Peripheral neuropathy

What peripheral neuropathy is

Your peripheral nerves carry messages between your brain and spinal cord and the rest of your body. They control feeling, movement and things that happen automatically, like digestion and heart rate. When these nerves are damaged, the messages go wrong. This is peripheral neuropathy.

It is common, especially as people get older. About 1 in 10 people aged 55 and over in the UK has it.

Common causes

• Type 1 or type 2 diabetes
• Drinking too much alcohol over many years
• Low vitamin B12
• Some chemotherapy medicines
• Some other medicines, such as certain antibiotics
• Underactive thyroid
• Kidney or liver disease
• Shingles, HIV and other infections
• Nerve injury
• Inherited conditions, such as Charcot-Marie-Tooth disease
• Guillain-Barré syndrome
• Rheumatoid arthritis, lupus and other immune conditions

Diabetes is the most common cause in the UK. High blood sugar slowly damages the small blood vessels that feed the nerves. Up to 1 in 4 people with diabetes have nerve damage. Sometimes no cause can be found. This is called idiopathic neuropathy.

Types of neuropathy

Neuropathy is described by which nerves are affected. Many people have more than one type.

Symptoms and how it progresses

Symptoms depend on which nerves are damaged. Common ones include:

• Pins and needles or tingling
• Numbness, or not feeling pain or heat
• Burning, stabbing or shooting pain
• Pain that is worse at night
• Feeling pain from light touch, such as bedclothes
• Muscle weakness, cramps or twitching
• Poor balance and falls
• Dizziness on standing, bowel or bladder changes

Most neuropathy develops slowly, over months or years. It usually starts in the toes and feet, because the longest nerves are affected first. Over time it can seem to spread up the legs and later into the hands. This is sometimes called a "glove and stocking" pattern.

1. Months to years

   Early signs

   Tingling, numbness or burning in the toes and feet. It may come and go at first.

2. Gradual

   Spreading

   Symptoms move up the feet and legs. Pain may get worse at night. Balance may be affected.

3. Later

   Hands and weakness

   The hands can be affected. Muscles may weaken. Loss of feeling raises the risk of foot injuries.

4. Ongoing

   Managing it

   Treating the cause, such as controlling blood sugar, can slow or stop it getting worse. Badly damaged nerves don't usually repair.

This is a typical pattern, not a rule. Some causes, such as Guillain-Barré syndrome, come on over days or weeks and need urgent help.

When to get urgent help

Diagnosis and referral

Your GP will ask about your symptoms and check feeling, strength and reflexes in your feet and hands. Blood tests look for common causes, such as diabetes, low vitamin B12, thyroid, kidney and liver problems.

If the cause isn't clear, or symptoms are unusual or getting worse quickly, your GP may refer you to a neurologist. Tests they may use include:

• Nerve conduction studies, using small electrical pulses on the skin
• Electromyography (EMG), using a fine needle in a muscle
• More blood tests, including for rare and inherited causes
• Sometimes an MRI or other scan
• Rarely, a lumbar puncture
• Rarely, a small nerve biopsy

If you have diabetes, you should have a foot check at least once a year at your GP practice or diabetes clinic. This includes testing the feeling in your feet. It is free on the NHS. If you are at higher risk, NICE says your feet should be checked more often: every 3 to 6 months for moderate risk, and every 1 to 2 months for high risk.

Treating nerve pain

The first step is to treat the cause, where possible. That might mean better control of blood sugar, B12 injections or tablets, cutting down alcohol, or changing a medicine that is damaging the nerves.

Ordinary painkillers such as paracetamol and ibuprofen often don't help nerve pain. Instead, doctors use medicines that calm down overactive nerves. These are called neuropathic pain medicines. They are started at a low dose and built up slowly.

How the NICE pathway works

1. Try one first-line medicine

   Several weeks at the highest dose you can manage

   NICE offers a choice of amitriptyline, duloxetine, gabapentin or pregabalin. Side effects are often worst in the first week or two and then ease. It can take several weeks of slowly building up before you know if a medicine helps. Local guidance often suggests giving each one 4 to 8 weeks.

2. Switch if it doesn't help

   Try another of the four

   If the first medicine doesn't work or you can't cope with the side effects, try one of the other three. You may need to try more than one. Ask before stopping, as some need to be reduced slowly.

3. Review regularly

   Early on, then at least once a year

   Your GP should check how well the medicine works, any side effects, your sleep, mood and daily activities, and whether you still need it.

4. Specialist pain service

   If pain is severe or treatments haven't worked

   NICE says you should be referred to a specialist pain service if your pain is severe, badly limits your daily life, or isn't helped by first-line medicines. You can be referred at any stage.

Specialist options

Surgery is not usually used for neuropathy itself. It may help where a single nerve is trapped, such as carpal tunnel syndrome. Other options from specialist services include:

Looking after your feet

If you can't feel your feet properly, you may not notice a cut, burn or blister. A small wound can turn into an ulcer, and an ulcer into a serious infection. Foot ulcers come before most diabetes-related amputations. Good daily foot care is one of the most important things you can do.

Self-help

Getting the best care

Neuropathy and work

Peripheral neuropathy can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has more than a minor effect on your daily life and has lasted, or is likely to last, at least 12 months. Conditions that get worse over time count. The law looks at how you would be without treatment.

If it counts, your employer must make reasonable adjustments. These might include:

• A seated role, or less standing and walking
• Flexible hours and regular breaks
• Working from home when needed
• Parking close to the entrance
• Changes to safety footwear rules
• Time off for appointments
• Avoiding work with vibrating tools or cold
• Help with fine hand tasks

Equipment that can help

• Ergonomic chair
• Sit-stand desk with an anti-fatigue mat
• Footrest
• Ergonomic keyboard and mouse
• Voice recognition software
• Easy-grip tools and pens
• Perching stool
• Walking aids

Access to Work is a government grant that can pay for equipment and support at work. For advice on your rights, contact Acas or Citizens Advice.

Benefits

Depending on how neuropathy affects you, you may be able to get Statutory Sick Pay, Personal Independence Payment (PIP) or Adult Disability Payment in Scotland, new-style Employment and Support Allowance or Universal Credit. If you have diabetes and take medicine for it, you can get free NHS prescriptions in England with a medical exemption certificate. Turn2us and Citizens Advice can help you check.

Support and sources

Last reviewed: October 2026.