Peripheral neuropathy — damage to the peripheral nerves producing pain, numbness, tingling and weakness, most commonly in the feet and hands — has many causes including diabetes, chemotherapy, alcohol, autoimmune conditions and vitamin deficiencies. Management involves addressing the underlying cause alongside specialist support for the neuropathic symptoms themselves.
See therapies that may helpThe peripheral nervous system connects the brain and spinal cord to the rest of the body. Peripheral neuropathy occurs when these nerves are damaged, producing a characteristic pattern of symptoms — typically starting in the feet and hands and potentially spreading proximally. The most common type is distal symmetric polyneuropathy.
Common causes include: diabetic neuropathy (the most common cause globally); chemotherapy-induced neuropathy; alcohol-related neuropathy; vitamin B12 deficiency; autoimmune conditions (Guillain-Barré, CIDP); kidney and liver disease; infections (Lyme disease, HIV); hereditary conditions (Charcot-Marie-Tooth); and idiopathic (no identifiable cause in around 25% of cases).
Peripheral neuropathy symptoms typically include:
Management of peripheral neuropathy combines addressing the underlying cause with symptom management:
A GP is the appropriate first contact for neuropathy symptoms to establish diagnosis and investigate the underlying cause. Referral to a neurologist may be needed for complex presentations. Pain clinic referral is appropriate for refractory neuropathic pain. Diabetes UK, Charcot-Marie-Tooth UK and condition-specific charities provide specialist resources and support.
Showing 10 therapies linked to Peripheral neuropathy support (adjunct).
| Therapy | Evidence | Notes |
|---|---|---|
| Cognitive Behavioural Therapist |
strong
|
CBT for peripheral neuropathy pain distress. |
| Counsellor |
moderate
|
Counselling for peripheral neuropathy distress. |
| Hydrotherapist |
moderate
|
Hydrotherapy for peripheral neuropathy. |
| Mindfulness Practitioner |
moderate
|
Mindfulness for peripheral neuropathy pain. |
| Nutritional Therapist |
moderate
|
Nutritional support for peripheral neuropathy (B12, B6). |
| Physiotherapist |
moderate
|
Balance and strength training for peripheral neuropathy. |
| Psychotherapist |
moderate
|
Psychotherapy for peripheral neuropathy distress. |
| Sex Therapist |
moderate
|
Sex therapy for peripheral neuropathy sexual impact. |
| Speech Therapist |
moderate
|
Speech therapy for peripheral neuropathy swallowing issues. |
| Hypnotherapist |
limited
|
Supportive for neuropathy pain with anxiety component. |
Whether neuropathy is reversible depends primarily on the cause. Neuropathy from vitamin B12 deficiency or alcohol (when drinking stops) can partially or fully reverse. Diabetic neuropathy may stabilise with good glucose control. Chemotherapy-induced neuropathy often gradually improves after treatment ends. Neuropathy from structural nerve damage or advanced degeneration may not fully reverse.
Diabetes is the most common cause of peripheral neuropathy globally, affecting around 50% of people with diabetes over their lifetime. Good blood glucose control significantly reduces the risk of developing diabetic neuropathy and slows its progression if already present.
Yes — careful daily foot inspection, appropriate footwear and regular podiatry are essential for people with diabetic neuropathy. Reduced sensation means injuries may go unnoticed, leading to serious complications. Diabetes UK recommends annual foot checks and people should seek prompt assessment for any foot injury or change.
Standard analgesics are largely ineffective for neuropathic pain because they target peripheral inflammation rather than the abnormal nerve signalling causing neuropathic symptoms. Neuropathic pain requires agents targeting nerve activity — anticonvulsants (gabapentin, pregabalin), tricyclic antidepressants or specific topical agents.
Yes — physiotherapy addresses the functional consequences of neuropathy rather than the nerve damage itself. Strength training compensates for weakness; balance training and proprioceptive exercises reduce fall risk; and walking aids or orthotics may help with foot drop. A physiotherapist with neurological condition experience is most appropriate.