What Is Neuropathy? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Peripheral neuropathy, or nerve damage, can result from a wide range of conditions such as diabetes and even treatments like chemotherapy.
It is not a single health condition. Rather, peripheral neuropathy is a term that describes peripheral nerve damage due to a range of health problems as well as their symptoms.
While this group of conditions is irreversible, you can take steps to help prevent peripheral neuropathy or manage it through diet, lifestyle, and treatment.
Peripheral neuropathy symptoms ultimately depend on the underlying cause and the individual. However, according to Mayo Clinic and the National Institute of Neurological Disorders and Stroke (NINDS), they may include:
Temporary or permanent numbness
Tingling, prickling, or burning sensation
Increased sensitivity to touch
Pain
Muscle weakness or wasting
Paralysis
Dysfunction in organs or glands
Impairment to urination and sexual function
Neuropathic Pain
Neuropathic pain can develop when the sensory nerves become damaged and transmit signals to the central nervous system in an altered and disordered fashion. It affects an estimated 7 to 10 percent of the general population worldwide.
The primer lists the following common conditions associated with peripheral neuropathic pain:
To understand how neuropathy acts in the body, it’s important to know that the nervous system is divided into two parts. The Institute for Quality and Efficiency in Health Care (IQWiG) describes them as the central nervous system — the brainand spinal cord — and the peripheral nervous system, which transmits messages between the central nervous system and the rest of your body.
In turn, two different parts make up the peripheral nervous system:
Somatic nervous system: a voluntary nervous system controlling all of the functions you are aware of and can consciously control, such as moving limbs.
Autonomic nervous system: an involuntary nervous system regulating processes you can’t consciously direct, such as heartbeat, breathing, and digestion.
Neuropathy can involve damage or disruption to both autonomic and somatic peripheral nerves. This can affect sensory and motor nerves.
Across a wide range of causes, the symptoms of neuropathic pain tend to be similar, says Vernon Williams, MD, a sports neurologist and director of the Center for Sports Neurology and Pain Management at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles.
“The character and quality of neuropathic pain tends to be pain that’s burning or electric in character,” says Dr. Williams.
Additionally, the pain will often be associated with other symptoms, such as:
Paresthesia: an abnormal sensation, whether spontaneous or evoked, typically not painful, according to the International Association for the Study of Pain.
Allodynia: a painful response to a stimulus that wouldn’t normally trigger pain signals.
Hyperalgesia: a dramatic or severe pain in response to a stimulus that normally causes mild pain.
Dysesthesia: an abnormal, unpleasant sensation, whether spontaneous or evoked, typically painful. (Allodynia and hyperalgesia are subtypes of dysesthesa.)
Types of Peripheral Neuropathy
Where the nerve damage occurs determines the type of neuropathy you have. According to the Foundation for Peripheral Neuropathy (FPN), these include:
Mononeuropathy When neuropathy involves damage to only one nerve, it is called mononeuropathy. Mononeuropathies are often caused by compression or injury to a nerve, such as carpal tunnel syndrome.
Polyneuropathy This most often affects multiple nerves. When this happens, doctors refer to the nerve damage as polyneuropathy. The symptoms depend on whether polyneuropathy involves autonomic, sensory, or motor nerves — or a combination of them. Autonomic nerve damage can affect bodily functions or blood pressure and lead to gastrointestinal symptoms. Damage to sensory nerves can affect sensations and sense of balance, while damage to motor nerves can affect movement and reflexes.
When polyneuropathy affects both sensory and motor nerves, the condition is known as sensorimotor polyneuropathy. This causes bodywide damage to nerve cells, fibers (axons), and coverings (myelin sheaths).
Distal Symmetric Polyneuropathy People with diabetes most often experience this type of polyneuropathy, according to the American Diabetes Association. In this form of polyneuropathy, the first nerve fibers to malfunction are those most distant from the central nervous system, with symptoms such as pain and numbness felt symmetrically in the feet, and then traveling up the legs as the condition progresses. The upper limbs may eventually experience symptoms.
