Peripheral Neuropathy

Peripheral neuropathy refers to damage of the nerves outside the brain and spinal cord. It typically causes numbness, tingling, burning pain, or weakness — most often in the hands or feet.

Table of Contents

Quick Facts

  • ICD-10: G62.9
  • Top cause: Diabetes
  • Most affected: Hands and feet
  • Often progressive: Yes, without treatment

Overview

Peripheral nerves transmit signals between the central nervous system and the rest of the body. When these nerves are damaged, the brain may receive distorted signals (pain, tingling) or fail to receive signals at all (numbness, weakness). The pattern of symptoms depends on which nerves are affected.

Symptoms

  • Numbness or reduced ability to feel touch or temperature
  • Tingling or pins-and-needles sensation
  • Burning or stabbing pain
  • Sensitivity to touch (allodynia)
  • Muscle weakness
  • Lack of coordination, falls
  • Dropping items, difficulty buttoning clothes

Symptoms often start in the toes and feet, then progress upward — the classic 'stocking-glove' distribution.

Causes

  • Diabetes (most common cause)
  • Vitamin deficiencies (B12, B6 excess, B1)
  • Alcohol use
  • Chemotherapy and certain medications
  • Autoimmune diseases (Guillain-Barré, CIDP, lupus)
  • Infections (shingles, HIV, Lyme disease)
  • Hereditary neuropathies (Charcot-Marie-Tooth)
  • Trauma or compression (carpal tunnel syndrome)
  • Kidney or liver disease
  • Hypothyroidism

Diagnosis

  • Neurologic examination
  • Blood tests (glucose, A1C, B12, thyroid, kidney/liver function, immune markers)
  • Nerve conduction studies and electromyography (EMG)
  • Skin biopsy for small-fiber neuropathy
  • Genetic testing in suspected inherited forms

Treatment

Address the cause

  • Tight glucose control in diabetes
  • Vitamin replacement when deficient
  • Avoid alcohol and offending medications when possible
  • Treat underlying autoimmune disease

Symptom management

  • Anticonvulsants (gabapentin, pregabalin)
  • Antidepressants (duloxetine, amitriptyline)
  • Topical agents (capsaicin, lidocaine)
  • Physical therapy
  • Foot care to prevent injuries

When to See a Doctor

See a doctor for new persistent numbness, tingling, weakness, or burning pain, especially if it interferes with daily activities or affects walking.

Related Conditions

Diabetic Peripheral Neuropathy

Most common form

 Numbness

A core symptom

 Diabetes

Top underlying cause

 Vitamin B12 Deficiency

A treatable cause

Frequently Asked Questions

Can peripheral neuropathy be cured?

If caught early and the cause is reversible (e.g., B12 deficiency, alcohol), nerves may recover partially or fully. Long-standing damage often improves only modestly.

Is neuropathy always painful?

No. Some people have predominantly numbness or weakness without much pain. Others have severe burning or shock-like sensations.

Why do my feet feel cold but look warm?

Sensory misperception is common in neuropathy. Nerves that report temperature can be damaged, producing the feeling of cold even when the feet are objectively warm.

Do supplements like alpha-lipoic acid help?

Some evidence supports alpha-lipoic acid for diabetic neuropathy symptoms; it should not replace treating the underlying cause. Discuss with your doctor before starting.

Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call your local emergency number immediately.

References

  • National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy.