Peripheral neuropathy
Peripheral Neuropathy Basics: Causes, Symptoms, Tests and Care
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. It often starts as tingling, burning or numbness in the feet. Diabetes is the leading cause, but there are more than 100 types. Care starts with finding the cause through an exam and blood tests, because treatment depends on what damaged the nerves.
Written by the Nervecept label deskUpdated
The basics01
What is peripheral neuropathy?
Peripheral neuropathy is a problem with the peripheral nerves, the long wires that carry signals between the spinal cord and the skin, muscles and organs. When they are damaged, signals get weak, mixed up or lost.
Millions of people in the U.S. live with it, and NINDS counts more than 100 types (NINDS, Peripheral Neuropathy). Some affect one nerve. Most affect many nerves at once, starting in the longest ones, which run to the toes.
That is why symptoms often begin in both feet and slowly climb. The hands may follow later.
Three kinds of nerves
- Sensory nerves carry touch, pain, heat and position. Damage brings tingling, burning or numbness.
- Motor nerves move muscles. Damage brings weakness, cramps or trouble with balance.
- Autonomic nerves run heart rate, sweat, digestion and bladder. Damage brings dizziness on standing or bowel and bladder changes.
Causes02
What causes peripheral neuropathy?
Diabetes is the most common cause of peripheral neuropathy. Other causes include low vitamin B12, too much vitamin B6, heavy alcohol use, kidney disease, some infections, chemotherapy and certain other drugs (NINDS, Peripheral Neuropathy).
High blood sugar and high blood fats such as triglycerides harm nerves over years (NIDDK, Diabetic Neuropathy). Some cancer drugs damage nerves in weeks (NCI, Nerve Problems and Cancer Treatment). In some people no cause is found, even after testing.
| Cause | How it harms nerves | Common clue or test |
|---|---|---|
| Diabetes | High glucose and blood fats damage nerves over time (NIDDK, Diabetic Neuropathy) | A1C and fasting glucose |
| Low vitamin B12 | Nerves lose a nutrient they need; can happen without anemia (NIH ODS, Vitamin B12) | B12 blood test; ask if you take metformin or acid reducers |
| Too much vitamin B6 | High doses over months can cause sensory neuropathy (NIH ODS, Vitamin B6) | A list of every supplement you take |
| Alcohol | Direct nerve toxicity plus poor nutrition (NINDS, Peripheral Neuropathy) | Drinking history |
| Chemotherapy | Some drugs injure nerves in the hands and feet (NCI, Nerve Problems and Cancer Treatment) | Timing after treatment began |
| Kidney disease, infections, other drugs | Waste buildup, immune effects or drug side effects (NINDS, Peripheral Neuropathy) | Kidney tests and a medicine review |
Symptoms03
What are the first signs of peripheral neuropathy?
The first signs are usually tingling, burning, pins and needles, or numbness in the toes and feet. Many people notice them most at night, when nothing else distracts them (NIDDK, Peripheral Neuropathy).
Some people feel the opposite of numbness. Bed sheets can feel painful, or a light touch can feel like a sting. Others feel nothing at all and only notice when they find a blister they never felt.
Weakness can come later: trouble lifting the front of the foot, more stumbles, or a loose grip. Problems with balance often show up first in the dark, when the eyes cannot make up for lost foot feeling.
Warning signs04
When is numbness or tingling an emergency?
Numbness or tingling is an emergency when it starts suddenly on one side of the body, or comes with a drooping face, slurred speech or lost bladder or bowel control. Those can be signs of a stroke or spinal cord pressure. Call 911.
Slow symptoms in both feet still need a visit, just not an ambulance.
- Sudden one-sided numbnessArm, leg or face, on one side of the body
- Face drooping, slurred speechOr trouble understanding speech
- Bladder or bowel changesLost control with back pain or numb inner thighs
- Weakness that spreadsGetting much worse over hours or days
- A foot sore that will not healOr a red, hot, swollen foot
SoonTingling, burning or numbness in the feet or hands that lasts more than a few weeks, keeps you up at night, or comes with diabetes, heavy drinking or chemotherapy: book a doctor visit and ask about B12 and blood sugar tests.
Call 911For sudden numbness or weakness on one side, a drooping face, trouble speaking, or sudden loss of bladder or bowel control.
Causes and warning signs from NINDS (NINDS, Peripheral Neuropathy) and MedlinePlus (MedlinePlus, Sciatica); foot sores from CDC (CDC, Your Feet and Diabetes).
Diagnosis05
How do doctors test for peripheral neuropathy?
Doctors test for peripheral neuropathy with a physical exam, blood tests and sometimes nerve studies. The exam checks feeling, reflexes, strength and balance. Blood tests look for causes such as diabetes and low B12.
A simple foot test uses a 10-gram nylon filament pressed on the sole. If you cannot feel it, protective feeling is reduced. The American Diabetes Association asks for this check every year in people with diabetes (ADA, Diabetic Neuropathy Position 2017).
History and exam
Your doctor asks when symptoms began, which medicines and supplements you take and how much you drink. Then comes a check of touch, vibration, reflexes and strength.
Blood and urine tests
Common ones are glucose or A1C, vitamin B12, kidney and thyroid tests. Results guide the next step.
