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Health condition · Clinically reviewed

Peripheral neuropathies, from glove-and-stocking numbness to a clear treatment plan.

Nerve damage causing numbness, tingling or burning pain is common - especially with diabetes. Finding the cause changes what treatment can achieve.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG173, NICE NG193 and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on neuropathic pain, diabetic foot care and cause-directed treatment.

Key facts

Peripheral neuropathies at a glance.

The essentials, in plain English - what it is, the common causes, and how it’s worked up and treated in the UK today.

  • What it is

    Damage to peripheral nerves causing sensory, motor and/or autonomic dysfunction - most often a symmetrical, length-dependent pattern.

  • Typical pattern

    A "glove and stocking" distribution - symptoms start in the feet and hands, the parts served by the longest nerves.

  • Commonest UK cause

    Diabetes mellitus - the single most common cause of peripheral neuropathy in the UK.

  • Other causes

    Alcohol excess, vitamin B12 deficiency, chronic kidney disease, chemotherapy, hypothyroidism, and inherited forms such as Charcot-Marie-Tooth.

  • Core investigation

    Bloods (HbA1c, B12/folate, renal, thyroid, liver function) plus nerve conduction studies to characterise the neuropathy.

  • Pain management

    NICE CG173 recommends amitriptyline, duloxetine, gabapentin or pregabalin as first-line options for neuropathic pain.

Why this guide matters

Finding the cause changes the plan.

Peripheral neuropathy is a pattern of nerve damage with many possible causes. The three points below shape everything else on this page.

  • Diabetes is the leading UK cause

    Most peripheral neuropathy seen in UK primary care traces back to diabetes - which is why glucose control matters so much.

  • Some causes are reversible

    B12 deficiency, hypothyroidism and some drug-induced neuropathies can improve substantially once corrected.

  • Pain relief follows a clear ladder

    NICE CG173 sets out first-line agents - amitriptyline, duloxetine, gabapentin and pregabalin - so treatment isn’t guesswork.

How the diagnosis is made

From first symptoms to a clear diagnosis.

The steps a UK GP or neurologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and pattern review

    Onset, distribution, and whether symptoms are sensory, motor or autonomic - the pattern usually points straight to a cause.

  2. 02

    Assessing

    Clinical examination

    Sensory testing (light touch, pinprick, vibration), reflexes and gait assessment to map the extent and type of nerve involvement.

  3. 03

    Assessing

    Falls and injury risk check

    Reduced proprioception and sensation raise fall risk - this is assessed alongside the neurological exam, particularly in older patients.

  4. 04

    Confirming

    Screening bloods

    HbA1c, B12 and folate, renal function, thyroid function and liver function - looking for the common reversible or treatable causes.

  5. 05

    Confirming

    Nerve conduction studies

    Characterises the neuropathy as axonal or demyelinating, and sensory, motor or mixed - guiding both cause and management.

  6. 06

    Preparing

    Specialist neurology referral

    Atypical presentations, rapid progression, marked asymmetry, or diagnostic uncertainty warrant a specialist opinion.

  7. 07

    Preparing

    Nerve biopsy - rarely needed

    Reserved for a small number of cases where the cause remains unclear after standard investigation, usually vasculitic or amyloid neuropathy.

Typical timeline: a first visit to a confirmed cause and plan in a few weeks.

Symptoms

What peripheral neuropathy actually feels like.

The classic sensory, motor and autonomic mix - and the features that mean it’s time to seek urgent assessment.

  • Numbness

    A dulled or absent sense of touch, usually starting in the toes and feet before spreading upward.

  • Tingling and pins and needles

    Paraesthesia is often the earliest symptom - intermittent at first, then more constant as nerves are affected further.

  • Burning pain, worse at night

    Neuropathic pain frequently disturbs sleep and can be described as burning, shooting or electric-shock-like.

  • Reduced sensation and fall risk

    Loss of proprioception affects balance and increases the risk of falls and unnoticed foot injuries.

  • Muscle weakness

    Seen in more advanced or motor-predominant neuropathies - foot drop is a recognisable late sign.

  • Postural hypotension

    An autonomic symptom - lightheadedness or fainting on standing, seen in diabetic and some inherited neuropathies.

  • Gastroparesis

    Delayed stomach emptying causing bloating, nausea and early fullness - another autonomic feature, common in longstanding diabetes.

  • Red flag - rapid or asymmetric onset

    Fast-progressing or markedly asymmetric symptoms need urgent assessment rather than routine follow-up.

Treatment

How peripheral neuropathy is treated in the UK.

Treat the underlying cause first, then manage pain and function with NICE CG173-guided medication, foot care and physiotherapy.

  • Treat the underlying cause

    Diabetes control, B12 replacement or alcohol cessation - addressing the driver is the single most effective step where possible.

  • Amitriptyline

    A first-line neuropathic pain option per NICE CG173 - low-dose, taken at night, with sedation as the main early side effect.

