In fact, neuropathy, which is sometimes referred to as peripheral neuropathy, is not a single health condition but rather a term used to describe a range of health problems involving damage to the peripheral nerves, as well as the symptoms of those issues. While the group of conditions is irreversible, you can take steps to help prevent neuropathy or manage it through diet, lifestyle, and treatment.
Temporary or permanent numbnessTingling, prickling, or burning sensationIncreased sensitivity to touchPainMuscle weakness or wastingParalysisDysfunction in organs or glandsImpairment to urination and sexual function
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 brain and spinal cord — and the peripheral nervous system, which transmits messages between the central nervous system and the rest of your body. (3) In turn, the peripheral nervous system is divided into a voluntary — or somatic — nervous system controlling all of the functions we are aware of and can consciously control, such as moving limbs; and an involuntary — or autonomic — nervous system regulating processes we can’t consciously direct, such as heartbeat, breathing, and digestion. Damage or disruption to both voluntary and involuntary peripheral nerves can be involved in neuropathy. Sensory and motor nerves can be affected. (1) Learn More About Signs and Symptoms of Neuropathy
Health Conditions
The Foundation for Peripheral Neuropathy (FPN) describes the following common causes of neuropathy: 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. (4) Idiopathic Neuropathy The second-largest group of neuropathy sufferers are those for which no cause has been identified — 23 percent — and therefore their condition is known as idiopathic peripheral neuropathy. (5) Chronic Alcoholism Alcoholic neuropathy is considered one of the most common forms of neuropathy. Roughly 65 percent of those diagnosed with alcohol-use disorder experience neuropathy, according to a January 2017 review. Cancer Specifically, chemotherapy-induced peripheral neuropathy afflicts 10 percent of Americans with neuropathy. (6,7) HIV/AIDS About 2 percent of total neuropathy cases are attributed to HIV/AIDs, which can be due to the effects of the human immunodeficiency virus or the drugs used to treat it. (8) Additional health conditions, including autoimmune diseases, and health events, such as physical trauma, are associated with neuropathy. (9) More on these later.
Dietary Risk Factors
Nutrient deficiencies — whether caused by disease-related malabsorption, alcoholism, or an unbalanced diet — can also lead to neuropathy. Vitamin B12 Deficiency A 2012 study of more than 2,000 older adults found that 7 percent of them presented with B12 deficiency, and that deficiency was associated with worse sensory and motor peripheral nerve function. (10) 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. Sources of vitamin B12 include fish, meat, poultry, eggs, milk and other dairy products. Getting more B12 in your diet is important if your doctor determines you’re deficient through a blood test, but taking B12 supplements or getting injections is also an option. (11) According to the National Institutes of Health’s Office of Dietary Supplements (ODS), the recommended daily allowance (RDA) of the nutrient for most people ages 14 and older is 24 micrograms (mcg), though women who are pregnant or lactating should get 26 mcg and 28 mcg, respectively. (12) 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. (12) Copper Deficiency This nutrient deficiency is another, though rarer, cause of neuropathy, says Norman Latov, MD, PhD, a neurologist at 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 offer dietary copper. (13) However, Dr. Latov says the deficiency is usually a result of an individual’s metabolism or malabsorption, rather than an unbalanced diet. Injectable and oral supplements can help treat the condition, according to a literature review from 2016. (14) Excess Nutrient Consumption Getting too much of a nutrient can also lead to neuropathy as well, Latov cautions. For instance, “too much B6 can be toxic to the nerves. The normal requirement is less than 2 milligrams a day, yet many B6 supplements are 100 milligrams 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 your blood levels checked to make sure they’re not in excess.” A peer-reviewed article contains more information about toxicity. (15) Exposure to Toxins in Food Toxins contained 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, and recommends that young children and women who are 16 to 49 years old, pregnant, or breastfeeding limit their servings to two to three a week (8 to 12 ounces for people over age 10). (16) Arsenic, another heavy metal, can also cause neuropathy if ingested in high amounts. Usually, this results from exposure via drinking water that has been exposed to industrial waste. Arsenic can be found in brown and white rice in trace amounts, but not at levels high enough to cause nerve damage. (17) A report from 2014 provides more detail on the nerve damage that both mercury and arsenic can cause. (18) “Brown rice can have high arsenic levels, and that can cause neuropathy too,” Latov says. Learn More About Causes of Neuropathy: Risk Factors and More Mononeuropathy When neuropathy involves damage to only one nerve, it is called mononeuropathy. (19) Mononeuropathies are often caused by compression or injury to a nerve, such as carpal tunnel syndrome. Polyneuropathy Most often, multiple nerves are affected, and when this happens, doctors refer to the nerve damage as polyneuropathy. The symptoms depend on whether autonomic, sensory, or motor nerves — or a combination of them — are involved. Autonomic nerve damage can affect bodily functions or blood pressure and even create gastrointestinal symptoms. Damage to sensory nerves can affect sensations and sense of balance, while damage to motor nerves can affect movement and reflexes. (19) When both sensory and motor nerves are involved, the condition is known as sensorimotor polyneuropathy, in which damage happens bodywide to nerve cells, fibers (axons), and coverings (myelin sheaths). (20) Distal Symmetric Polyneuropathy This is a common type of polyneuropathy and the one most prevalent among people with diabetes, 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 extremities may also become involved eventually. (21) Learn More About Polyneuropathy and Other Types of Neuropathy
Neuropathic Pain
Neuropathic pain can develop when the nerves of the somatic nervous system become damaged and transmit sensory 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. (22) The primer lists the following common conditions associated with peripheral neuropathic pain (22):
Postherpetic neuralgia (a complication of herpes zoster, also known as shingles)Trigeminal neuralgia (pain from a nerve carrying signals from the face to the brain)Diabetic neuropathyHIV-associated peripheral sensory neuropathyLeprosyPeripheral nerve injury pain.
