There are more than 100 different types of peripheral neuropathy, a condition resulting in impaired communication between the central nervous system (your brain and spinal cord) and the rest of your body. The type of nerves affected determines the type of symptoms patients experience. If small-fiber sensory nerves are damaged, tingling, numbness, shooting pain and burning sensations result. If large-fiber motor nerves are damaged, weakness and loss of balance may develop. If autonomic nerve fibers are involved, patients often experience cold, clammy feet and hands.

“Individuals most at-risk for developing neuropathy are patients with multiple chronic ailments, taking numerous medications, particularly the elderly,” says Gregory P. Cofano, DC, DIBCN, a chiropractic neurologist from the Sound Pain Solutions network.

Here are three common causes of this progressive disease that affects an estimated 20 million Americans.


Diabetes is the most common cause of neuropathy in Western countries, affecting as many as 60% of diabetic patients at some point during the course of the disease. In fact, nerve damage resulting in diabetic nerve pain is the most often-diagnosed complication of diabetes.

“This is a major concern considering the steadily rising numbers of Americans being diagnosed with both prediabetes and diabetes,” Cofano says. “It’s very important to inform patients that being in a state of prediabetes also carries a risk of small-fiber nerve damage over time. Given what we understand about the metabolic stress of this disease and the likelihood of subsequent nerve damage we need to do a better job at preventing this national epidemic.”

Chronic disease

Eight percent of people 55 and older have some form of polyneuropathy, which affects multiple nerves and is the most common form of the condition, according to a study published in the Journal of Neurology, Neurosurgery and Psychiatry.

“We’re definitely seeing a correlation between the growth of our aging population, many of whom suffer with chronic disease, and the incidents of neuropathy,” Cofano says. “This is partly because the elderly are on more prescription medications than ever before — many of which can contribute to neuropathy symptoms such as tingling in the legs and feet, and sharp pain.” These prescriptions include certain antibiotics, cardiovascular medicines and rheumatologic medicines.


Chemotherapy-induced peripheral neuropathy is a common downside of several commonly used cancer treatments, including taxanes, platinum agents and vinca alkaloids. Symptoms may include severe pain, impaired movement, changes in heart rate and blood pressure, problems with balance, trouble breathing, paralysis and even organ failure.

More than half of patients undergoing these chemotherapy treatments experience CIPN within the first month, but symptoms may decrease or disappear altogether after six months or more.

Idiopathic peripheral neuropathy

While the cause of neuropathy most often can be determined, approximately 30% of cases are idiopathic, meaning the cause is unknown. Some research suggests a connection to autoimmune responses due to food sensitivities. For example, studies have shown a correlation between gluten sensitivity and the development of neuropathy.

Managing neuropathy: Early detection is key

There’s no cure for peripheral neuropathy, but early detection is key to managing symptoms.

“We know that peripheral neuropathy typically progressively worsens. In our clinics we have found that if treatment is initiated early enough, significant improvement can be attained in most cases,” Cofano says. “Evaluation and examination are recommended at the onset of symptoms to optimize the treatment options for relief.”

7 symptoms of peripheral neuropathy

Common symptoms to watch for include:

  • Burning or tingling of the hands or feet.
  • The feeling as if a sock was rolled up or balled up under the foot.
  • Sensation of burning of the skin when it is not hot to the touch. Sensation of ice-cold skin when it is not cold to the touch.
  • Balance problems related to the inability to properly feel the ground with your feet.
  • Coordination problems related to the inability to properly feel what you are touching with your fingers.
  • Symptoms that are worse at night.
  • The weight of the cover or sheets on top of the feet causes pain or discomfort.

Who is most at-risk to get neuropathy?

According to Dr. Cofano, the elderly are most at-risk for neuropathy. Other risks contributing to the onset of neuropathy include:

  • Diabetes and prediabetes
  • Cholesterol-lowering medications, such as statin drugs
  • Topical and oral antifungal medications
  • Exposure to industrial cleaning products, toxins, and heavy metals
  • Lower extremity nerve or circulation damage such as frost bite or traumatic ankle/foot injuries.
  • Poor blood circulation in the legs and feet
  • Degenerative diseases of the spine
  • Autoimmune conditions

Sound Pain Solutions clinics provide care for chronic spine and joint pain as well as peripheral neuropathy. Their FDA-cleared therapies include nonsurgical decompression, high-dose laser, chiropractic care and advanced rehabilitation procedures. All care is supervised by staff chiropractic physicians.