Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, most often causing burning, numbness, tingling or sharp pain in the feet and hands. The most common causes are diabetes, chemotherapy, HIV, vitamin B12 deficiency and alcohol. Treatment has two parts: dealing with the cause where possible, and relieving symptoms with medicines, foot care, exercise and, for some people, newer regenerative approaches still being studied.
Stem cell treatment vs medicines alone
| Medicines alone | Stem cell treatment | |
|---|---|---|
| What it does | Dampens pain signals day to day | Aims to support damaged nerves and their blood supply |
| How it is given | Daily tablets, often for years | Minimally invasive injections or infusion, then follow-up |
| Common downsides | Drowsiness, dizziness, weight gain for some | Short recovery; results vary between people |
| Works with | Your current care | Your current medicines and your own doctor's care |
Our partner clinic in Bangkok has treated more than 1,000 patients with regenerative medicine. A doctor reviews your case free and recommends the treatment that is right for you, alongside your own doctor, oncologist or HIV specialist. Get your free assessment.
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
Neuropathy treatment: what works
| Option | What it does | Evidence |
|---|---|---|
| Stem cellsRecommended | Aim to support nerve repair | Promising clinical studies |
| Treat the cause | Blood sugar control, B12, stopping alcohol | Strong where a cause is found |
| Medicines | Duloxetine, pregabalin, gabapentin, amitriptyline | Recommended first line (NICE) |
| Capsaicin cream or patch | Calms pain signals in the skin | Moderate |
| Exercise and foot care | Balance, circulation, preventing injury | Good |
| PRP around nerves | Growth factors from your blood | Small trials |
Find your type
- Diabetic neuropathy: the most common type
- Chemotherapy-induced neuropathy: during or after cancer treatment
- HIV-related neuropathy: the most common nerve problem in HIV
- Neuropathy in the feet, burning feet, numbness and tingling
Can damaged nerves heal?
Peripheral nerves can regrow slowly, roughly a millimetre a day, if the cause is removed. Some damage is permanent, but symptoms can often improve. See can nerves regenerate?
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
Supportive care for cancer and HIV patients
If your neuropathy comes from chemotherapy or HIV, symptom relief can improve sleep, walking and quality of life. Regenerative treatment is considered alongside, never instead of, your oncologist's or HIV doctor's care, and it does not treat cancer or HIV.
When to see a doctor quickly
Weakness that spreads over days, numbness climbing up the legs, or symptoms after a new medicine need prompt medical review. See when to see a doctor.
What your peripheral nerves do
Peripheral nerves carry signals between your brain and spinal cord and the rest of the body. There are three kinds. Sensory nerves carry touch, temperature, vibration and pain. Motor nerves move your muscles. Autonomic nerves run things you do not think about, such as heart rate, sweating, digestion and blood pressure. Neuropathy can affect any of them, but sensory nerves are hit first in most people.
The longest nerves in the body run to the feet, so they are the most vulnerable. That is why most neuropathy starts in the toes and climbs slowly up the legs, and only later affects the fingers. Doctors call this a "length-dependent" or "stocking and glove" pattern.
Symptoms in detail
Neuropathy causes two kinds of symptoms. Positive symptoms are sensations that should not be there: burning, electric shocks, stabbing pain, pins and needles, or a feeling of walking on pebbles. Negative symptoms are sensations that are missing: numbness, not feeling the floor properly, not noticing a cut or a hot bath. Many people have both at once, which is confusing: the feet can feel numb and painful at the same time.
Symptoms are often worse at night, when there is less to distract the brain from nerve signals. Loss of position sense in the feet affects balance, especially in the dark or on uneven ground, and raises the risk of falls. When autonomic nerves are involved, people may notice dizziness on standing, bladder or bowel changes, or abnormal sweating.
The main causes, explained
- Diabetes: the most common cause worldwide. High blood sugar damages small nerves and the tiny blood vessels that feed them.
- Chemotherapy: platinum drugs, taxanes, vinca alkaloids and bortezomib can damage nerves; see chemotherapy neuropathy.
- HIV: both the virus and some older medicines can cause a painful sensory neuropathy; see HIV neuropathy.
- Vitamin B12 deficiency: common with long-term metformin, acid-reducing medicines, a vegan diet or absorption problems. It is very treatable if found early.
- Alcohol: heavy long-term drinking damages nerves directly and through poor nutrition.
