What causes peripheral neuropathy?

Diabetic peripheral neuropathy is the most common cause of neuropathy worldwide. Elevated blood sugar damages the small blood vessels that feed the nerves, particularly in the longest nerves of the body, the ones that reach the feet. Over time, this microvascular damage cuts off nerve nutrition and causes the classic tingling, numbness, and burning pattern.

What surprises many patients is that even pre-diabetes (blood sugar in the 100 to 125 fasting range) can begin to damage small nerve fibers. This means that a person can develop early neuropathy years before receiving a formal diabetes diagnosis.

Certain chemotherapy agents, particularly platinum-based drugs, taxanes, and vinca alkaloids, have a high incidence of causing peripheral neuropathy. Symptoms can begin during treatment or in the months after, and they often persist long after chemotherapy ends.

CIPN can be among the most challenging neuropathies, but it does respond to focused care. Our approach for CIPN patients prioritizes circulation support, nervous system regulation, and gentle rehabilitation rather than aggressive intervention.

B12 deficiency is one of the most under-diagnosed causes of neuropathy. It is also one of the most reversible if caught early. Other relevant deficiencies include folate, B6 (excess or deficiency), and vitamin E. Anyone with persistent neuropathy symptoms should have a thorough nutritional workup as part of the evaluation.

Not all "neuropathy" is peripheral neuropathy. Nerve roots compressed in the lumbar spine can produce symptoms identical to peripheral neuropathy in the legs and feet, sciatica being the most well-known example. Cervical spine compression can do the same for the arms and hands.

This distinction matters enormously. Compression neuropathy often responds rapidly to chiropractic care, postural correction, and targeted decompression, while metabolic peripheral neuropathy requires a different protocol. Our evaluation always distinguishes these.

In 25 to 30 percent of cases, no single cause is identified despite thorough workup. This is called idiopathic peripheral neuropathy. The good news is that idiopathic cases still respond well to drug-free care focused on nerve regeneration, circulation, and inflammation control. A lack of definitive cause does not mean a lack of treatment options.

Autoimmune conditions (lupus, rheumatoid arthritis, Sjögren's), heavy metal exposure, alcohol-related nerve damage, post-viral neuropathy, kidney or liver dysfunction, and certain medications can all contribute. Many patients present with more than one contributor at once, which is why thorough intake is essential.