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Nerve Damage & Peripheral Neuropathy

Peripheral neuropathy — damage to the nerves outside the brain and spinal cord — affects millions of Americans and often starts as tingling, burning or numbness in the feet. Diabetes is the most common cause. Finding and treating the cause matters, and numb feet need protecting from heat, pressure and wounds.

Get emergency or urgent care right away if:

  • Weakness is spreading quickly — over hours or days, often starting in the feet and moving up the legs, or you suddenly have trouble climbing stairs or walking. This can be Guillain-Barré syndrome, in which weakness can reach the breathing muscles and become life-threatening; people with it are usually admitted to the hospital, often to intensive care (NINDS). Call 911 if breathing or swallowing becomes hard. See our Guillain-Barré syndrome guide.
  • Numbness or weakness comes on suddenly in the face, arm or leg, especially on one side, or with sudden confusion, trouble speaking or seeing, loss of balance or a severe headache. These are signs of a stroke, not neuropathy. Think B.E. F.A.S.T. (Balance, Eyes, Face, Arms, Speech, Time), note when symptoms started, and call 911 for an ambulance rather than driving (CDC).
  • You have diabetes or numb feet and find a wound, blister, burn or sign of infection. Call your provider right away about a cut, blister or bruise that doesn’t start to heal after a few days, or skin that becomes red, warm or painful (NIDDK), or a foot sore that is infected or won’t heal (CDC). Untreated, an infected foot ulcer can lead to gangrene and, in severe cases, amputation (NHS).

Never wait for a chiropractic, acupuncture, massage or coaching appointment for any of these. And never warm a numb foot with a heating pad, hot soak or heat device — see Protecting numb feet.

What is peripheral neuropathy?

Peripheral nerves branch out from the brain and spinal cord to the whole body. They carry the messages that move your muscles and run breathing, heartbeat and digestion, and they carry back the feelings of pain, heat and cold (MedlinePlus). Peripheral neuropathy covers the more than 100 conditions that damage this network, and it affects millions of people in the U.S. (NINDS). In the UK, almost 1 in 10 people aged 55 or over are estimated to have it (NHS).

Three kinds of nerves, three kinds of symptoms

Most neuropathies affect all three to some degree (NINDS). Damage may involve a single nerve (mononeuropathy), several separate nerves (mononeuritis multiplex) or many nerves (polyneuropathy). Polyneuropathy is the most common: it hits the longest nerves first, so symptoms usually begin in the feet, seem to creep upward, and later reach the hands (NHS). The most common mononeuropathy is carpal tunnel syndrome (NHS). Symptoms are often worse at night (NIDDK), may build over days, weeks or years, and are rarely life-threatening (NINDS).

What causes it?

Sometimes no cause is found (idiopathic neuropathy) (NHS).

Why it matters: if you can’t feel your feet, you may not notice pressure or an injury that turns into a sore; with diabetes such wounds heal slowly and can become infected, leading to loss of a toe, foot or part of the leg. Neuropathy also makes falls and fractures more likely, and chronic nerve pain can bring anxiety and depression (NIDDK).

See a provider soon (not an emergency) for pain, tingling or loss of feeling in the feet, loss of balance or weakness, or a foot cut or ulcer that isn’t getting better (NHS) — or for symptoms that disturb daily life or sleep, changes in digestion, urination or sexual function, or dizziness or fainting (CDC). The sooner neuropathy is diagnosed, the better the chance of limiting the damage (NHS).

