What is peripheral neuropathy?
Plain English definition
Peripheral neuropathy is damage to nerves outside the brain and spinal cord. These nerves carry sensation, control movement, and regulate automatic functions like blood pressure and sweating. When they misfire or go quiet, you may notice symptoms first in the toes and fingers, then in the feet and hands.
Why it matters
Symptoms span a wide range, from mild tingling to severe stabbing or burning pain. Numbness can make it hard to feel the floor or a hot bath, while pain can wake you from sleep. Left unchecked, neuropathy can affect balance, safety, and day-to-day independence.
Hallmark symptoms include “shooting pain”
Sensory symptoms you might notice
People often describe shooting or electric shock-like pain in the hands or legs. Tingling, pins and needles, and numbness are common, as is tenderness, with even light touch causing irritation. Some notice temperature changes or a sensation of walking on pebbles.
Motor and autonomic symptoms
Neuropathy can weaken the ankles and feet, leading to tripping, poor coordination, and falls. Autonomic nerves may also be involved, causing dizziness on standing, changes in sweating, or bowel, bladder, and sexual dysfunction. These clues help your clinician pinpoint the nerve types affected.
When to call a clinician urgently
Seek care promptly for new or rapidly worsening pain, numbness, or weakness, especially if symptoms spread over hours to days. Sudden foot drop, severe imbalance, or loss of bladder or bowel control also requires urgent evaluation. Fast action can prevent complications.
What causes peripheral neuropathy?
The most common and metabolic causes
Diabetes is the leading cause in the United States. Over time, high glucose injures small fibers that carry pain and temperature as well as larger fibers that control balance. Good glycemic control reduces the risk and can slow disease progression.
Other medical and lifestyle triggers
Alcohol misuse, low vitamin levels such as B12 and thyroid, kidney, or liver disease can all damage nerves. Excessive vitamin B6 from supplements, rather than from food, may also cause sensory neuropathy. Addressing these drivers early can stabilize or improve symptoms.
Immune, infectious, hereditary, and toxic causes
Autoimmune conditions such as CIDP, lupus, and Sjögren syndrome can inflame nerves. Infections, including shingles, Lyme disease, and HIV, are known triggers, as are certain chemotherapy drugs and heavy metals. Some neuropathies are inherited, and nerves can also be injured by entrapment or trauma.
How doctors diagnose it
Stepwise evaluation
Diagnosis starts with a detailed history and neurological exam, followed by targeted tests. Common laboratory tests include glucose (A1c) and B12, with others based on risk factors. Nerve conduction studies and EMG assess how signals travel; autonomic testing evaluates blood pressure and sweating; and, in select cases, a skin or nerve biopsy confirms small fiber disease. If you are in Scottsdale, Phoenix, or Glendale, AZ, an experienced neurologist can coordinate these steps and streamline referrals to specialty care.
Evidence-based treatment options
Treat the cause, protect the function
The primary objective is to treat the underlying cause of the neuropathy. This entails tighter glucose control, correcting deficiencies, limiting alcohol intake, and managing autoimmune or toxic exposures. Physical therapy, balance training, and fall prevention protect mobility while you address the root cause.
Medications for nerve pain
Pain often improves rather than disappears. First-line options include gabapentinoids, SNRIs, and TCAs, with sodium channel blockers considered in select cases. Opioids are not recommended for the routine management of painful diabetic neuropathy.
Non-drug and interventional options
Topical therapies such as lidocaine or capsaicin can help with focal pain, while regular exercise and diligent foot care support long-term function. For refractory cases, neuromodulation or scrambler therapy may be considered after specialist evaluation. A referral to a neurology or pain team clarifies the candidate’s status and timing.
Living safely with neuropathy
Daily self-care checklist
- Inspect feet daily and wear protective, well-fitted footwear.
- Stay active with low-impact exercise as tolerated.
- Stop smoking to improve circulation and nerve healing.
- Monitor glucose closely if you have diabetes.
- Keep regular follow-ups with your primary care and neurology teams.
Who’s at higher risk?
Key risk factors to know
Risk rises with long-standing diabetes, alcohol misuse, and low B vitamins, especially B12. Certain infections and autoimmune diseases increase risk, and family history suggests a hereditary form. Knowing your risk helps you and your clinician choose the right screening and prevention plan.
FAQ
Is shooting pain in my hands or legs always neuropathy?
Not always. Sharp, electric pain with numbness or tingling is a classic neuropathic feature; therefore, schedule an evaluation to rule out treatable causes.
Which deficiencies or supplements are linked to neuropathy?
B12 deficiency is a well-known cause. Excess vitamin B6 from supplements may also cause sensory symptoms.
How is neuropathy confirmed?
After the exam, clinicians may order blood tests, nerve conduction studies, or EMG, autonomic testing, and occasionally a skin or nerve biopsy.
What treatments help painful diabetic neuropathy?
Guidelines support gabapentinoids, SNRIs, TCAs, and sodium channel blockers, while avoiding routine opioid use.
Can neuropathy be reversed?
Some causes improve when the trigger is corrected, such as restoring B12 or improving glycemic control. Pain relief is typically about meaningful reduction rather than complete elimination.
Ready for next steps? Connect with a neurology team that treats neuropathy every day. If you are in Scottsdale, AZ, Phoenix, AZ, or Glendale, AZ, schedule a visit to obtain a clear diagnosis and a personalized plan that aligns with your goals. Call today to request an appointment and start protecting your function and quality of life in Scottsdale, Phoenix, or Glendale, AZ.