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. This is a symptom of neuropathy, also known as peripheral neuropathy.

Neuropathy is nerve damage. And it can have many different causes and affect many different nerves.

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

What is neuropathy?

The word “neuropathy” means nerve damage or dysfunction. The human 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. It can affect just one nerve, or it can affect several nerves. The type and number of nerves involved determines what kind of symptoms you’ll have. 

Typically, neuropathy is a long-term condition. But depending on the underlying cause, it could be reversible.

What causes neuropathy?

There are more than 200 possible causes of neuropathy. But diabetes is the most common cause of neuropathy in the U.S. 

Other causes include:

• Trauma (injury): 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: Certain hereditary conditions, like Charcot-Marie-Tooth disease, are rarer causes of neuropathy.

What are the different types of neuropathies?

First, it’s helpful to know the different types of peripheral nerves:

• Sensory nerves: These are the nerves that help you feel.

• Motor nerves: These nerves help you move. 

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

Neuropathy can affect any of these nerve types, or a combination of types. As such, there are over 100 different types of neuropathy.

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Peripheral neuropathy might also be categorized into types depending on where in the body it occurs or what causes it. For example:

• Cranial neuropathy: This is damage to any of the 12 cranial nerves.

• Diabetic neuropathy: This type is due to diabetes.

• Focal neuropathy: Focal neuropathy is damage to a single nerve or group of nerves in one location.

• Inflammatory neuropathy: This type is due to infection or inflammation in the body.

• Toxic neuropathy: This is due to chemicals or medications, like chemotherapy.

What are the symptoms of neuropathy?

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

Common symptoms of neuropathy include:

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

• Painful sensitivity to touch

• Painful burning, shooting, or aching sensation

• Loss of sensation

• Muscle weakness

• Muscle twitching

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

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, lightheadedness, or fainting

• Loss of balance

• Digestive symptoms

• Changes in breathing or heart rate

How is peripheral neuropathy diagnosed?

Peripheral neuropathy is often diagnosed based on a combination of elements, including:

• Symptoms: including where the symptoms are and how they feel

• History of symptoms: such as when the symptoms started

• A physical exam: including assessing loss of sensation or muscle strength

Sometimes, performing tests to rule out other conditions may be helpful. These tests may include:

• Blood work

• Spinal fluid tests

• Imaging (in some cases)

There are also tests that are specific to nerve function:

• A nerve conduction study (NCS) tests conduction through nerves. It can help identify which nerves are damaged. 

• Electromyography (EMG) tests how well a muscle responds to a nerve signal.

EMG and NCS are often performed at the same time.

What are the treatments for peripheral neuropathy?

Treatment for peripheral neuropathy usually depends on its cause. Treating the underlying cause first may help with symptom relief. 

Here are some examples of causes and related treatments:

• Injury: When neuropathy is caused by an injury, rehabilitation may help improve symptoms. 

• Pressure on a nerve: Using orthopedic devices, like braces or splints, may help you to maintain a position that reduces pressure on a nerve and improves pain, numbness, or weakness. Surgery can sometimes help relieve symptoms caused by nerve damage or compression.

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

• An underlying condition: Treating an underlying condition, like diabetes or autoimmune disease, can help improve symptoms and prevent neuropathy from becoming worse.

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

• Gabapentin (Neurontin) 

• Pregabalin (Lyrica)

• Antidepressants, such as duloxetine (Cymbalta)

• Local anesthetics, such as capsaicin

There are also some non-medication options for treating peripheral neuropathy. These include:

• Acupuncture

• Transcutaneous electrical nerve stimulation (TENS)

• Exercise

• Meditation

What are the long-term risks of peripheral neuropathy?

If the underlying cause of neuropathy isn’t treated, it can cause some long-term problems:

• Neuropathy involving a motor nerve: This can cause muscle wasting and weakness. This can make it difficult to do your usual daily activities and move around. It can also increase your risk of falling.

• Neuropathy of a sensory nerve: This type of neuropathy can cause long-term numbness or an inability to feel pain or discomfort. This can make it difficult for you to know if you’ve accidentally hurt yourself — like if you step on something sharp — which can lead to infection. In serious cases, the resulting infection could be life- or limb-threatening.

• Neuropathy of autonomic nerves: This can affect your circulation and heartbeat. This can contribute to dizziness, increased risk of falling, and even dangerous heart rhythms.

What can you do to prevent peripheral neuropathy?

The best ways to prevent peripheral neuropathy are to:

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

• Get clear on medication side effects. Avoid taking medications that are known to possibly cause neuropathy, unless absolutely necessary.

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

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in NYC. She's 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:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She is co-executive director at Nonclinical Physicians Network and has served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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