How it is diagnosed

Related guides: foot pain and problems, balance problems, cancer, magnet therapy, circulation problems and burns. A separate shingles guide is on the way.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Find and treat the cause (diabetes control, B12 replacement, changing a medicine, immune treatments); nerve-pain medicines by class; lidocaine or capsaicin on the skin; physical therapy, braces and walking aids; regular foot exams. Medicare Part B covers medically necessary physical therapy (20% after the deductible). Tests and medicines: cost estimate being researched. Some neuropathies improve when the cause is treated; others are permanent. Pain medicines ease symptoms but don’t repair nerves, and several may need trying.
Chiropractic No established role for nerve damage itself. A chiropractor may help with back or neck pain, but numbness should be diagnosed by a medical provider first. Without insurance, a first appointment commonly about $90–$200 and a follow-up visit about $55–$100. We found little research. The NHS says chiropractic may not be safe if you have a nerve condition such as peripheral neuropathy.
Acupuncture Fine needles for nerve pain, most studied for diabetic and chemotherapy-related neuropathy, alongside standard care. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare doesn’t cover it for neuropathy. Low-certainty evidence it may ease diabetic nerve pain; mixed, low-quality evidence for chemotherapy neuropathy. Avoid needles in numb, broken or infected skin.
Herbal medicine Vitamin B12 when a test shows you are low; alpha-lipoic acid, B vitamins and benfotiamine are popular. Capsaicin cream comes from chili peppers. Cost estimate being researched. A 2024 Cochrane review found alpha-lipoic acid probably has little or no effect on diabetic neuropathy symptoms. Too much vitamin B6 can itself cause neuropathy.
Massage therapy Gentle Swedish-style massage for comfort and relaxation, sometimes used for chemotherapy-related neuropathy — light pressure and no heat on numb areas. One national chain’s franchises list about $125–$160 for a 60-minute massage for non-members; memberships about $70–$90 a month. Small early trials in cancer patients are encouraging but not conclusive. Tell the therapist where you have numbness.
MBHA Wellness Coach Blood sugar, alcohol and smoking goals; daily foot checks; safe exercise and balance work; fall-proofing the home; sleep and coping with chronic pain. Cost estimate being researched. Supports — never replaces — medical care. Managing diabetes and staying active can help keep nerve damage from getting worse.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on the type of nerve damage and your symptoms (NINDS). It has two parts: treating the cause, and easing the symptoms.

1. Treat the underlying cause

  • Diabetes: good control may help improve neuropathy, or at least stop it getting worse (NHS).
  • Vitamin B12 deficiency is treated with injections or tablets (NHS); if metformin is the cause, it can usually be continued with B12 supplements (NIDDK).
  • A medicine side effect may improve if the medicine is stopped (NHS) — a decision for your doctor, never on your own.
  • Immune-related neuropathies may be treated with steroids, immune-suppressing medicines, immunoglobulin (IVIg) or plasmapheresis, which filters antibodies from the blood (NINDS).

When the cause is corrected, neuropathy sometimes resolves as nerves regrow (NINDS). But not every cause can be treated, and for some people the damage is permanent or slowly worsens (NHS).

2. Nerve-pain medicines (by class)

Nerve pain usually doesn’t respond well to everyday painkillers such as acetaminophen and ibuprofen (NHS, NIDDK). The main prescription options are certain antidepressants — tricyclics such as amitriptyline and nortriptyline, and SNRIs such as duloxetine, which can ease pain even if you aren’t depressed — and anti-seizure medicines such as gabapentin and pregabalin (NIDDK, NHS).

These are started low and adjusted gradually. Tiredness, dizziness or feeling “drunk” are common; don’t drive if you feel drowsy, and expect to be more sensitive to alcohol. If the first medicine doesn’t help, another may (NHS). They ease pain but don’t repair nerves, and some aren’t recommended for older adults or people with heart disease (NIDDK). NINDS says opioids are not recommended for neuropathy pain (NINDS). We don’t list doses.

3. Treatments on the skin

Lidocaine patches or creams and capsaicin cream can help small painful areas (NINDS). Capsaicin, the substance that makes chili peppers hot, can irritate the skin and cause burning or itching; don’t use it on broken or inflamed skin, and wash your hands after applying it. Stronger capsaicin patches are applied in a clinic (NHS).

4. Physical therapy, braces and devices

Physical therapy can improve strength and balance (NIDDK); splints can support weak ankles and walking aids help you get around (NHS). A bed cradle keeps sheets off painful feet at night (NIDDK). TENS, a gentle current through skin pads, may be prescribed alongside other treatments for severe nerve pain (NINDS), but a 2017 Cochrane review rated the evidence very low quality and couldn’t say confidently whether it works; reported side effects were minor skin irritation (Gibson et al., Cochrane, 2017).

5. Other symptoms and surgery

Autonomic problems such as dizziness on standing, bladder or bowel trouble are treated one by one (NHS). Surgery helps only when a nerve is being squeezed, as in carpal tunnel syndrome; most neuropathies aren’t helped by it (NINDS).

What it costs

Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it; you pay 20% of the Medicare-approved amount after the deductible (Medicare.gov). Self-pay therapy, nerve tests, medicines and TENS units: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no established role in treating peripheral neuropathy itself, and we found little research on it: a search of the medical literature turned up mainly single-patient case reports.

When the problem may be in the spine

Not all numbness is polyneuropathy. Slipped disks can press on nerve roots as they leave the spinal cord, and spine imaging can find such a pinched nerve (NINDS). If a medical workup points there, our back pain and neck pain guides review the evidence for chiropractic care. Get a diagnosis first — numbness has many causes that need different treatment.

