Peripheral neuropathy is a condition where nerves in your body get damaged, causing numbness, tingling, pain, or weakness—usually starting in your toes and moving up. About 1 in 100 adults worldwide has this condition, and diabetes is the leading cause. Scientists have identified over 200 different reasons why nerves can become damaged, ranging from medications to vitamin deficiencies. While doctors have several medications that can help manage the pain, completely fixing nerve damage is rare. This review examines what causes neuropathy, how doctors diagnose it, and what treatments work best.

The Quick Take

  • What they studied: What causes nerve damage in the body, how doctors identify it, and which medicines help reduce the pain it causes
  • Who participated: This is a review article that summarizes information from many different studies about peripheral neuropathy affecting adults worldwide
  • Key finding: Diabetes causes more than half of all nerve damage cases in Western countries. Only about 4 out of 10 people taking standard doses of gabapentin (a common nerve pain medication) experience significant pain relief
  • What it means for you: If you have diabetes, nerve damage is a real risk you should watch for. If you develop numbness or tingling in your feet, talk to your doctor early. While current medicines help some people, they don’t work for everyone, so prevention and early detection are important

The Research Details

This is a review article, which means doctors and scientists gathered and summarized information from many different research studies about peripheral neuropathy. Rather than conducting one new experiment, the authors looked at what we already know about nerve damage—its causes, how it develops, how doctors diagnose it, and what treatments are available. They examined over 200 known causes of nerve damage and looked at which medicines doctors recommend most often. This type of review helps doctors and patients understand the big picture of a health condition by bringing together all the current knowledge in one place.

Review articles are important because they help organize what scientists have learned from many different studies into one clear summary. Instead of reading hundreds of individual research papers, patients and doctors can read one comprehensive overview. This helps doctors make better decisions about how to treat patients and helps patients understand their condition better.

This review was published in JAMA, one of the most respected medical journals in the world, which means it was carefully reviewed by other experts. However, because this is a summary of existing research rather than a new study, the strength of the findings depends on the quality of the studies it reviews. The authors provide clear information about what we know well and what remains uncertain.

What the Results Show

Peripheral neuropathy affects about 1 in 100 adults worldwide, making it a common condition. Diabetes is by far the most common cause in Western countries, responsible for more than half of all cases. The condition typically starts in the longest nerves in your body—the ones that reach your toes—and gradually moves upward over time. Symptoms usually affect sensation (feeling) more than movement, causing numbness, tingling, or pain. Diabetic nerve damage can also affect automatic body functions like blood pressure control. The researchers found that over 200 different causes of nerve damage exist, including inherited conditions, certain medications (especially cancer drugs), alcohol use, vitamin B12 deficiency, and blood disorders. Interestingly, in about 1 out of 4 cases, doctors cannot identify what caused the nerve damage even after thorough testing.

The review identified several first-line medications that doctors prescribe most often: gabapentin, pregabalin, duloxetine, and amitriptyline. However, the effectiveness is limited—only about 38% of people taking gabapentin experienced at least a 50% reduction in pain. Some patients benefit from combining multiple medications, though the review notes that pain often continues despite treatment. The prognosis varies depending on the underlying cause, but complete recovery of nerve function is uncommon, even when the cause can be treated.

This review synthesizes decades of research on peripheral neuropathy. It confirms what previous studies have shown: diabetes is the dominant cause in developed countries, and current medications provide only partial relief for many patients. The finding that 27% of cases have no identifiable cause aligns with previous research and remains an important area for future investigation.

Because this is a review of existing research rather than a new study, its findings are only as strong as the studies it summarizes. The review doesn’t provide specific numbers on how many people were studied overall. Some causes of nerve damage may be underdiagnosed or underreported in the literature. The medication effectiveness data (like the 38% pain reduction with gabapentin) comes from specific studies and may not apply equally to all patients. The review focuses mainly on Western populations, so findings may differ in other parts of the world.

The Bottom Line

If you have diabetes, work with your doctor to keep blood sugar well-controlled, as this is the best way to prevent nerve damage (high confidence). If you develop numbness, tingling, or pain in your feet or hands, see a doctor promptly—early detection matters (high confidence). If you’re diagnosed with nerve damage, ask your doctor about gabapentin, pregabalin, duloxetine, or amitriptyline as first-line treatments, understanding that these help some people but not others (moderate confidence). Consider combination therapy if a single medication isn’t working well enough (moderate confidence). Don’t expect complete reversal of nerve damage, but focus on managing symptoms and preventing progression (high confidence).

Anyone with diabetes should be especially attentive to signs of nerve damage. People taking medications known to cause nerve damage (certain cancer drugs, HIV medications, or amiodarone for heart rhythm) should discuss this risk with their doctor. People with vitamin B12 deficiency, heavy alcohol use, or a family history of inherited nerve conditions should be aware of their increased risk. People already diagnosed with peripheral neuropathy should use this information to understand their condition better and discuss treatment options with their healthcare provider.

If you start taking medication for nerve pain, you may notice some improvement within 1-2 weeks, though full effects can take 4-6 weeks. Preventing nerve damage through diabetes control happens gradually over months and years. Complete reversal of existing nerve damage is rare, but slowing progression and managing symptoms can happen relatively quickly with proper treatment.

Want to Apply This Research?

  • Track daily pain levels (0-10 scale) and specific symptoms (numbness, tingling, weakness) in your feet and hands. Note which activities make symptoms better or worse, and record any medication changes. This data helps you and your doctor see if treatments are working.
  • If you have diabetes, use the app to log blood sugar readings and track how well you’re controlling it—this is the most important way to prevent nerve damage from getting worse. Set reminders to take nerve pain medications at the same time each day. Log any new symptoms immediately so you can discuss them with your doctor at your next visit.
  • Check in weekly with your symptom tracking to spot patterns. Share your tracked data with your doctor every 3 months to evaluate whether your current treatment plan is working. If pain isn’t improving after 6-8 weeks on a medication, discuss alternatives with your doctor. For diabetes patients, monitor blood sugar control monthly and aim for your doctor’s recommended targets.

This review summarizes medical research about peripheral neuropathy but is not a substitute for professional medical advice. If you experience numbness, tingling, pain, or weakness in your extremities, consult a healthcare provider for proper diagnosis and treatment. Do not start, stop, or change any medications without talking to your doctor first. The effectiveness of treatments varies from person to person. This information is for educational purposes and should not be used for self-diagnosis or self-treatment.