Understanding your pain
Peripheral neuropathy symptoms
Peripheral neuropathy is damage to the peripheral nerves, the nerves outside the brain and spinal cord that carry feeling and movement signals to and from the rest of the body. It most often starts in the feet and can later affect the legs and hands.
Neuropathy symptoms can vary from person to person. They may include:
- burning, sharp or shooting pain;
- tingling or “pins and needles” feelings;
- numbness, or trouble feeling touch, heat or cold;
- pain from a light touch, such as bedsheets on your feet;
- weakness, or trouble with balance and walking.
Symptoms are often worse at night, and they usually affect both sides of the body.
What may be causing it
Common causes of peripheral neuropathy
Many conditions can damage the peripheral nerves:
- Diabetes. The most common cause in the United States. Over time, high blood sugar can damage the nerves.
- Chemotherapy. Some cancer medicines can cause nerve pain, which may continue after treatment ends.
- Low vitamin B12. Some other vitamin problems can affect the nerves too.
- Heavy alcohol use and some toxins.
- Kidney, liver or thyroid problems.
- Some infections, such as shingles.
- Injury or pressure on a nerve.
- Autoimmune conditions, in which the immune system attacks the nerves.
Sometimes no cause is found.
Pain, tingling or numbness that travels from your lower back down a leg may come from a pinched spinal nerve root instead (radiculopathy), which is evaluated differently.
Diabetic neuropathy treatment
Diabetic neuropathy pain
Diabetes is the most common cause of peripheral neuropathy. Over time, high blood sugar can damage the nerves, most often in the feet and legs.
Painful diabetic neuropathy can cause burning, sharp or electric pain, tingling or numbness, often in both feet and often worse at night. Our providers treat the nerve pain. Your primary care doctor or endocrinologist keeps managing your diabetes, and keeping your blood sugar, blood pressure and cholesterol near your goals can help keep nerve damage from getting worse.
Options for diabetic nerve pain may include:
- Medication management Nerve pain medicines and creams or patches applied to the skin, with regular follow-up.
- Spinal cord stimulation Certain spinal cord stimulation systems are FDA-approved to treat painful diabetic neuropathy in the legs and feet when other treatments have not given enough relief. A short trial comes first.
How much any treatment helps varies from person to person. Check your feet every day, and tell the clinician who manages your diabetes about any sore, blister or wound.
When to book a visit
When to see a pain specialist for neuropathy
Consider an appointment if burning, tingling or numbness in your feet or hands does not go away, keeps you up at night, or makes it hard to walk, work or sleep. If you have diabetes or have had chemotherapy and notice new nerve symptoms, tell the clinician who manages that care as well.
When to seek emergency care
Sudden weakness or numbness, especially on one side of the body or face, trouble speaking, or weakness that spreads quickly up the legs or arms can be an emergency. Call 911 or go to an emergency room. If you have diabetes and find a foot sore or wound that is red, swollen, warm or not getting better, contact your doctor right away.
Your evaluation
How we evaluate peripheral neuropathy
Your provider aims to find what may be causing your nerve pain and how it affects your daily life. An evaluation may include:
Medical history
Your symptoms and when they started, other health conditions such as diabetes, your medicines, any past cancer treatment and alcohol use.
Physical exam
How well you feel touch, vibration and temperature, your reflexes, strength and balance, and a look at your feet.
Blood tests
Your provider may order or review blood tests, such as blood sugar, vitamin B12 and thyroid levels, to look for causes that can be treated.
Nerve testing, if needed
Your provider may refer you for nerve conduction studies or electromyography (EMG), which measure how the nerves are working.
Which of these you need depends on your symptoms and exam. You then hear what may be causing your symptoms and discuss which tests or treatments make sense for you.
Your care options
Treatment options for peripheral neuropathy
Treatment depends on the cause, on where you feel symptoms and on how they affect your life. Care for the cause, such as blood sugar control in diabetes, is part of the plan, and your provider can work alongside the clinicians who manage it.
- Medication management Nerve pain medicines, such as some first developed for seizures or depression, and creams or patches applied to the skin, with a careful plan and regular follow-up.
- Nerve blocks Numbing medicine placed near a specific nerve. May be considered when pain comes from one nerve or one area.
- Spinal cord stimulation A device that sends mild electrical pulses to the spinal cord, tried first during a short trial. May be considered when nerve pain continues despite other treatments, including painful diabetic neuropathy.
- Peripheral nerve stimulation A device that sends mild electrical pulses to a nerve outside the spine. Your provider can tell you whether it may fit you.
Staying active within your limits, checking your feet every day and wearing shoes that protect them are part of care too. Not every option suits every person, and your plan is based on your evaluation. If a procedure is recommended, the team explains the steps, the possible risks and what recovery looks like before you decide.
Common questions
Questions about peripheral neuropathy
Your provider can answer questions about your own care at your visit.
What is peripheral neuropathy?
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. It often causes burning pain, tingling or numbness that starts in the feet and can spread to the legs and hands. Diabetes is the most common cause, but chemotherapy, low vitamin B12, heavy alcohol use and other conditions can also cause it.
Do you treat diabetic neuropathy?
Yes. Our providers treat the nerve pain of diabetic neuropathy, with options such as nerve pain medicines and, for some people, spinal cord stimulation after a trial. Your primary care doctor or endocrinologist keeps managing your blood sugar, which helps protect your nerves.
What kind of doctor treats neuropathy?
Several kinds of clinicians care for neuropathy. Primary care doctors, endocrinologists and neurologists often look for and manage the cause, and a pain management practice focuses on nerve pain that continues. At Lewis Pain & Physical Medicine in Frisco, our providers evaluate neuropathy pain and work alongside the clinicians who treat the cause.
What treatments are there for neuropathy pain?
There is no single best treatment for everyone. Care often combines treatment of the cause, such as blood sugar control, with nerve pain medicines or creams and patches applied to the skin. When those are not enough, procedures such as nerve blocks or spinal cord stimulation may be considered for some patients.
Can neuropathy get better?
Sometimes. When a cause such as low vitamin B12 is found and treated, symptoms may improve. Nerve damage from long-standing diabetes often does not go away, so treatment aims to ease pain and help you stay active. Your provider can tell you what may be realistic for you.
Can a nerve block help neuropathy?
A nerve block places numbing medicine, sometimes with a steroid, near a specific nerve. It may help some patients when pain comes from one nerve or a small area, and it is used less often when neuropathy affects both feet evenly. How long any relief lasts varies, and your provider can explain whether a block may fit you.
Related care
Clinical references
This page shares general information. It is not medical advice and does not replace a visit with a qualified clinician.