Safety

  • The NHS says chiropractic may not be safe if you have a nerve condition such as peripheral neuropathy, or if you take blood thinners or have a higher risk of bleeding or stroke (NHS).
  • Soreness, stiffness or headache often follows manipulation and usually passes within 24 hours. Serious problems are very rare, but the risk may be greater with underlying health problems (NCCIH).
  • With nerve damage you may not feel heat (NIDDK). MBHA suggests telling your chiropractor about any numbness and declining heat packs on numb areas.

What it costs

Without insurance, a first appointment commonly runs about $90–$200 and a follow-up visit about $55–$100 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

NINDS lists acupuncture among complementary treatments that may help people manage chronic nerve pain (NINDS), and NCI says it is sometimes advised for nerve problems after cancer treatment (NCI). The research is promising in places but of low quality.

What the research says

  • Diabetic neuropathy: a 2025 review of 14 trials (1,169 people) found low-certainty evidence that acupuncture may reduce pain compared with sham (pretend) acupuncture, with little or no difference in physical functioning or side effects (Lan et al., 2025).
  • Chemotherapy-induced neuropathy: a 2019 review of three trials found mixed results and judged the evidence insufficient to recommend acupuncture, though clinicians may consider it given its safety (Li et al., 2019). A 2023 review of nine trials concluded it may be effective and safe, but called for more rigorous studies (Pei et al., 2023).
  • Nerve pain in general: a 2017 Cochrane review found too little evidence to support or refute acupuncture (Ju et al., Cochrane, 2017).
  • Part of acupuncture’s effect appears to come from nonspecific (placebo) effects (NCCIH).

Safety — especially with numb feet or diabetes

  • Complications have come from non-sterile needles and poor technique; the FDA requires needles to be sterile and single-use (NCCIH).
  • Acupuncture may not be safe if you take blood thinners or have a higher risk of bleeding (NHS).
  • With diabetes, wounds heal slowly and infect easily (NIDDK). MBHA suggests avoiding needles in numb, broken or infected skin, declining heat lamps or moxibustion (burning herbs near the skin) on areas you can’t feel well, and checking your feet afterward.

What it costs

About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). Medicare covers acupuncture only for chronic low back pain, not neuropathy (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

The NHS notes people may try herbal medicine, benfotiamine (a form of vitamin B1) or alpha-lipoic acid, but says the evidence is not always clear and advises asking a doctor first in case they interfere with treatment (NHS). NIDDK says diabetes experts have made no special recommendations about supplements (NIDDK).

Vitamin B12 — when you are actually low

B12 deficiency is a real, treatable cause of nerve damage (NINDS). It is found with a blood test and treated with injections or tablets (NHS, NHS). If you take metformin, ask about checking your level (NIDDK).

B vitamins and alpha-lipoic acid

More is not better with vitamin B6. Excess B6 is a well-known cause of neuropathy (NINDS). The NHS warns that large amounts can cause loss of feeling in the arms and legs, sometimes permanently (NHS). Check the labels of “nerve support” blends and multivitamins, and tell your doctor everything you take.

Herbs and your other medicines

Capsaicin, from chili peppers, is covered under Conventional medicine. The NHS warns that herbal medicines may not mix well with diabetes medicines such as metformin or blood thinners such as warfarin, and advises against buying unlicensed herbal medicines online (NHS). We don’t list doses.

Approach 5 of 6

Massage therapy

NINDS lists massage among approaches that may help people manage chronic nerve pain (NINDS), and NCI says it is sometimes advised after cancer treatment (NCI). It won’t repair nerves, but it may bring comfort.

What the research says

  • In a 2022 pilot trial of 71 cancer survivors with chemotherapy-related neuropathy in the legs, massage three times a week eased symptoms more than twice a week, with some suggestion that leg massage worked best; leg massage did not differ significantly from head-and-shoulder massage (Lopez et al., 2022).
  • In a 2019 trial of 40 women receiving the chemotherapy drug paclitaxel, those given massage before each infusion had less nerve pain at 12 weeks than those receiving usual care (Izgu et al., 2019).
  • We found little research on massage for diabetic neuropathy.

Safety

  • The risk of harm appears low, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue work or in older adults (NCCIH).
  • Numb skin can’t warn you about heat (NIDDK). MBHA suggests gentle pressure only, no hot stones or heated pads on numb areas, no massage over broken skin, and a foot check afterward. If even light touch hurts (NINDS), tell the therapist.

What it costs

At one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members, and memberships run about $70–$90 a month (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Quitting smoking, avoiding alcohol, exercising, eating well and keeping a healthy weight all support healthier nerves (NINDS). An MBHA Wellness Coach can help you build those habits alongside — never instead of — your medical care.

