Common Causes
| Cause | Type of Neuropathy | Clues |
|---|---|---|
| Diabetes (most common) | Length-dependent sensorimotor | Worse in feet first ('stocking' distribution) |
| Vitamin B12 deficiency | Subacute combined degeneration | Macro cytosis; dorsal column signs; cognitive change |
| Alcohol excess | Sensorimotor polyneuropathy | Painful; worse at night; dietary history |
| Chemotherapy (taxanes, platinum) | Sensorimotor; often painful | After cancer treatment |
| Chronic kidney disease | Uraemic neuropathy | Bilateral; restless legs |
| Hypothyroidism | Mixed; + carpal tunnel | Check TFTs |
| Hereditary (CMT) | Predominantly motor; foot deformity | Family history; young onset |
| Vasculitis / autoimmune | Mononeuritis multiplex | Multiple individual nerve involvement; asymmetric |
Investigations
- Nerve conduction studies (NCS) + electromyography (EMG) — differentiates axonal vs demyelinating, maps distribution
- Blood tests: FBC, B12, folate, fasting glucose, HbA1c, TFTs, eGFR, protein electrophoresis (MGUS), ANA
- Anti-ganglioside antibodies (anti-MAG, GQ1b) for specific neuropathies
- Skin punch biopsy — quantifies small-fibre nerve density (painful neuropathy with normal NCS)
Small-Fibre NeuropathyStandard nerve conduction studies only test large myelinated fibres. Small-fibre neuropathy (painful, burning, autonomic symptoms) requires skin biopsy or quantitative sensory testing — it can be missed with standard NCS.
Can neuropathy be reversed?
Depends on cause. Diabetic neuropathy is partially reversible with excellent glucose control. B12-deficiency neuropathy improves with replacement (though slowly). Alcohol neuropathy improves with abstinence. Chemotherapy-induced is often permanent.
What medications help neuropathic pain?
First-line: duloxetine (SNRI), gabapentin, or pregabalin. Second-line: tricyclics (amitriptyline). Topical: lidocaine patches, high-dose capsaicin. Tramadol for breakthrough. Opioids generally avoided.
What does neuropathy feel like?
Classic description: burning, tingling, 'pins and needles,' electric shock sensations, or numbness — usually starting in the feet and hands. The skin may be exquisitely painful to light touch (allodynia).
Is peripheral neuropathy dangerous?
The main dangers are: falls from loss of balance and proprioception, foot ulceration from loss of protective sensation (especially in diabetes), and autonomic neuropathy affecting heart rate and blood pressure.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.