daily function.
• What lifestyle steps support neuropathy care?
  Daily foot checks, supportive shoes, and prompt care for any cuts or blisters help prevent infections. Gentle exercise supports circulation, strength, and mood. A balanced diet with adequate B vitamins and limited alcohol can protect nerve health, especially if diabetes or other medical conditions are present.
• When should I contact my clinician urgently?
  Seek urgent care if you notice new or rapidly worsening weakness, trouble walking, sudden loss of balance, signs of infection in the feet, severe or unusual pain, changes in bladder or bowel control, or signs of a severe medication reaction such as trouble breathing, swelling of the face or tongue, or a spreading rash.
• How can a healthcare advocate support someone with neuropathy?
  An advocate can help you track symptoms, organize your medication list, prepare questions for visits, and coordinate care among primary care, specialists, therapists, and pharmacies. They can also support insurance appeals, help explore clinical trials or second opinions, and connect you with physical therapy, foot care, and community resources.
• What is the big picture for living with peripheral neuropathy?
  Neuropathy can be life changing, but many people feel and function better with a combination of good condition control, the right medicines, movement and foot care, and steady follow up. Learning about your options, using reputable medical sources, and asking for help from clinicians and advocates can make the condition more manageable over time.

References

1. Mayo Clinic – Peripheral Neuropathy Overview
2. NIH – Neuropathy Medication Guide
3. Cleveland Clinic – Neuropathy Management
4. Harvard Health – Managing Peripheral Neuropathy

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.