The nerve damage behind neuropathy can happen in a variety of ways, affecting the nerve axons (along which impulses transmit to other cells), myelin sheath (which covers and protects the axon), or a combination of both.
Poorly Managed Diabetes The most common type of neuropathy in the United States is diabetic peripheral neuropathy, which affects people who have diabetes with poorly controlled blood sugar, and accounts for about 60 percent of the total people with neuropathy.
Idiopathic Neuropathy Doctors cannot identify a clear cause in 23 percent of cases. Medical professionals describe their condition is known as idiopathic peripheral neuropathy.
Chronic Alcohol Use Disorder Alcoholic neuropathy is considered one of the most common forms of peripheral neuropathy. Roughly 66 percent with alcohol-use disorder diagnosis experience peripheral neuropathy, according to a review published in 2022.
Cancer Around 10 percent of people in the United States with peripheral neuropathy have it due to chemotherapy treatment.
Other health conditions, like autoimmune diseases, and health events, such as physical trauma, have links to peripheral neuropathy. More on these later.
Vitamin B12 Deficiency According to a case report published in 2022, peripheral neuropathy is the most common symptom of vitamin B12 deficiency.A deficiency of B12 causes damage to the myelin sheath that surrounds and protects nerves, explains the FPN. The nerves won’t function properly without this protection.
Taking metformin (Glucophage), which people with type 2 diabetes commonly use to control their blood sugar, may increase your risk of vitamin B12 deficiency, per the ODS. If you are taking the medication, be sure to inform your physician so he or she can look out for a possible deficiency and recommend supplementation or dietary advice.
Copper Deficiency This nutrient deficiency is a rarer cause of neuropathy, says Norman Latov, MD, PhD, a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center, and the director of the peripheral neuropathy clinical and research center at Weill Cornell Medical College in New York City. Beef, nuts, and legumes provide dietary copper. However, Dr. Latov says the deficiency is usually a result of an individual’s metabolism or malabsorption, rather than an unbalanced diet. Copper supplements can help treat the condition, according to a literature review from 2023.
Excess Nutrient Consumption Getting too much of a nutrient can also lead to neuropathy, Latov cautions. For instance, “Too much B6 can be toxic to the nerves. The normal requirement is less than 2 milligrams (mg) a day, yet many B6 supplements are 100 mg or more. B6 is also an additive to all sorts of packaged foods,” Latov says. “Susceptibility [to absorbing the nutrient] varies, so if you take B6 supplements, you really should have a medical professional check your blood levels to make sure they’re not in excess.” A peer-reviewed article provides more information about toxicity.
Exposure to Toxins in Food Toxins in foods we tend to think of as healthy, such as seafood, can also lead to neuropathy, he adds. “In our center, we see people with very high levels of mercury, which can cause neuropathy.” The Environmental Protection Agency reports that fish can contain mercury.
Large amounts of ingested arsenic, another heavy metal, can also cause peripheral neuropathy. Usually, this results from exposure via drinking water that has had exposure to industrial waste. Arsenic is also present in brown and white rice, but not at high enough levels to cause nerve damage. A review from 2023 provides more detail on the nerve damage that both mercury and arsenic can cause.
There are a number of ways in which neuropathy can be diagnosed, says Williams. Generally the process will start with your physician taking down a patient history that includes a description of your complaints, as well as a physical examination to check the functioning of the area in question.
After that, tests may be ordered, including:
Electrodiagnostic Testing This includes nerve conduction testing, where a medical professional stimulates the nerves, records their responses, and analyzes them for abnormalities. Doctors also use electromyography, where they insert small needles into individual muscles to get audio and visual information on how the nerves supplying that muscle are functioning.
Blood Tests These can be ordered to check for elevated blood sugar (as seen in type 2 diabetes), toxins, vitamin deficiencies, hereditary disorders, and evidence of an abnormal immune response.
Skin Biopsies A physician makes a small incision to remove a sample of skin for examination. It may help to distinguish certain disorders affecting the small nerve fibers, such as painful sensory neuropathies affecting nerve fibers called axons.
