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Health condition · Clinically reviewed

Peripheral neuropathy, the glove and stocking pattern - and how it's treated.

Nerve damage causing numbness, tingling or pain, usually starting in the feet. Diabetes is the leading UK cause, and it's manageable once identified.

Looking for the fuller picture? See our in-depth guide to peripheral neuropathies, covering every type and cause in detail.

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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 NG19 and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on neuropathic pain drugs and diabetic foot care.

Key facts

Peripheral neuropathy at a glance.

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

  • What it is

    Damage to the peripheral nerves that carry signals between the brain, spinal cord and the rest of the body.

  • Typical pattern

    A symmetrical "glove and stocking" distribution - numbness and tingling starting in the toes and fingers, spreading upward.

  • Common causes

    Diabetes is the leading cause in the UK, alongside alcohol excess, vitamin B12 deficiency, chronic kidney disease and chemotherapy.

  • Related term

    This page covers the singular condition. See our full guide to peripheral neuropathies for the broader group of nerve disorders.

  • Diagnosis

    Nerve conduction studies plus targeted bloods (HbA1c, B12, renal and liver function) confirm the type and likely cause.

  • Pain management

    Amitriptyline, duloxetine, gabapentin or pregabalin are the four first-line options for neuropathic pain under NICE CG173.

How the diagnosis is made

From first symptoms to a clear plan.

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 of symptoms

    When numbness, tingling or pain started, and whether it follows the classic glove and stocking distribution.

  2. 02

    Assessing

    Neurological examination

    Testing vibration sense, light touch, pinprick and ankle reflexes to map the extent of nerve involvement.

  3. 03

    Assessing

    Screening bloods

    HbA1c or fasting glucose, full blood count, B12 and folate, renal and liver function, and thyroid function as standard.

  4. 04

    Confirming

    Nerve conduction studies

    Measures how fast and how strongly electrical signals travel along peripheral nerves - confirms axonal versus demyelinating patterns.

  5. 05

    Confirming

    Further tests if atypical

    Asymmetrical, rapidly progressive or motor-predominant presentations may need nerve biopsy, MRI or specialist immunology bloods.

  6. 06

    Treating

    Neurology referral

    Rapid progression, marked weakness, or no clear cause found on first-line testing warrants specialist review.

  7. 07

    Treating

    Underlying cause treated first

    Optimising glucose control, stopping alcohol, correcting B12 deficiency or reviewing chemotherapy dosing where relevant.

Typical timeline: a first visit to a confirmed cause within a few weeks.

Symptoms

What peripheral neuropathy actually feels like.

The classic glove and stocking pattern of numbness, tingling and pain - and the features that mean it's time to escalate.

  • Numbness and tingling

    Pins and needles or reduced sensation, typically starting in the toes and fingertips.

  • Glove and stocking pattern

    Symmetrical symptoms in both feet, then hands, that spread proximally as nerves are affected in order of length.

  • Burning or shooting pain

    Neuropathic pain often described as burning, stabbing or electric-shock-like, frequently worse at night.

  • Muscle weakness

    Weakness or wasting in the feet or hands can develop when motor nerve fibres are affected.

  • Loss of balance

    Reduced proprioception (position sense) increases the risk of trips, falls and unsteady gait.

  • Autonomic symptoms

    Some causes also affect autonomic nerves - dizziness on standing, sweating changes or bowel and bladder issues.

  • Foot ulceration risk

    Reduced sensation in diabetic neuropathy means injuries can go unnoticed, raising the risk of ulcers and infection.

  • Red flag - rapid onset weakness

    Fast-progressing weakness over days needs same-day assessment to rule out Guillain-Barre syndrome.

Treatment

How peripheral neuropathy is treated in the UK.

Treating the underlying cause first, then one of four first-line drugs for neuropathic pain under NICE CG173.

  • Amitriptyline

    A low-dose tricyclic taken at night - a well-established first-line option for neuropathic pain.

  • Duloxetine

    An SNRI antidepressant with good evidence in diabetic peripheral neuropathy specifically.

  • Gabapentin

    An anticonvulsant titrated gradually - effective for burning and shooting neuropathic pain.