Nerve studies if needed
A nerve conduction study measures how fast signals travel. Electromyography (EMG) checks muscle response. A skin biopsy can count small nerve fibers.
Bring a list of every pill and supplement. Hidden B6 in multivitamins is an easy cause to miss (NIH ODS, Vitamin B6).
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See packsCare by cause06
How is peripheral neuropathy treated?
Peripheral neuropathy is treated by addressing the cause and easing the symptoms. Fixing the cause can stop damage from getting worse. Pain medicines ease symptoms but do not undo nerve damage (NIDDK, Peripheral Neuropathy).
For nerve pain, NINDS lists duloxetine, nortriptyline, gabapentin, pregabalin and creams or patches with lidocaine or capsaicin, and says opioids are not recommended (NINDS, Peripheral Neuropathy). Neurology guidelines add exercise, tai chi, mindfulness and CBT for people who prefer non-drug care (AAN, Painful Diabetic Neuropathy 2022).
| Cause | Usual first step | Source |
|---|---|---|
| Diabetes | Bring glucose, blood pressure and cholesterol close to goal; check feet daily | (NIDDK, Peripheral Neuropathy) (ADA, Diabetic Neuropathy Position 2017) |
| Low B12 | B12 replacement by pill or shot, as prescribed | (NIH ODS, Vitamin B12) |
| Excess B6 | Stop the extra B6; symptoms usually fade over time | (NIH ODS, Vitamin B6) |
| Chemotherapy | Report symptoms early; the cancer team may adjust treatment; duloxetine for established pain | (NCI, Nerve Problems and Cancer Treatment) (ASCO Post, CIPN guideline 2020) |
| Alcohol | Stop drinking and correct nutrition with a doctor's help | (NINDS, Peripheral Neuropathy) |
Daily life07
What can I do at home for peripheral neuropathy?
At home, protect your feet, stay active and keep a symptom log. Numb feet cannot warn you about cuts or burns, so your eyes must do the job.
Look at your feet every day, wear shoes indoors and light hallways at night to cut fall risk (NCI, Nerve Problems and Cancer Treatment).
Walking, cycling or swimming most days helps fitness and mood, and exercise is one of the non-drug options in the neurology guideline (AAN, Painful Diabetic Neuropathy 2022). Our foot care guide has a daily checklist.
Each night, rate the worst tingling or pain from 0 to 10 and note sleep. After four weeks, the pattern tells your doctor more than memory can.
Supplements08
Can a supplement like Nervecept help peripheral neuropathy?
There is no evidence that Nervecept helps peripheral neuropathy, because the product has never been tested in a trial. Its ingredients were studied mostly for knee and hip joints, at higher doses than one capsule holds.
The biggest line is glucosamine sulfate 500 mg, made from crayfish, so the capsule contains shellfish and is off limits with that allergy (FDA, Food Allergies). It holds no B12, which matters if a blood test shows you are low. See every line on the ingredients page.
FDA does not approve supplements, and a product sold to treat a disease is legally a drug (FDA 101: Dietary Supplements). A capsule can sit beside medical care, never in its place.
Do not stop or lower a prescribed nerve pain, diabetes or other medicine because you start a supplement. Ask your doctor first, and check interactions in our supplements and medicines guide.
FAQ09
Peripheral neuropathy questions
Can peripheral neuropathy get better on its own?
Sometimes. When the cause is removed, such as stopping excess vitamin B6 or replacing low B12, symptoms often improve over months. Damage from long-term diabetes usually does not go away, but good glucose control can keep it from getting worse.
Is peripheral neuropathy the same as diabetic neuropathy?
No. Diabetic neuropathy is one kind of peripheral neuropathy, and the most common. Peripheral neuropathy also includes nerve damage from low B12, alcohol, chemotherapy, kidney disease, infections and more than 100 other types.
What blood tests check for causes of neuropathy?
Common first tests are glucose or A1C, vitamin B12, kidney function and thyroid tests. Your doctor may add others based on your history, such as tests for infections or immune problems.
Why is foot numbness often worse at night?
Nerve symptoms often feel stronger at night, when the body is still and there are fewer distractions. NIDDK lists night-time worsening as a common pattern. Tell your doctor if it keeps you from sleeping.
Does a nerve conduction study hurt?
It can feel strange but is usually brief. Small electric pulses on the skin cause a quick tingle or twitch. The needle part of EMG can sting a little. Ask your clinic what to expect beforehand.
Can too much vitamin B6 cause numb feet?
Yes. Long-term high-dose B6 can cause sensory neuropathy, and the adult upper limit is 100 mg a day. Check multivitamins, energy drinks and nerve supplements for hidden B6, and tell your doctor what you take.
Which kind of doctor handles peripheral neuropathy?
Start with your primary care doctor, who can run the first tests. You may be referred to a neurologist for nerve studies, or to a podiatrist for foot care if you have diabetes or numb feet.
Who wrote this10
Written and reviewed by
Pages built from the label, the sales page and linked NIH, FDA, CDC, FTC and peer-reviewed sources.
Last updated . Read our editorial standards and how we check reviews. This website is run by a Nervecept licensed U.S. outlet, not by the manufacturer or the distributor. We earn money when you buy through our order links.
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