Quantitative Sensory Testing (QST) This helps to assess damage to the nerve endings involved in sensing temperature and vibrations, QST uses computer testing to measure how the nerves in question react to these stimuli.
Peripheral neuropathy can be long-lasting, even permanent. However, in the case of cancer patients undergoing chemotherapy, the nerve damage can be temporary.
According to a survey study on peripheral neuropathy in people who were receiving chemotherapy treatment that was published in 2023, 48 percent of those in the survey received a neuropathy diagnosis within two weeks of starting treatment. These symptoms lasted for 73.3 months, or just over six years, on average, with the shortest and longest durations spanning a range of two weeks to more than 20 years.
Prognosis of Peripheral Neuropathy
The prognosis for neuropathy depends on the type you have and how much it has progressed. Nerve damage can be permanent. However, correcting the underlying condition that caused neuropathy can allow nerves to recover or regenerate in some cases.
For instance, getting your blood sugar under control can help halt the progression of nerve damage and improve the symptoms of diabetic neuropathy. Without blood sugar control, diabetic neuropathy can worsen. Higher diabetic neuropathic pain may also have links to smoking tobacco, according to a 2020 paper, so kicking the habit may also improve neuropathy symptoms over time.
Sometimes surgery can help address nerve damage, says Peter Highlander, DPM, a podiatrist based in Bellevue, Ohio. Through neurolysis, a surgeon may remove any scar tissue or constricting tissue around or within a nerve to release pressure. Dr. Highlander says that in his practice, certain nerve surgery procedures work better when the patient still has some sensation in the nerve.
Physical therapy can help in some cases of motor neuropathies involving muscle weakness or wasting, says R. Glenn Smith, MD, a neurologist at Houston Methodist. The success of such therapy can depend on how much nerve damage there is and the age of the patient. The extent of recovery is often less dramatic for older patients, he adds.
A wide variety of treatments and medications for neuropathy is available. However, their success depends on the type of nerve damage and the severity of symptoms, according to the FPN.
Medication Options
Williams says antidepressant and anti-seizure medications are “the types of categories we’re likely to turn to and can be most helpful.” This is because they act on pain from abnormal nerve firings or nerve signals.
“Antidepressants have an effect on some of the neurotransmitters like norepinephrine and serotonin, which can have an effect on pain,” he explains.
Williams notes the following antidepressant options that may help treat neuropathy:
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine
Norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine
Serotonin receptor modulators, such as trazodone (Oleptro), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves
Anti-seizure medications are another class of medications that may be effective at treating neuropathy. Gabapentin (Neurontin) and pregabalin (Lyrica) are examples of anti-seizure medications that people use to relieve nerve pain due to shingles or as a result of diabetes, according to a paper published in 2019.
Common over-the-counter medications can provide some relief from mild-to-moderate neuropathic pain, according to Williams. These include:
As mentioned, Highlander says surgery can be useful to release pressure on a nerve and may help to treat damage that occurs due to carpal tunnel syndrome and diabetic neuropathy.
Nerve Stimulation
Neuromodulation is another option. It can involve placing an electrode along a peripheral nerve. “These are helpful by essentially turning off pain signals,” explains Williams. “You can do that very selectively with individual peripheral nerves or you can take a more regional approach with spinal cord stimulation.”
Alternative and Complementary Therapies
Research into alternative therapies for neuropathic symptoms has shown some noteworthy results.
Cannabidiol (CBD) Derived from the same cannabis sativa plant that produces marijuana and hemp, cannabidiol has been used in the treatment of chronic, noncancer neuropathic pain, but more studies are necessary to prove that it’s effective. A small, randomized, controlled clinical trial that was published in 2020 found that “there was a statistically significant reduction in intense pain, sharp pain, and cold and itchy sensations in the CBD group when compared to the placebo group.” However, a study published in 2023 found no significant difference in neuropathy pain relief effects between cannabis-derived medicines and a placebo.
