What Is Neuropathy, and What Causes It?

Most people are familiar with that uncomfortable “pins and needles” feeling that can happen when you sit in a certain position for too long. But some people experience symptoms like that all the time. It is called neuropathy, also known as peripheral neuropathy. 

Neuropathy happens when a nerve or group of nerves does not function normally. And it can have many different causes, including diabetes, trauma, nerve injury, illness, or medications. 

We’ll discuss what neuropathy is, how it is diagnosed and treated, and what you can do to prevent neuropathy and its long-term complications if you are at risk.

What is peripheral neuropathy?

The word “neuropathy” means nerve damage or dysfunction. Our nervous system has two parts: the central nervous system, which is the brain and spinal cord, and the peripheral nervous system, which includes all of the other nerves throughout the body. 

Peripheral neuropathy refers specifically to damage of the peripheral nerves — the nerves that are outside the brain and spinal cord in the rest of your body. Neuropathy can be related to problems in the central nervous system, but it can also happen when the brain and spinal cord function normally. 

There are three types of peripheral nerves:

• Sensory nerves are ones that help you feel.

• Motor nerves are ones that help you move. 

• Autonomic nerves perform automatic functions, like sweating, breathing, and digesting food.

Neuropathy can affect any of these nerve types. In some cases, it can affect just one nerve. In other cases, it can affect several nerves. The type and number of nerves involved affects what kind of symptoms you have. 

Typically, neuropathy is a long-term condition. But this also depends on the underlying cause. 

What causes peripheral neuropathy?

The most common cause of neuropathy in the U.S. is diabetes. As many as 60% to 70% of people with diabetes have neuropathy. 

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But diabetes isn’t the only cause of neuropathy. Other causes include:

• Trauma: Accidents, cuts, and broken bones can directly injure a nerve. This can also happen during medical procedures, like surgery.

• Illness: Vascular disease, autoimmune conditions, infections, vitamin deficiencies, alcohol misuse, kidney disease, and cancer can all cause neuropathy.

• Medications: Chemotherapy, blood pressure medications, and antibiotics are common offenders. 

• Genetic disorders: These are rare causes.

What causes neuropathy in feet in particular?

When people have neuropathy, it is common to experience it in the feet. And certain conditions are well known for causing neuropathy in the feet in particular:

• Diabetes: People with diabetes and neuropathy are most likely to experience symptoms in their legs and feet. 

• Vascular disease: When problems with the blood vessels cause neuropathy, they often affect the feet first. This is because they are the farthest body part from the heart. 

• Charcot-Marie-Tooth disease: Often referred to as CMT disease, this is an inherited condition that commonly causes nerve damage in the feet.

• Peroneal nerve palsy: The peroneal nerve is located on the outside of the knee and in the lower leg. Because of its location in the leg, it is vulnerable to compression or injury. When that happens, it leads to something called “foot drop,” when it becomes difficult for a person to lift their foot. 

What are the symptoms of peripheral neuropathy?

The symptoms of peripheral neuropathy may feel different for different people. This is because the symptoms depend on the type, the number, and the location of the peripheral nerves affected. 

Common symptoms include:

• Numbness, tingling, or a pins-and-needles sensation

• Painful sensitivity to touch

• Loss of pain or sensation

• Muscle weakness

• Loss of muscle mass (sometimes called “muscle wasting”)

Sometimes, these symptoms can be worse at night. Some people with peripheral neuropathy may also experience other types of neuropathy, such as those associated with the autonomic nervous system. These symptoms can be more subtle but include: 

• Heat intolerance

• Emotional changes 

• Dizziness and loss of balance

• Digestive symptoms

How is peripheral neuropathy diagnosed?

Peripheral neuropathy is often diagnosed based on a combination of symptoms, the history of symptoms, and a physical exam. Sometimes, tests to evaluate for other conditions may be helpful. These tests may include blood work, spinal fluid tests, and imaging in some cases.