Diabetes and alcohol goals

To help prevent diabetes-related nerve damage, NIDDK advises being active, following your meal plan, getting help to quit smoking, limiting alcohol to no more than one drink a day for women and two for men, and taking prescribed medicines (NIDDK). Staying near your blood sugar, blood pressure and cholesterol goals can keep nerve damage from getting worse (NIDDK).

Moving safely and preventing falls

Walking, dancing, yoga, swimming and cycling are easy on the feet (NIDDK). For chemotherapy-related neuropathy, a 2024 review of 15 trials found exercise improved numbness, tingling, pain and balance, though the authors called for larger studies (Huang et al., 2024). At home, move rugs, add rails and bath mats, wear sturdy shoes, and get up slowly (NCI). See our balance guide.

The nightly foot check

Check your feet every evening when you take off your shoes, including between your toes, using a mirror or a helper if needed (NIDDK).

Coping with chronic pain

Meditation and talk therapy can help some people cope with chronic pain and the depression and anxiety that may follow nerve injury (NINDS). See our depression guide.

Another approach

Protecting numb feet from heat, pressure and wounds

When you lose feeling in your feet, you may not feel a pebble in your sock or a blister (NIDDK), and you may keep walking on a blister until it becomes an ulcer (NHS).

Heat is the hidden danger

NIDDK warns that with nerve damage you may burn your feet and not know it (NIDDK). Doctors have described people with diabetic neuropathy who suffered serious, painless burns — one while treating a small sore with a hot paraffin foot bath (Putz et al., 2008). In one burn center, people with diabetes and foot burns tended to delay seeking care and needed amputation more often than other burn patients (Momeni et al., 2018).

  • No heating pads or hot water bottles on your feet; keep feet away from heaters and open fires, and wear socks in bed instead (NIDDK).
  • Test bath water with a thermometer or your elbow, and don’t soak your feet (NIDDK). If your hands are numb too, ask someone to check the water, and use potholders in the kitchen (NCI).
  • Wear shoes on hot pavement and at the beach (NIDDK).
  • MBHA adds: the same caution applies to heated foot spas and insoles, saunas, heat lamps and far-infrared mats or wraps — anything warm against skin you can’t feel well. Ask your doctor first, keep sessions short and low, and check your skin afterward. Any burn or blister on a numb foot is a reason to call your provider; our burns guide covers first aid.

Pressure and wounds

Another approach

Magnets and infrared devices: what the evidence shows

Magnetic insoles, ankle bracelets and infrared devices are widely sold for numb, burning feet.

Static magnets

  • NCCIH’s summary: research on static magnets for pain is extremely limited, and no conclusive evidence shows they work for any kind of pain. A 2021 review of seven static-magnet studies, including diabetic neuropathy, had mixed results: four showed improvement and three did not (NCCIH).
  • The largest trial (2003) gave 375 people with diabetic neuropathy magnetic or look-alike insoles for four months. In months three and four, burning fell 12% with magnets versus 3% with sham insoles — statistically significant but modest (Weintraub et al., 2003). A small 2023 trial of 64 people reported better symptom scores with magnetic ankle bracelets than sham bracelets (Nazeri et al., 2023).
  • For chemotherapy-related nerve pain, the little research available has not shown a benefit (NCCIH).

Safety: NCCIH says magnetic therapy appears to be safe, but some magnets may interfere with pacemakers and insulin pumps; remove magnetic products before an MRI; keep small magnets away from children; and don’t use magnets to put off seeing a provider (NCCIH). If you use magnetic insoles, MBHA suggests checking numb feet for rubbing or pressure marks. See our magnet therapy guide.

Infrared devices

A 2017 review of six trials of monochromatic infrared energy for diabetic neuropathy found possible short-term gains in foot sensation that were probably not sustained, and no relief of nerve pain; the evidence was low quality (Robinson et al., 2017). Medicare decided in 2006 that infrared light and heat devices are not reasonable and necessary for diabetic or other peripheral neuropathy and does not cover them; CMS notes these devices can also warm the skin (CMS). On numb skin, follow the heat cautions above.

Another approach

Nerve damage from cancer treatment

Chemotherapy-induced peripheral neuropathy can cause tingling or numbness in the hands and feet, weak muscles that make you trip or fumble buttons, and digestive, bladder or blood pressure changes (NCI). Not everyone on chemotherapy develops it, but it may continue long after treatment stops (NINDS). Tell your cancer team early — early diagnosis and treatment are the best way to control symptoms and prevent further damage — and ask whether acupuncture, massage, physical therapy or yoga might help you (NCI). The research on each is summarized above. See our cancer guide.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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