  • Duloxetine

    Particularly useful in diabetic neuropathic pain - a first-line SNRI option under the same NICE guidance.

  • Gabapentin

    An anticonvulsant used for neuropathic pain - titrated gradually to balance benefit against drowsiness and dizziness.

  • Pregabalin

    Similar mechanism to gabapentin, often with more predictable dosing - another NICE CG173 first-line choice.

  • Foot care and injury prevention

    Daily foot checks, well-fitting footwear and prompt attention to any skin break - essential where sensation is reduced, especially in diabetes.

  • Physiotherapy

    Gait and balance training plus muscle strengthening help offset the fall risk and functional impact of sensory and motor loss.

  • Specialist pain management

    For pain that doesn’t respond to first-line agents, a pain clinic can offer combination therapy or other targeted approaches.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173).

  • NICE. Diabetic foot problems: prevention and management (NG19).

  • NICE. Rehabilitation after critical illness and other guidance on peripheral neuropathy assessment (NG193 context).

  • National Institute for Health and Care Excellence and Royal College of Physicians guidance on diabetic and metabolic neuropathy screening.

Red flags

When peripheral neuropathy needs urgent attention.

Most peripheral neuropathy is manageable in primary care. These are the situations that aren’t - and where urgent or specialist review is needed.

  • Rapidly progressive weakness

    Ascending weakness over days, as in Guillain-Barre syndrome, is a medical emergency requiring same-day hospital assessment.

  • Breathing or swallowing difficulty

    Any respiratory or bulbar involvement alongside neuropathy needs immediate emergency care.

  • Marked asymmetry

    Neuropathy affecting one side much more than the other points away from a typical length-dependent cause and needs specialist review.

  • Unexplained rapid onset

    Symptoms developing over days rather than months should be assessed urgently rather than watched.

  • Autonomic instability

    Significant postural hypotension, arrhythmia or bladder/bowel dysfunction alongside neuropathy warrants prompt specialist input.

  • Unexplained weight loss or systemic illness

    Neuropathy with systemic features can signal an underlying malignancy or paraproteinaemia needing investigation.

  • Diabetic foot ulceration or infection

    Any skin break, ulcer or infection on a foot with reduced sensation needs urgent podiatry or diabetic foot clinic review.

  • New numbness with back pain

    Consider cauda equina or spinal cord pathology if neuropathic symptoms accompany saddle anaesthesia or sphincter disturbance - this needs emergency assessment.

  • Suspected toxic or drug-induced cause

    New neuropathy after starting a known neurotoxic medication (including some chemotherapy agents) should prompt review of the drug and specialist advice.

Living with it

A manageable condition, with daily habits that matter.

Four things that make the biggest difference day to day - daily foot checks, controlling the underlying cause, staying active safely, and knowing when to escalate.

A quiet reminder

Small daily checks prevent big problems.

A minute spent looking at your feet each evening is one of the most effective things you can do.

  1. 01 Protect

    Check your feet every day

    Reduced sensation means injuries can go unnoticed - a daily look, especially in diabetes, catches problems early.

  2. 02 Control

    Keep the underlying cause managed

    Steady blood glucose, avoiding alcohol excess and treating B12 deficiency all slow or halt further nerve damage.

  3. 03 Move

    Stay active with the right support

    Physiotherapy-guided balance and strength work reduces falls and helps maintain independence.

  4. 04 Escalate

    Don’t wait out unrelieved pain

    If first-line medication isn’t helping after a fair trial, ask for a review or pain clinic referral rather than persisting alone.

Frequently asked

Everything we get asked about peripheral neuropathy.

Quick answers on causes, tests, pain relief and daily foot care.

  • What is peripheral neuropathy?

    Damage to the peripheral nerves - those outside the brain and spinal cord - causing sensory, motor or autonomic symptoms. It most often follows a symmetrical, length-dependent "glove and stocking" pattern, starting in the feet and hands.

  • What is the most common cause in the UK?

    Diabetes mellitus. Chronic high blood glucose damages small nerve fibres over time, which is why regular diabetic foot and nerve checks are part of routine diabetes care.

  • Can peripheral neuropathy be reversed?

    It depends on the cause. Vitamin B12 deficiency and some drug-induced neuropathies can improve significantly once the cause is corrected. Diabetic and chemotherapy-induced neuropathy are usually managed rather than reversed, aiming to prevent further progression.

  • What tests will I need?

    Blood tests including HbA1c, B12 and folate, renal function, thyroid function and liver function screen for common causes. Nerve conduction studies characterise the type of neuropathy. Nerve biopsy is rarely needed.

  • What medications treat neuropathic pain?

    NICE CG173 recommends amitriptyline, duloxetine, gabapentin or pregabalin as first-line options. These are chosen based on other health conditions and side-effect profile, and doses are built up gradually.

  • Why is foot care so important with neuropathy?

    Reduced sensation means cuts, blisters or pressure injuries can go unnoticed and become infected before they are felt. Daily foot checks and well-fitting footwear are central to preventing diabetic foot complications.

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