There are also tests that are specific to nerve function:

• Nerve conduction studies help identify which nerves are damaged.

• Electromyography (EMG) is a test that looks at both nerve and muscle function. It can help determine if weakness is due to a problem with the nerve or a problem with the muscle. 

• A neurodiagnostic skin biopsy can help diagnose peripheral neuropathy of very small nerve fibers.

Can I test for neuropathy at home?

Yes, you can test for neuropathy in your feet at home using what is known as the “Ipswich test.” This is a simple test that doesn’t require any special equipment. Here are the steps:

• Close your eyes.

• Ask a friend or family member to gently and quickly tap the first, third, and fifth toes of each of your feet using their index finger.

If you cannot feel them touching your foot, it is possible you may have neuropathy. But keep in mind this is a screening test. It is best to follow up with your provider for additional testing mentioned above.

What are the treatments for peripheral neuropathy?

Treatment for peripheral neuropathy usually depends on its cause. When neuropathy is caused by an injury, rehabilitation may help improve symptoms. Orthopedic devices, like braces or splints, may help maintain a position that reduces pressure on a nerve and improves pain, numbness, or weakness. Surgery can also help alleviate symptoms caused by nerve damage or compression.

In the case of medication-related neuropathy, stopping the medication often improves symptoms. 

The same is true for neuropathy caused by diabetes or autoimmune disease. Treating the underlying condition may not cure the condition, but it can help improve symptoms and prevent neuropathy from becoming worse.

There are several types of medications that can help treat the pain associated with neuropathy. Some of these medications are known to treat neuropathic pain, which means pain related to nerve damage. Examples of these medications include: 

• Gabapentin (Neurontin) 

• Pregabalin (Lyrica)

• Antidepressants

• Seizure medications

• Local anesthetics 

There are also some non-medication options for treating peripheral neuropathy, such as acupuncture and transcutaneous electrical nerve stimulation (TENS). These treatments may be helpful for some people, but more research is needed, particularly for TENS therapy. 

Is neuropathy curable?

In most cases, there is no cure for neuropathy. But many of the treatments described above can help improve the discomfort neuropathy may cause. And if the neuropathy is due to an underlying condition, treating that condition can often prevent it from worsening.

What are the long-term risks of peripheral neuropathy?

If the underlying cause of neuropathy is not treated, it can cause some long-term problems:

• Neuropathy involving a motor nerve can cause muscle wasting and weakness. Weakness can make it difficult to do your usual daily activities, and it can also increase your risk of falling.

• Neuropathy of a sensory nerve can cause long-term numbness or inability to feel pain or discomfort. This can make it difficult for you to know if you have accidentally hurt yourself — like if you step on something sharp — and it can lead to infection. In serious cases, the injury and infection can become severe and can even require surgery.

What can you do to prevent peripheral neuropathy?

The best ways to prevent peripheral neuropathy are to:

• Treat any medical conditions that may cause nerve damage, like diabetes.

• Avoid taking medications that are known to possibly cause neuropathy, unless absolutely necessary.

• Talk to your healthcare team about the risks of nerve injury from a medical procedure before deciding to have one.

Is there anything that makes peripheral neuropathy worse?

Some factors may make peripheral neuropathy worse like:

• Smoking: Smoking makes the blood vessels smaller. This makes it harder for the blood to carry nutrients and oxygen to the nerves in your arms and legs, which may make neuropathy worse.

• Diet: Eating a diet that is rich in saturated fat (think greasy or fried foods) may cause worsened inflammation throughout the body and could make neuropathy worse. 

• Vitamin deficiencies: Certain vitamin deficiencies have been shown to make neuropathies worse. Your provider can help test your vitamin levels to see if a supplement may be good for you.

• Alcohol: Some peripheral neuropathies are caused by alcohol use.

• Stress: Chronic stress may make neuropathy hurt more. 

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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