- Other causes: thyroid and kidney disease, autoimmune conditions, inherited neuropathies such as Charcot-Marie-Tooth disease, and some infections.
- Unknown: in a share of people, careful testing finds no cause (idiopathic neuropathy). Symptom relief still works the same way.
How neuropathy is diagnosed
A doctor starts with your story and a careful examination: reflexes, strength, vibration sense with a tuning fork, pinprick and a monofilament test on the feet. Blood tests look for diabetes (HbA1c), B12, thyroid, kidney and liver problems and some other causes. Nerve conduction studies and EMG measure how fast and how strongly nerves carry signals. If those are normal but symptoms suggest small nerve fibres are affected, a skin biopsy can count the tiny nerve endings in the skin.
Bring these results if you ask us for a case review. They help a doctor judge what could help.
Living well with neuropathy
- Feet first: check them every day, wear well-fitting shoes, never walk barefoot. Small wounds can become serious when feeling is reduced.
- Move every day: walking, cycling, swimming and balance training help circulation, strength and confidence.
- Sleep: cool the feet, keep bedding off them, and treat night pain properly; poor sleep makes pain worse.
- Mood: long-term nerve pain is exhausting. Feeling low or anxious is common and treatable, and treating it often eases pain too.
- Pace yourself: spread activity through the day rather than doing everything at once.
After cancer treatment
More people than ever are surviving cancer, and many live with neuropathy from treatment that saved their lives. It is a real, recognised condition, not something to put up with in silence. Duloxetine, exercise, physiotherapy and occupational therapy can help. Some survivors with persistent symptoms ask about PRP or stem cell approaches once cancer treatment is complete and their oncologist agrees. These do not treat cancer, and they are considered only as supportive care.
Living with HIV today
Modern antiretroviral therapy (ART) lets people with HIV live long, healthy lives, and the nerve-damaging HIV medicines of the past are now rarely used. Neuropathy still affects some people, especially those diagnosed years ago. Keep taking ART, talk to your HIV doctor about symptoms, and ask about options such as the high-concentration capsaicin patch. Any regenerative approach is supportive care alongside, never instead of, HIV treatment.
What regenerative research is exploring
Damaged nerves need three things to recover: the cause removed, enough blood supply, and the right repair signals. Regenerative research focuses on the last two. PRP concentrates growth factors from your own blood, and one randomised trial in painful diabetic neuropathy found less pain and better nerve test results after injections around the nerves. Mesenchymal stem cells release signals that, in laboratory and early human studies, support nerve fibres and small blood vessels and calm inflammation. This is promising but early, and results vary. See our stem cell page for the latest studies from China, Korea and Japan.
Questions to ask before any new treatment
- What is the evidence for my type of neuropathy?
- What results are realistic, and how will we measure them?
- How does this fit with my current medicines and my own doctor's care?
- What are the risks, and what happens if it does not help?
Treatment by type at a glance
| Type | First steps | Pain relief | Regenerative options |
|---|---|---|---|
| DiabeticRecommended | Blood sugar control, B12 check, daily foot care | Pregabalin or duloxetine first line | Perineural PRP (one positive trial), stem cells (early) |
| Chemotherapy-inducedRecommended | Tell your oncology team early; dose changes during treatment | Duloxetine (ASCO) | PRP or stem cells after treatment, with oncologist agreement |
| HIV-related | Keep taking ART, medicine review | Capsaicin 8% patch | Supportive regenerative care alongside HIV care |
| B12 deficiency | B12 injections or tablets | Usual nerve pain medicines if needed | Rarely needed once B12 is corrected |
| Unknown cause | Full blood tests, nerve studies | First-line medicines | Discuss case by case |
How long does improvement take?
Nerves recover slowly. When the cause is removed, small sensory fibres can begin to regrow within weeks, but long nerves to the feet take months, because regrowth runs at around a millimetre a day. Pain often improves before numbness does. Keep a simple symptom diary, noting sleep, pain scores, walking distance and balance, so you and your doctor can see real change over 3 to 6 months rather than judging day to day.
Travelling for treatment
Some people with persistent symptoms travel to Bangkok, one of Asia's main medical-travel hubs, for regenerative approaches that are not available or not covered at home. A trip is usually 5 to 7 days. Before anything is booked, a doctor reviews your nerve tests and medical history and tells you honestly whether anything could help, alongside the care you already have. Read the guide for your country: Australia, UK, USA, Canada, Singapore and UAE.