Alpha Lipoic Acid The antioxidant has been used to treat diabetic neuropathy at Houston Methodist Hospital in Houston, says Dr. Smith. It is a naturally occurring fatty acid found in foods, such as spinach, broccoli, yams, and potatoes. In a review of eight placebo-controlled studies published in 2022, three of them found that alpha lipoic acid reduced symptoms, but five found no significant difference. The most common method of delivery in these studies was injection, and the most common dose was 600 mg per day. However, all of the studies concluded that alpha lipoic acid was safe and that people tolerate it well, reporting no side effects.
Carnitine Another fatty acid, this is sometimes deficient in people with neuropathy, resulting in an insufficient blood supply to nerves. The body makes all of the carnitine that it needs in healthy children and adults, so it is not necessary to get more from supplements or nutritional sources such as meat, poultry, and dairy.
However, supplementing in its fatty acid form, known as acetyl-L-carnitine, can help treat neuropathy, says Smith. A systematic review published in 2019 singled out acetyl-L-carnitine as effective for people with diabetic neuropathy.
Curcumin Curcumin, the active chemical in turmeric, has demonstrated benefits for people with diabetic neuropathy. A review published in 2018 found that circumin might reduce the risk of several diabetes complications, including neuropathy. However, a paper published in 2023 concludes that most studies testing the effects circumin on diabetes complications took place using animals and individual cells. More human studies could help to demonstrate curcumin’s potential for reducing peripheral neuropathy risk.
Prevention of Neuropathy
As the Foundation for Peripheral Neuropathy notes, you can adjust your eating habits to address underlying causes of neuropathy like diabetes, celiac disease, and nutrient deficiencies like not having enough vitamin B12.
Yet some causes of neuropathy, such as Charcot-Marie-Tooth disease, are hereditary, so it's not possible to prevent them. The condition, which affects more than 126,000 people in the United States, causes muscle weakness and atrophy, according to the NINDS.
People with neuropathy may need to make adjustments to their diet and activity level.
Diet and Peripheral Neuropathy
Proper nutrition is key for preventing or treating any health issues that may be at the root of peripheral neuropathy.
For diabetic neuropathy, Matthew Villani, DPM, a podiatrist in Sanford, Florida, says he often recommends the multivitamin Metanx, which contains vitamin B12. As mentioned, long-term use of metformin can leave you deficient of this vitamin. He also urges having a diabetes-friendly diet to help keep blood sugar levels in a healthy range.
The American Diabetes Association’s nutrition guide offers advice for managing your blood sugar, which may help you prevent or minimize nerve damage. There is no one-size-fits-all diet for diabetes, but a good start includes limiting sweets and sugar-sweetened beverages, as well as large portions of foods that are high in starches or carbohydrates. Opt for a balanced diet that is heavier on vegetables and fruits, and includes portion-controlled high-fiber and whole grains, low-fat or nonfat dairy, and lean proteins like poultry and fish.
Having celiac disease can put you at risk for developing nerve damage, so if you have a celiac disease diagnosis, stick to your prescribed gluten-free diet. If you have alcohol-related neuropathy, the best advice is to abstain from drinking alcohol to help control your symptoms.
Exercise and Peripheral Neuropathy
Making fitness a part of your routine can help to address the muscle weakness that some people experience with neuropathy, as well as reduce pain. In people with diabetic neuropathy, regular exercise can also help lower high blood sugar (hyperglycemia). But be sure you talk to your healthcare team before beginning a new exercise regimen because neuropathy can affect how you respond (or don’t respond) to injury or activities that risk injury. Before one of his patients begins exercising, Williams typically assesses the patient’s feet, degree of neuropathy, blood flow to the extremities, and their risk for deformities and foot ulcers.
Dr. Villani adds that it’s important to start slowly and only gradually increase the length and severity of your exercise. “If you are walking, go for a quarter of a mile, and then go home and take a look at your feet,” he explains. “If there [are] any areas of concern, consult a professional to make sure that your shoes are wide enough and large enough.”
Furthermore, he says, “do a daily inspection before and after you do exercise to make sure there are no areas of increased redness [or] skin breakdown. We recommend that people wear white socks so that if there’s any sort of drainage or bleeding, it can be seen.”
Highlander recommends purchasing a small mirror to keep at your bedside to check the bottoms of your feet. Or, he says, you could have a loved one check them.