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 Medicine 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 PainAllodynia: 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 dysesthesia).
Learn More About Neuropathic Pain and How It’s Treated After that, tests may be ordered, including: (23) Electrodiagnostic Testing This includes nerve conduction testing, where nerves are stimulated and their responses are recorded and analyzed for abnormalities, and electromyography where small needles are inserted 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 small incision is made 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) Used 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.
Prognosis of Neuropathy
The prognosis for neuropathy depends on the type you have and how much it has progressed. Nerve damage can be permanent. (24) However, correcting the underlying condition that caused neuropathy can allow nerves to recover or regenerate in some cases. (2) For instance, getting your blood sugar under control can help halt the progression of nerve damage and improve the symptoms of diabetic neuropathy. If that underlying cause isn’t being addressed, neuropathy can worsen. (2) Higher diabetic neuropathic pain is also associated with smoking tobacco, according to a 2020 paper, so kicking the habit may also improve neuropathy symptoms. Sometimes nerve damage can be addressed with surgery, says Peter Highlander, DPM, a podiatrist based in Bellevue, Ohio. Through neurolysis, any scar tissue or constricting tissue around or within a nerve may be removed in order to release pressure on the nerve. (25) This technique is more commonly used to treat the pain of carpal tunnel syndrome but can be employed to treat diabetic neuropathy, according to a report from 2020. (26) 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. According to a 2014 review, just over two-thirds of those who had chemotherapy experienced neuropathy one month after their treatment. But after six months, that proportion had decreased to 30 percent. (27)
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:
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), which restore the chemical balance in the nerve cells of the brainSerotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrineNorepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrineSerotonin 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 found to be effective at treating neuropathy. “We believe the mechanism of effect is on calcium channels, and that can reduce transmission of those abnormal nerve signals, often within the peripheral nerve or the spinal cord,” Williams says. Gabapentin (Neurontin) and pregabalin (Lyrica) are examples of anti-seizure medications that are used to relieve nerve pain in people who have had shingles or have diabetes, according to a 2019 paper. (28) While antidepressants and anti-seizure medications are considered first-line treatment for neuropathy, patients can also get a measure of relief from other “traditional, nonspecific” medications, Williams says. Common over-the-counter medications that people reach for to address mild to moderate neuropathic pain include:
Acetaminophen (Tylenol)Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve)Topical treatments such as capsaicin and lidocaine creams (29)
Prescription medications can be taken as well. Options include:
COX-2 inhibitors like celecoxib (Celebrex)OpioidsTramadol (Ultram) (29)
Surgery
As mentioned, Dr. Highlander says surgery can be useful to release pressure on a nerve and can be used to treat damage caused by carpal tunnel syndrome and diabetic neuropathy. (26)
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 needed to prove its efficacy. 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.” (30) However, another study from 2018 asserted that there isn’t enough good evidence to say that any cannabis-derived product works for chronic neuropathic pain. (31) 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, potatoes, Brussels sprouts, yeast, and organ meats such as kidney and liver. A 2016 review of randomized controlled trials concluded that 600 mg of oral or intravenous alpha lipoic acid improved symptoms in five of the trials studied. (32) Carnitine Another fatty acid, it is sometimes deficient in cases of 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. (33) However, supplementing in its fatty acid form, known as acetyl-L-carnitine, can help treat neuropathy, says Smith. Some studies have shown nerve regeneration and an improvement in nerve pain after acetyl-L-carnitine supplementation. (34)
Diet and Neuropathy
