What Does Neuropathy Feel Like? Symptoms and Causes

Neuropathy usually starts small: a foot that feels asleep for no reason, or a burning in the toes at bedtime. These are the ten questions patients ask us most once they get there.

What does peripheral neuropathy feel like at first?

It usually starts as tingling, burning or numbness in both feet, especially at night. The National Institute of Diabetes and Digestive and Kidney Diseases describes affected areas as feeling “burning,” “tingling, like ‘pins and needles’,” “numb,” “painful” or “weak.” Many people also notice their feet feel oddly sensitive, so a bedsheet resting on them is uncomfortable. It comes on over months, not overnight, and it usually affects both sides rather than one. Source: NIDDK.

Is peripheral neuropathy the same as idiopathic neuropathy?

No, they answer two different questions. “Peripheral” tells you where the damage is, meaning the nerves outside the brain and spinal cord. “Idiopathic” tells you why, or rather that testing did not find a why. So idiopathic peripheral neuropathy is just peripheral neuropathy with no cause found after a workup. It is a subtype, not a second condition. Source: Castelli et al., American Family Physician.

What causes peripheral neuropathy?

Diabetes is the most common identifiable cause. Up to one-half of people with diabetes have peripheral neuropathy, according to the NIDDK. Other known causes include vitamin B12 deficiency, thyroid and kidney disease, chemotherapy and some other medications, heavy alcohol use, autoimmune conditions, infections, and nerve compression or injury. Carpal tunnel syndrome is the most common single-nerve version. Source: NIDDK; StatPearls.

Why do I have neuropathy if I am not diabetic?

Because a large share of cases never get a cause identified at all. Peripheral neuropathy is idiopathic in 25 to 46 percent of cases, depending on the study. That means a workup that comes back clean is a common result, not a sign something was missed. The testing is still worth doing, because it catches the causes you can act on, such as B12 deficiency or thyroid disease. Source: Castelli et al., American Family Physician.

Is diabetic neuropathy reversible?

Nerve damage that has already happened is generally not reversible. The NIDDK notes that medicines prescribed for the pain “do not change the nerve damage.” What blood sugar control can do is slow how fast more damage builds up, which is why your primary care physician or endocrinologist stays central to your care. Managing symptoms and repairing nerves are different goals, and it is worth keeping them apart when you weigh your options. Source: NIDDK.

How common is peripheral neuropathy, really?

It is far more common with age. In two large US studies, about 13 to 14 percent of adults aged 40 and over had peripheral neuropathy by monofilament testing, rising to roughly 39 percent among older adults in the ARIC cohort. Rates ran about 28 percent in people with diabetes versus 12 percent in people without. Estimates vary a lot depending on how it is measured, so treat any single number as a rough guide. Source: Hicks et al., PMC8476511.

What early warning signs should I not ignore?

The biggest one is an injury on your foot you never felt happen. Also worth prompt attention: numbness or tingling lasting more than a few weeks, symptoms climbing from the toes toward the ankle, new unsteadiness on your feet, tripping or catching a toe, or symptoms appearing in the hands too. Reduced sensation means ordinary damage goes unnoticed, and in people with diabetes that is a well-documented path to foot complications. Source: CDC, Diabetes and Nerve Damage.

How does neuropathy progress if nothing is done?

It usually spreads slowly upward and inward from the toes. Symptoms that start in the toes often come to involve the whole foot, then the lower leg, and the hands may follow the same pattern later. Sensory changes tend to come first, and some people later develop weakness, balance trouble and a higher risk of falls. How fast this happens depends heavily on the underlying cause, so no one can give you a reliable timeline. Source: StatPearls, Neuropathy.

Which doctor should I see for neuropathy?

Usually more than one, because different pieces sit with different specialists. Your primary care physician is the right starting point and orders the first bloodwork. A neurologist handles nerve conduction studies and EMG and confirms the diagnosis. An endocrinologist manages the diabetes side when that is the cause. A chiropractic physician is worth seeing when the pattern suggests the spine may be involved, or when you want non-drug options alongside your medical care. Source: Castelli et al., American Family Physician.

Can chiropractic care help neuropathy?

It depends on what is producing the symptoms. If a compressed nerve root in the low back or neck is causing the burning and tingling, that is a mechanical spine problem and it is squarely in scope. Those radicular symptoms are often one-sided and follow a band down the limb, while peripheral neuropathy is usually symmetrical and stocking-shaped. If the cause is genuinely peripheral, chiropractic care is not addressing the nerve damage itself, but it can help with the mechanical pain and stiffness that come along with it. Source: Castelli et al., American Family Physician.

What non-drug options are available?

Several, and the right one depends on which category you fall into. At our Tampa clinic those include:

• Sanexas electroanalgesia. A drug-free option offered to help manage chronic nerve-related pain symptoms. It uses an FDA-cleared device, which is not the same as FDA approval to treat any condition, and it is not FDA-approved to treat or reverse neuropathy. Results vary.
• DRX9000 spinal decompression. Used when disc or nerve-root compression is contributing. It targets the spinal source, not peripheral nerve damage.
• Chiropractic adjustments. For the spinal component, when the exam supports it.
• Massage and soft tissue work. For circulation, comfort, and the muscle guarding that builds up around a painful limb.
• IV nutritional therapy. B-vitamin and nutrient support. This supports hydration and general wellness and is not intended to diagnose, treat, cure or prevent any disease. Results vary.

We have written separately about what a Sanexas session actually involves, and you can read more on our neuropathy care page. Source: StatPearls, Neuropathy.

The PMHC difference

• We rule out spinal contributors first. Assuming a peripheral cause without checking the spine is how treatable compression gets missed. On-site digital X-ray and a hands-on exam come before any plan.
• Several options under one roof. Chiropractic, electroanalgesia, decompression, massage and IV therapy are all in the building, so the plan can change as we learn how you respond.
• Plans built around the presumed cause. Spinal-driven symptoms and idiopathic peripheral neuropathy call for different approaches.
• We coordinate. Your primary care physician, neurologist and endocrinologist stay in the loop, and we refer out when your symptoms point outside our scope.
• Dr. Baker’s background. Over a decade as a licensed massage therapist in Tampa before earning his Doctor of Chiropractic degree, so soft tissue and joint mechanics get assessed together. More on his training and background.

Sources

• National Institute of Diabetes and Digestive and Kidney Diseases, “Peripheral Neuropathy.”
• Castelli G, Desai KM, Cantone RE. “Peripheral Neuropathy: Evaluation and Differential Diagnosis.” American Family Physician.
• Hicks CW, et al. “Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts.”
• Hammi C, Yeung B. “Neuropathy.” StatPearls, NCBI Bookshelf.
• Centers for Disease Control and Prevention, “Diabetes and Nerve Damage.”