Understanding Peripheral Neuropathy

Introduction

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.

What peripheral nerves do

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.

Common causes

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 you might notice

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.

How doctors diagnose peripheral neuropathy

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) 904-4027or sign up at https://app.understoodcare.com/.

Treatment approaches that help

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.

Everyday safety and self care

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.

When to seek urgent care

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.

Working with your care team

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/.

Outlook

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.

FAQ

• What is peripheral neuropathy?
  Peripheral neuropathy is nerve damage outside the brain and spinal cord. It affects nerves that carry sensation, control muscles, and support automatic functions like blood pressure, sweating, and digestion. Symptoms can include numbness, tingling, burning pain, weakness, and balance problems. It may affect a single nerve or many nerves, often starting in the feet.
• What do peripheral nerves do?
  Peripheral nerves act as communication lines between your brain, spinal cord, and body. Sensory nerves carry touch, pain, and temperature. Motor nerves control movement and reflexes. Autonomic nerves help regulate heart rate, blood pressure, digestion, bladder function, and sweating. Damage to any of these can change how you feel, move, or tolerate daily activities.
• What causes peripheral neuropathy?
  Many conditions can injure peripheral nerves. Common causes include diabetes and prediabetes, low vitamin B12, thyroid disease, kidney or liver disease, and heavy alcohol use. Autoimmune diseases, vasculitis, infections such as shingles or Lyme disease, HIV, chemotherapy, and some toxins can also cause neuropathy. Some neuropathies are inherited. In many adults, the cause remains unknown even after testing.
• What symptoms should I watch for?
  Symptoms often begin in the toes and feet, then may move up the legs and later affect the hands. You may notice tingling, pins and needles, burning or electric shock like pain, reduced feeling for temperature or vibration, cramps, or muscle weakness. Balance can worsen. Autonomic symptoms can include dizziness when standing, sweating changes, bowel or bladder issues, and sexual dysfunction.
• How do doctors diagnose peripheral neuropathy?
  Diagnosis starts with your story and a focused neurologic exam. Your clinician looks at the pattern of symptoms and tests strength, reflexes, sensation, and balance. This guides which lab tests and nerve tests are needed. The goal is to look for treatable causes and define the type of nerve injury.
• What lab tests are usually done?
  Initial blood work often includes a complete blood count, metabolic panel, kidney and liver tests, thyroid function tests, fasting glucose and A1C, vitamin B12 with follow up tests if needed, and serum protein electrophoresis. Additional tests depend on your history and exam, such as checks for infections or autoimmune disease.
• What are nerve conduction studies and EMG?
  Nerve conduction studies measure how fast and how strongly nerves send signals. Electromyography (EMG) checks how muscles respond to nerve input. Together they help show which nerves are affected and whether the problem is in the nerve, the muscle, or the junction between them.
• What is a skin biopsy for small fiber neuropathy?
  In some people, small pain and temperature fibers are affected while standard nerve tests are normal. A small skin biopsy can measure nerve fiber density in the skin. This helps confirm small fiber neuropathy when symptoms suggest it.
• When is imaging needed?
  Imaging such as MRI is usually reserved for suspected nerve entrapment or structural problems based on your exam. Most peripheral neuropathy diagnoses rely on clinical evaluation and targeted lab and nerve tests rather than routine scans.
• How is the underlying cause treated?
  Treating the cause is the first step. For diabetes, improving blood sugar control can slow or reduce nerve damage. Low vitamin B12 is treated with replacement. Thyroid, kidney, or liver disease should be managed carefully. Doctors may adjust medicines that can injure nerves. Autoimmune and infectious causes may need specific drugs such as immunotherapy or antibiotics.
• What medicines can help with nerve pain?
