Neuropathy is a group of disorders that damage peripheral or autonomic nerves, causing sensory, motor, or autonomic symptoms. Common causes include diabetes, alcohol, infections, toxins, and vitamin deficiencies. Diagnosis relies on clinical exam plus tests such as nerve conduction studies, EMG, and targeted lab work. Treatment aims to address reversible causes, manage pain with medications like duloxetine or gabapentin, and support function through therapy and fall prevention. Refer to neurology for progressive, unclear, or autonomic cases.

What is neuropathy?

Neuropathy is an umbrella term for disorders that damage the peripheral or autonomic nerves and interfere with how the nervous system sends signals between the brain/spinal cord and the rest of the body. It is not a single disease but a pattern of nerve injury that can be sensory, motor, autonomic, or mixed.

Major types

Peripheral (poly)neuropathy

Affects many nerves, typically starting in the hands or feet. Common patterns include symmetric numbness, tingling, burning, or weakness.

Mononeuropathy

Involves a single nerve (for example, carpal tunnel syndrome) and produces symptoms limited to that nerve's distribution.

Autonomic neuropathy

Impacts involuntary functions such as heart rate, blood pressure, digestion, bladder control, or sweating.

Common causes

Neuropathy has many causes. The most frequent include diabetes, excessive alcohol use, certain infections (for example, shingles/herpes zoster), autoimmune disorders, inherited conditions, and nutritional deficiencies such as vitamin B12 or vitamin E. Toxic exposures and some medications - notably some chemotherapy agents and older antiretroviral drugs - can also damage nerves.

Prompt treatment of the underlying cause often limits progression and can improve symptoms.

Symptoms to watch for

Symptoms vary by type and affected nerves. Typical complaints include:

  • Numbness, tingling, or burning in the hands and feet
  • Muscle weakness, cramps, or loss of coordination
  • Loss of reflexes and balance problems
  • Unusual sweating, dizziness on standing, gastrointestinal symptoms, or bladder dysfunction when autonomic nerves are involved
Symptoms can develop gradually or suddenly depending on the cause.

How neuropathy is diagnosed

A careful medical history and neurologic exam guide testing. Common diagnostic tools include:

  • Nerve conduction studies (NCS) and electromyography (EMG) to measure large-fiber function
  • Blood tests to identify diabetes, vitamin deficiencies, autoimmune markers, or other systemic causes
  • Small-fiber neuropathy evaluation (skin biopsy or specialized sensory testing) when symptoms suggest small-fiber involvement
  • Autonomic testing when autonomic symptoms are present
These tests help determine the type, severity, and likely cause of the neuropathy.

Treatment and management

Treatment has two goals: treat any reversible cause and relieve symptoms. Approaches include:

  • Disease-directed care: glucose control for diabetic neuropathy, vitamin replacement for deficiencies, stopping or changing an offending drug, or immunotherapy (for some autoimmune neuropathies)
  • Symptom management: medications such as duloxetine, pregabalin, gabapentin, or certain antidepressants; topical agents like lidocaine or capsaicin for localized pain
  • Non-pharmacologic care: physical therapy, occupational therapy, balance training, foot care, and fall prevention
Refer to a neurologist when diagnosis is uncertain, symptoms progress, or specialized treatments (for example, IVIG, plasmapheresis, or surgical decompression for mononeuropathy) are under consideration.

When to seek care

See a clinician for new or progressive numbness, persistent pain, weakness, unexplained falls, or symptoms of autonomic dysfunction (fainting, severe constipation, urinary problems). Early evaluation improves the chance of identifying treatable causes and limiting permanent nerve damage.

FAQs about Neuropathy

Is neuropathy the same as nerve pain?
Not always. Neuropathy is any nerve disorder; nerve pain (neuropathic pain) is one common symptom. Neuropathy can also cause numbness, weakness, or autonomic problems without severe pain.
Can neuropathy be reversed?
It depends on the cause. Some causes (timely glucose control, vitamin replacement, stopping a toxic drug) can stop progression and allow partial recovery. Chronic nerve damage may be permanent, but symptoms can often be managed.
What tests will a doctor use to diagnose neuropathy?
Doctors start with history and neurologic exam. Common tests include blood work, nerve conduction studies (NCS), electromyography (EMG), skin biopsy or sensory testing for small-fiber neuropathy, and autonomic testing when indicated.
Which medicines help nerve pain?
First-line medicines often include duloxetine, pregabalin, gabapentin, and certain tricyclic antidepressants. Topical lidocaine or capsaicin can help localized pain. Choice depends on symptom pattern, other health conditions, and side effects.
When should I see a neurologist?
See a neurologist for progressive symptoms, unclear diagnosis, severe weakness, autonomic symptoms (fainting, bladder problems), or when specialized treatments such as IVIG or plasmapheresis may be needed.