Neuropathy — damage or dysfunction of the peripheral nerves — affects millions of Indians, most commonly as a complication of diabetes. Peripheral nerves carry signals between the brain, spinal cord, and the rest of the body: motor signals (movement), sensory signals (touch, pain, temperature), and autonomic signals (heart rate, digestion, blood pressure). When they are damaged, the result depends on which fibres are affected — tingling and burning pain in the feet, weakness in the hands, unexplained falls from loss of balance, or silent internal complications like delayed gastric emptying or orthostatic dizziness. Identifying the cause — diabetes, B12 deficiency, thyroid disease, alcohol, medications, or autoimmune conditions — is the key to treatment. Many causes are reversible if caught early.
Last reviewed: 10 August 2026
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Expert answers from our medical team
Diabetes is by far the most common cause — diabetic peripheral neuropathy affects up to 50% of people with long-standing diabetes. Vitamin B12 deficiency is the second most common, particularly in vegetarians, older adults, people on metformin (which reduces B12 absorption), and those on prolonged proton pump inhibitors. Other causes: thyroid disease (both hypothyroid and hyperthyroid), chronic alcohol use, autoimmune conditions (Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy), hereditary neuropathies (Charcot-Marie-Tooth), medication toxicity (certain chemotherapy drugs, isoniazid for TB), and HIV. A systematic blood test panel (glucose, HbA1c, B12, thyroid, kidney and liver function, ANA, ANCA, HIV) identifies most causes. Nerve conduction studies localise and characterise the nerve damage.
Sensory neuropathy typically starts in the feet and moves upward in a 'stocking and glove' distribution. Symptoms range widely: tingling (pins and needles), burning pain, electric shock sensations, hypersensitivity to touch (even bed sheets feel painful), or paradoxically — numbness and loss of sensation. Night worsening happens because daytime activity and distraction reduce pain perception; in bed, with no distraction and cooler temperatures that affect nerve conduction, pain becomes more prominent. Loss of proprioception (position sense) causes unsteadiness — particularly in the dark when vision can't compensate. Autonomic neuropathy causes different symptoms: lightheadedness on standing, constipation or diarrhoea, erectile dysfunction, or difficulty regulating blood pressure.
Reversal depends on the cause. B12 deficiency neuropathy: often significantly reversible with B12 replacement (injections are more reliable than oral in severe deficiency) — symptoms may improve over months. Thyroid-related neuropathy: generally reverses with thyroid normalisation. Alcohol-related neuropathy: stops progressing and partially reverses with complete alcohol cessation and nutritional support. Diabetic neuropathy: progression halted by tight blood sugar control, but existing nerve damage has limited reversibility — focus is on slowing further damage and managing symptoms. Guillain-Barré syndrome: usually recovers over months with appropriate treatment (IVIG or plasmapheresis). Hereditary neuropathies: not reversible, but managed. The earlier the cause is identified and treated, the better the recovery potential.
Standard painkillers (paracetamol, ibuprofen) generally don't work well for neuropathic pain — the mechanism is different. Medications that modify nerve signal transmission are used instead. First-line options: pregabalin and gabapentin (anticonvulsants that reduce nerve excitability — used at low to moderate doses for pain, not for their anticonvulsant effect), duloxetine (an antidepressant with strong evidence for diabetic neuropathic pain), and amitriptyline (a tricyclic antidepressant at low doses). Topical options: lidocaine patches and capsaicin cream for localised pain. Tramadol or opioids are sometimes used for severe refractory pain but carry dependency risk. Treatment is often trial-and-error — what works varies between individuals, and combinations are sometimes needed.
Diabetic neuropathy removes the pain warning signal — you can step on a nail or develop a blister without feeling it, leading to wounds that don't heal well because of poor circulation, and ultimately to infection and amputation. Prevention: inspect both feet every day (use a mirror for the sole, or ask a family member) — look for blisters, cuts, redness, swelling, or skin changes. Wash feet daily in lukewarm water (test temperature with elbow, not feet — you may not feel if it's too hot). Dry thoroughly between the toes. Moisturise heels (but not between toes). Wear well-fitted closed shoes — never walk barefoot outside or on hot surfaces. Cut toenails straight across. See a podiatrist or doctor promptly for any wound — never try to self-treat. Annual foot examination by a doctor should be part of routine diabetes care.
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