Tingling, numbness and nerve pain: what is peripheral neuropathy?

First, when is this an emergency?

Sudden weakness or numbness on one side, facial drooping or difficulty speaking can be signs of stroke. Call your local emergency service immediately, even if the symptoms go away. This is different from waiting for a routine appointment about ongoing tingling.3

What do peripheral nerves do?

Peripheral nerves connect the brain and spinal cord with the rest of the body. Sensory nerves carry information such as touch, pain and temperature. Motor nerves help muscles move. Autonomic nerves help regulate processes such as sweating and blood pressure. Different nerves and causes can produce different patterns.1

What might someone notice?

Some people feel pins and needles, burning, pain or reduced sensation, often in the feet or hands; others notice weakness, balance difficulties or changes in automatic functions. Symptoms can have other explanations and may come on at different speeds. New, persistent or worsening symptoms deserve a clinical discussion rather than a self-diagnosis.1

What can cause it?

Possible causes include diabetes, some medicines, alcohol, vitamin deficiencies, excess vitamin B6 from supplements, immune conditions and inherited disorders. Sometimes a cause is not found. The pattern, timing, medical history and products used help a clinician decide what to investigate. For a common source of confusion, see how B6 and B12 can affect nerves differently. Nitrous oxide exposure is one distinct question; see how it can affect B12 and nerves.145

What happens at an assessment?

A clinician may ask when symptoms started, which areas are affected, whether there is weakness or a change in balance, and about medical conditions and medicines. Bring a list or photos of all supplements, including combination magnesium and multivitamin products. An examination can check sensation, strength and reflexes; blood tests may look for causes such as diabetes or B12 deficiency. The tests depend on the person.24

Can a normal nerve test rule it out?

Not always. Nerve-conduction studies mainly assess larger nerve fibres, so they can be normal in some small-fibre neuropathies. A specialist may consider other tests, including a small skin biopsy or tests of automatic nerve function, when appropriate. No single test or online checklist explains every symptom.12

Can nerves recover?

Sometimes symptoms improve when a cause is identified and addressed, but recovery varies and may be incomplete. Care may include addressing an underlying condition, managing symptoms and protecting areas with reduced sensation from injury. A “nerve repair” claim needs evidence of meaningful benefit in the relevant condition; the ARA-290 studies illustrate why an image and symptom improvement are different outcomes.

Reduced feeling in the feet can make cuts or blisters harder to notice. For people with diabetes, the US National Institute of Diabetes and Digestive and Kidney Diseases advises checking the feet daily and contacting a clinician promptly about a sore, swelling or another foot problem. Ask for help with checking if you cannot see or reach your feet. A clinician can explain foot care and follow-up for your own circumstances, including if you have reduced sensation for another reason.1678