  Several groups of medicines are used for neuropathic pain. These include serotonin norepinephrine reuptake inhibitors such as duloxetine, tricyclic antidepressants such as amitriptyline or nortriptyline, and gabapentinoids such as gabapentin or pregabalin. Topical options include lidocaine patches and capsaicin systems for certain cases. Opioids are generally discouraged for long term nerve pain because risks often outweigh benefits.
• What non medicine therapies are useful?
  Physical therapy can improve strength, flexibility, and balance. Occupational therapy helps with daily tasks and home safety. Gentle exercise supports mood and function. Cognitive and behavioral approaches can help you cope with chronic pain. Proper foot care and well fitted shoes lower the risk of injuries and ulcers, especially in people with diabetes.
• Are procedures ever used for neuropathy pain?
  For some people with focal nerve entrapment or severe pain that does not respond to standard treatments, specialists may consider targeted procedures. Options can include nerve blocks or device based therapies in selected cases. Your care team will discuss potential benefits and risks if this becomes relevant.
• What daily steps can I take to protect my feet?
  Check your feet every day for cuts, blisters, redness, or pressure spots. Wash and dry gently, moisturize dry skin, and avoid lotion between the toes. Trim nails carefully or see a podiatrist if trimming is hard or nails are thick. Wear cushioned, well fitting shoes and seamless socks at all times, even indoors, to protect numb areas.
• How can I reduce my fall risk at home?
  Keep floors clear of clutter and cords. Remove or secure throw rugs. Add night lights in the bedroom, hallway, and bathroom. Consider grab bars near the toilet and in the shower, plus nonslip mats in the tub. A shower chair or raised toilet seat can also help. Physical therapy can teach balance and strength exercises to reduce falls.
• What lifestyle habits support nerve health?
  Eat a balanced diet with enough B vitamins. Limit alcohol and stop smoking if you can. Stay active with safe, regular movement that matches your abilities. Work with your care team to manage blood sugar, blood pressure, and cholesterol. These steps support overall health and may slow progression of some neuropathies.
• When should I seek urgent care?
  Seek immediate medical attention if you have sudden or rapidly worsening weakness, trouble walking, new difficulty breathing, chest pain, loss of bladder or bowel control, or widespread numbness. These can be signs of serious nerve or spine problems and need fast evaluation.
• How often should I follow up with my clinician?
  Regular follow up is important. Ask your clinician how often to check in based on your diagnosis and symptoms. At visits, review your pain levels, function, foot checks, medication side effects, and any new problems. Bring an updated medication list and your symptom log.
• How can an advocate help if I have neuropathy?
  An Understood Care advocate can help you prepare questions, track symptoms, arrange podiatry and physical therapy referrals, and coordinate with your clinicians. Advocates can also help with transportation, home safety planning, and medication reviews so your treatment plan is clear and manageable. For support, you can call (646) 904 4027 or sign up at https://app.understoodcare.com/.
• What is the outlook for peripheral neuropathy?
  Outlook depends on the cause and how early it is treated. Some neuropathies improve when the cause is corrected. Others stabilize with good management. Even when nerves do not fully recover, many people can reduce pain, protect their feet, and stay active through a mix of medical treatment, self care, and ongoing support.

References

• NINDS Peripheral Neuropathy overview
  https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy
• NINDS Peripheral Neuropathy booklet PDF
  https://www.ninds.nih.gov/sites/default/files/2025-05/peripheral-neuropathy.pdf
• Mayo Clinic Peripheral Neuropathy symptoms and causes
  https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
• Mayo Clinic Peripheral Neuropathy diagnosis and treatment
  https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067
• MedlinePlus Peripheral Neuropathy
  https://medlineplus.gov/ency/article/000593.htm
• MedlinePlus Peripheral Nerve Disorders
  https://medlineplus.gov/peripheralnervedisorders.html
• Cleveland Clinic Peripheral Neuropathy
  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy
• CMAJ review on diagnosis and management of polyneuropathy
  https://pmc.ncbi.nlm.nih.gov/articles/PMC9928442/
• AAN guideline update on oral and topical treatment for painful diabetic polyneuropathy
  https://pubmed.ncbi.nlm.nih.gov/34965987/
  https://www.neurology.org/doi/10.1212/WNL.0000000000013038

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.