neuropathy flare ups

Overview

Peripheral neuropathy is a condition where nerves outside the brain and spinal cord are damaged. It often causes burning, tingling, or numbness, usually in the hands or feet. A 'flare-up' is a period when these symptoms suddenly become worse than usual.

Yes. Peripheral neuropathy is very common, with millions of people worldwide living with it. Diabetic neuropathy is the most common kind, but many other health problems can cause nerve damage.

It can affect anyone, but it is more common in older adults, people with diabetes, those who drink heavily, and people with certain vitamin deficiencies or autoimmune conditions.

Symptoms

Common symptoms

• Burning or shooting pain in the hands or feet
• Tingling or 'pins and needles'
• Numbness or reduced feeling
• Weakness, especially in the legs or arms
• Sensitivity to touch or temperature changes

Causes

Main causes

• High blood sugar from diabetes damages nerve fibers over time
• Vitamin B12 deficiency or other vitamin imbalances
• Autoimmune diseases, where the immune system attacks nerve tissue
• Infections such as shingles or Lyme disease
• Toxins, alcohol, or certain medications (ask your doctor about your medicines)

Risk factors

• Diabetes, especially if blood sugar is not well controlled
• Heavy alcohol use
• Family history of neuropathy
• Chronic kidney disease or liver disease
• Hormone imbalances, such as thyroid problems

When to see a doctor

See a doctor urgently if:

• Sudden, severe, or rapidly spreading symptoms
• Weakness that prevents walking or doing daily tasks
• Loss of bladder or bowel control with back pain

Book a routine appointment if:

• Symptoms that keep coming back or are getting worse
• Numbness or tingling that does not go away
• Concern about balance or falls
• Foot sores that are slow to heal

Diagnosis

A doctor will ask about your symptoms, medical history, and lifestyle, and then examine your nerves, reflexes, and strength to look for patterns.

Tests that may be done

• Blood tests to check for diabetes, vitamin deficiencies, and other causes
• Nerve conduction studies, which measure how fast electrical signals travel along your nerves
• Electromyography (EMG), which checks how well your muscles respond to nerve signals
• Sometimes imaging tests such as MRI to look at the nerves and surrounding bones

What to expect at your appointment

The process is usually not painful, though some tests involve small needles or mild shocks. You will be told the results later, and your doctor will review the findings with you and suggest next steps.

Treatment

Treatment focuses on three things: treating the underlying cause, calming the flare-up, and protecting your nerves from further damage. A healthcare team can tailor a plan to your needs.

Self-care at home

• Apply heat or cold packs to sore areas (with a towel between the pack and your skin)
• Rest the affected limb when symptoms spike, but keep moving gently once the worst is over
• Wear comfortable, supportive shoes and check your feet daily for cuts or blisters
• Try relaxation techniques such as slow breathing to reduce stress, which can make pain feel worse

Medical treatments

Doctors may suggest medications that work on nerve pain, or topical treatments applied to the skin. Physical therapy can help with strength and balance. Some people benefit from transcutaneous electrical nerve stimulation (TENS), which uses gentle electrical pulses. Talking therapies, such as cognitive behavioural therapy (CBT), can help with the emotional side of chronic pain. Medicines should always be prescribed and monitored by a qualified healthcare provider.

When is surgery considered?

Surgery is rarely needed for neuropathy. It may be considered if a specific nerve is being squeezed by surrounding tissue, such as in some cases of carpal tunnel syndrome.

Living with this condition

Learn to pace yourself: break tasks into short chunks and rest between them. Plan your day around times when you usually have most energy. Keep a small notebook of your symptoms to help you and your doctor spot patterns.

Lifestyle tips

• Protect your sleep by aiming for a regular bedtime routine
• Keep alcohol intake low, as alcohol can worsen nerve damage
• Stop smoking; it reduces blood flow to nerves
• Manage stress with mindfulness, hobbies, or talking with friends

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruits, whole grains, and lean proteins. Work with a physiotherapist to find safe exercises, such as swimming or stationary cycling, that do not put too much pressure on your feet.

Mental health and emotional wellbeing

Living with constant or unpredictable pain can be exhausting and stressful. It is normal to feel frustrated, anxious, or low. If you are struggling emotionally, talk to your doctor. If you are in crisis or having thoughts of harming yourself, reach out to a mental health crisis line or your local emergency services right away.

Prevention

Not all neuropathy can be prevented, especially if it runs in your family. But you can lower your risk by managing health conditions like diabetes, eating well, avoiding heavy alcohol, and taking good care of your feet.

Vaccines

Staying up to date with recommended vaccines, such as the flu and shingles vaccines, may help prevent infections that can sometimes cause nerve problems. Ask your healthcare provider what is right for you.

Screening programmes

If you have diabetes, it is important to have regular foot checks and nerve screening as part of your routine care. People with other risk factors may also be monitored.

Complications

If left untreated

• Permanent loss of feeling in the hands or feet
• Muscle weakness and wasting
• Unnoticed injuries that become infected, especially in the feet
• Balance problems that increase the risk of falls and fractures
• Reduced quality of life due to chronic pain

Long-term outlook

With good management, many people with neuropathy have long periods without flare-ups, and symptoms can improve or stay stable. While nerve damage is often not reversible, the goal is to reduce symptoms, avoid further damage, and keep you active and comfortable.

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