Several neuropathy complications stem from loss of sensation. The issue with losing sensation from neuropathy isn’t necessarily the initial injury, which may be as minor as a blister from a new pair of shoes. Rather, it’s the resulting infection — a particular issue among people with diabetes. “If it’s where there’s diminished sensation in the feet, there can be areas of increased pressure that can cause sores or ulcers,” says Villani. “Infections can develop because there are open wounds, which can also progress into bone infection. Unfortunately, amputations often become necessary if ulcers progress to that point.”
Neuropathy can lead to complications during surgery as well, explains Highlander. That is because of a condition called Charcot neuropathic osteoarthropathy (or Charcot, for short), in which inflammation and unaddressed injuries subject bones, joints, and soft tissues (especially those in the feet) to microfractures and deformity. This is not the same disorder as Charcot-Marie-Tooth disease, and it can have many causes, including diabetic neuropathy.
“A neuropathic ankle fracture is [at a] much higher risk for complications, and so it should be treated differently. If a patient knows they have neuropathy, that should be brought up before surgery,” says Highlander.
An estimated 30 million people in the United States have some form of neuropathy, according to the Foundation for Peripheral Neuropathy.
Diabetic peripheral neuropathy is the most common type, affecting 6 in 10 people who have any type of neuropathy. Furthermore, 60 to 70 percent of people with diabetes develop neuropathy. So do 30 to 40 percent of people undergoing chemotherapy.
The types of neuropathy and different pain communication methods complicate determining which racial and ethnic groups experience neuropathy the most.
The U.S. Food and Drug Administration reports that American Indians/Alaska Natives (14.7 percent), Hispanics (12.5 percent), Black Americans (11.7), and Asian Americans (9.2 percent) have higher rates of diabetes than white people (7.5 percent).
However, in a study of more than 1,900 people who had painful diabetic peripheral neuropathy symptoms that was published in 2017, Black (65 percent) and Hispanic (49 percent) participants were less likely than white participants (87 percent) to rate their pain as moderate or severe. Also, significantly fewer Black and Hispanic individuals reported having received a painful diabetic peripheral neuropathy diagnosis. However, higher proportions of those who were Black and Hispanic reported difficulty communicating with their healthcare provider about their pain symptoms and feeling less comfortable about doing it. They were also younger, on average, than white participants. Researchers said more research in diverse populations is needed to understand the disparities.
Following diabetes, idiopathic neuropathy, chemotherapy, and HIV/AIDS, other types of neuropathy make up the remaining 5 percent of cases, according to the FPN. These are caused by:
Metabolic disorders such as hypoglycemia or kidney failure
This nonprofit not only provides education and research, but it’s also an excellent resource if you’re looking for support. Browse the site for general information on neuropathy, ranging from symptoms to coping tips. You’ll also find newsletters, podcasts, and information on how to locate a local support group. It’s a one-stop shop for everything on neuropathy.
The HNF brings awareness not only to neuropathy but also Charcot-Marie-Tooth disease (CMT) and other inherited neuropathies. CMT is a genetic disorder that occurs due to a gene mutation. The HNF is a great place for family members and caregivers to educate themselves. Check out the blog, newsletter, and webinar, or research upcoming events and clinical trials.
The FPN is an amazing resource for food and nutrition advice. Controlling blood sugar starts with good nutrition. The site offers basic diet tips for controlling blood sugar, as well as tips for eating to help beat inflammation. This resource also guides you in grocery shopping for healthy foods and using supplements for neuropathy.
For more on how to build an anti-inflammatory diet, check out our article.
Want to get involved and help raise awareness of neuropathy? Visit the Neuropathy Action Foundation’s website and see how you can do your part. Sign up to receive the NAF’s newsletters and advocacy alerts, make a contribution to the organization, or find tools to educate others about this condition. Looking to join a support group? There’s also information on how to find one in your area.
You’ve come to the right place if you need help finding a support group for neuropathy. This site provides information about online and local support groups in your area, and you can read articles on neuropathy and get information on clinical trials.