Proper nutrition is key for preventing or treating any health issues that may be at the root of 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. (35) 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, thereby preventing or minimizing 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/whole grains, low-fat or nonfat dairy, and lean proteins like poultry and fish. (36) Having celiac disease can put you at risk for developing nerve damage, so if you have been diagnosed with this disorder, stick to the gluten-free diet prescribed for you. Gluten is found in many types of bread, pasta, cereal, and processed foods that contain wheat, rye, barley, and sometimes oats. (37) If you have alcoholism-related neuropathy, it goes without saying that the best advice is to abstain from drinking to help control your symptoms. Heavy drinking can result in malabsorption of the nutrients such as vitamin B12, as well as direct poisoning of nerves. (38) Learn More About the Relationship Between Nutrition and Neuropathy 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.” (39) 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 plastic mirror to keep at your bedside to check the bottoms of your feet. Or, he says, you could have a loved one check them. Remember that if you’ve lost any sensation, you may not know when you are overdoing it with exercise. On the other hand, get as much exercise as is safe. The Foundation for Peripheral Neuropathy has a guide to getting started. Learn More About How to Exercise Safely if You Have Neuropathy Also, exercise can help to prevent or slow the progression of diabetic neuropathy and strengthen muscles wasted by motor neuropathies. (20) Yet some causes of neuropathy, such as Charcot-Marie-Tooth disease, are hereditary and cannot be prevented. The condition, which affects more than 126,000 people in the United States, causes muscle weakness and atrophy, according to the NINDS. (40) 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. (41) “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. Learn More About the Complications of Neuropathy: How It Affects Your Body in the Short and Long Term 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. (7) 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). (42) Yet in a 2017 study of more than 1,900 people who had painful diabetic peripheral neuropathy symptoms, 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. (43) However, a 2015 study found that women of African descent being treated for breast cancer with specific chemotherapy drugs known as taxanes were more likely to report painful neuropathy symptoms than women of European descent. (44)
Metabolic disorders such as hypoglycemia or kidney failureAutoimmune disorders such as celiac disease, rheumatoid arthritis, lupus, sarcoidosis, Sjögren’s syndrome, and Guillain-Barré syndromeInfectious diseasesPhysical traumaCompressionRepetitive stressToxicityHereditary disorders such as Charcot-Marie-Tooth diseaseHormonal disordersAlcoholismCertain nutrient deficiencies or excesses
Because chronic high blood pressure and diabetes can cause neuropathy or nerve pain, we couldn’t compile a resource list without including the American Diabetes Association. Here, you’ll find a detailed description of sensations you may have with neuropathy, along with information about treatments. Find out more about the potential health complications of type 2 diabetes. Western Neuropathy Association (WNA) 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.
Favorite Resource for Comorbidities
Hereditary Neuropathy Foundation (HNF) The HNF brings awareness not only to neuropathy but also Charcot-Marie-Tooth disease (CMT) and other inherited neuropathies. CMT is a genetic disorder caused by 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. Livestrong Neuropathy is a common complication of cancer, whether due to the location of your tumor or the treatment, such as chemotherapy, that you’ve undergone. On the Livestrong Foundation website you can find essential info on the cancer-related triggers and treatments for nerve damage, the best questions to ask your doctor about neuropathy, and resources for finding a neuropathy support group. For more on the connection between cancer and nerve damage, check out our article.
Favorite Resource for Diet Advice
The Foundation for Peripheral Neuropathy (FPN) 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.
Favorite Resource for Advocacy
Neuropathy Action Foundation (NAF) 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.
Favorite Resource for Neuropathy Products
The Foundation for Peripheral Neuropathy Muscle weakness and pain due to neuropathy can cause physical limitations. But this doesn’t have to stop you from living your best life. Plenty of assistive devices can help you maintain your independence. The foundation recommends items you can use inside and outside of the house.
Favorite Resources for Online Support
Our Neuropathy Friends If you’re active on social media, stop by the Our Neuropathy Friends Facebook page and join the discussion. Comprising more than 4,000 members, this website is an excellent place to connect with people who understand your situation firsthand. Ask questions, share tips, or relate your personal experiences. Neuropathy Commons 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. The Foundation for Peripheral Neuropathy We’ve included the FPN thrice, and for good reason. The FPN has excellent resources for finding virtual support groups.