  • Pregabalin

    Similar mechanism to gabapentin with more predictable dosing - a NICE CG173 first-line choice.

  • Treating the underlying cause

    Tight glucose control in diabetes, B12 replacement, alcohol cessation, or a chemotherapy dose review where relevant.

  • Diabetic foot care

    Annual foot checks, well-fitting footwear and prompt attention to any cuts or blisters prevent ulceration.

  • Physiotherapy

    Balance training and strengthening exercises reduce fall risk and support daily function.

  • Specialist pain clinic referral

    Considered when first-line drugs are not tolerated or symptoms remain poorly controlled.

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. Diabetes (type 1 and type 2) in adults: diagnosis and management (NG17/NG28).

  • Royal College of Physicians. Guidance on peripheral neuropathy assessment and referral.

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 assessment is needed.

  • Rapidly progressive weakness

    Ascending weakness over hours to days may indicate Guillain-Barre syndrome - a medical emergency needing same-day hospital assessment.

  • Breathing difficulty

    Weakness affecting the chest or breathing muscles alongside limb symptoms needs immediate emergency care.

  • Bladder or bowel dysfunction

    New incontinence or retention alongside leg symptoms may signal spinal cord or cauda equina involvement - seek urgent review.

  • Unexplained foot ulcer

    Any ulcer or non-healing wound in a person with reduced foot sensation needs prompt diabetic foot service referral.

  • Marked asymmetry

    Neuropathy affecting one side much more than the other is atypical and warrants specialist neurology assessment.

  • Weight loss or systemic upset

    Neuropathy alongside unexplained weight loss, fevers or night sweats should prompt a wider search for an underlying cause.

Living with it

A manageable condition, with a clear plan.

Four things that make the biggest difference day to day - daily foot checks, managing the cause, patience with medication and reducing fall risk.

A quiet reminder

Small daily habits protect your feet the most.

A minute checking your feet each evening can catch problems long before they become serious.

  1. 01 Feet

    Check your feet daily

    Look for cuts, blisters or colour changes, especially if diabetic - reduced sensation means injuries can go unnoticed.

  2. 02 Control

    Manage the underlying cause

    Good glucose control, reducing alcohol, and correcting B12 deficiency all slow or halt further nerve damage.

  3. 03 Patience

    Give medication time to work

    Neuropathic pain drugs are titrated slowly - full benefit can take several weeks at an effective dose.

  4. 04 Balance

    Reduce your fall risk

    Well-fitting shoes, good lighting at home and balance exercises help offset reduced sensation in the feet.

Frequently asked

Everything we get asked about peripheral neuropathy.

Quick answers on causes, diagnosis, pain relief and foot care.

  • What is peripheral neuropathy?

    Damage to the peripheral nerves that carry signals between the brain and spinal cord and the rest of the body. It usually causes numbness, tingling, weakness or pain, most often in a symmetrical glove and stocking pattern starting in the feet.

  • What is the difference between peripheral neuropathy and peripheral neuropathies?

    They describe the same underlying condition. This page focuses on the singular presentation and its management; our companion guide to peripheral neuropathies covers the wider group of nerve disorders and their individual causes in more depth.

  • What causes peripheral neuropathy?

    Diabetes is the most common cause in the UK. Other causes include long-term alcohol excess, vitamin B12 deficiency, chronic kidney disease, chemotherapy and some inherited or autoimmune conditions.

  • How is it diagnosed?

    A clinical examination assessing sensation and reflexes, combined with nerve conduction studies and screening bloods (HbA1c, B12, renal and liver function), usually confirms the diagnosis and points to a likely cause.

  • What is the best treatment for neuropathic pain?

    NICE CG173 recommends amitriptyline, duloxetine, gabapentin or pregabalin as first-line options. The right choice depends on other health conditions, medication interactions and individual tolerance.

  • Why is foot care so important for diabetic patients?

    Reduced sensation means small injuries such as blisters or cuts can go unnoticed and progress to ulcers or infection. Daily foot checks, proper footwear and annual diabetic foot screening substantially reduce this risk.

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