Peripheral neuropathy

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, producing numbness, tingling, pain or weakness, most often in the feet and hands.

Diabetes is the most common cause, followed by chemotherapy, alcohol use, vitamin B12 deficiency, autoimmune disease, infections and inherited disorders. Symptoms typically begin in the toes and spread upward in a stocking-and-glove pattern, reflecting damage to the longest nerve fibers first. Some people lose sensation and are prone to unnoticed injuries, while others experience burning pain that worsens at night.

Assessment includes a neurological examination testing sensation, reflexes and strength, blood tests to identify a cause, and nerve conduction studies or electromyography to confirm and characterize the damage. Managing the underlying cause is central to care. Cannabinoids have been studied for neuropathic pain, including painful neuropathy, with modest and inconsistent results and no approved use.