Neuropathy: When Your Nerves Become the Source of Pain
Understanding nerve damage, neuropathic pain, treatment, prevention — and finding hope when the pain becomes part of everyday life
There are many different kinds of pain.
There is the pain of a sprained ankle, an arthritic joint, a pulled muscle or an injury. And then there is nerve pain.
Nerve pain can feel completely different. It may burn, sting, tingle, throb, shoot, stab or feel like an electric shock. Sometimes something as gentle as a bedsheet touching the skin can become painful. Other people experience the opposite — numbness or a loss of sensation that means they no longer feel an injury developing.
This is neuropathy.
And for those living with it, neuropathy can become much more than a medical condition. It can interfere with sleep, movement, work, relationships, independence and quality of life.
For our family, this subject is particularly personal.
Why neuropathy matters to us
My husband, Danie, has lived with diabetes for more than five decades. Over the years, the effects of diabetes on his body became increasingly serious, including the development of severe nerve problems.
Eventually, the consequences contributed to the loss of his legs.
Living alongside someone with this kind of pain changes the way you understand the word pain. It isn't simply something that hurts. It can affect how a person walks, sleeps, moves, rests and experiences everyday life.
It was one of the reasons I became determined to develop Avobetic — a topical product specifically formulated with Danie's diabetic challenges and nerve-related discomfort in mind.
But our experience has also taught us something important:
Neuropathy isn't only a diabetes problem.
There are many possible causes of nerve damage, and understanding the cause is an important first step towards managing it.
What exactly is neuropathy?
Neuropathy refers to damage or dysfunction of nerves, particularly nerves outside the brain and spinal cord — known as the peripheral nervous system.
Our peripheral nerves perform several important jobs. Some carry information about pain, temperature, touch and vibration. Others control muscles, while another group — the autonomic nerves — helps regulate things we don't consciously think about, such as blood pressure, sweating, digestion, heart rate and bladder function.
When these nerves become damaged, the symptoms depend on which nerves are affected.
⚠️ Neuropathy Warning Signs
Don't ignore persistent changes in sensation, pain or strength. 🔥 Burning, stabbing or shooting pain ⚡ Electric-shock sensations 🦶 Persistent tingling or pins and needles 🧊 Numbness or reduced sensitivity 👣 Loss of balance or difficulty walking 💪 Muscle weakness 🤕 Pain from light touch 🩹 Unnoticed cuts, blisters or sores 🌡️ Unusual sweating or temperature changes 🩸 Changes in digestion, bladder function or blood pressure When should you seek help urgently? New or rapidly worsening weakness, sudden loss of sensation, difficulty walking, or a wound that becomes red, swollen, infected or doesn't heal should be assessed promptly. |
Someone might experience:
Burning or tingling
Pins and needles
Numbness
Shooting or stabbing pain
Electric-shock sensations
Extreme sensitivity to touch
Pain from normally harmless contact
Muscle weakness
Loss of balance or coordination
Changes in temperature sensation
Problems with sweating
Digestive or bladder problems
Changes in blood pressure
One particularly dangerous aspect of neuropathy is loss of sensation.
A person may have a blister, cut, burn or developing ulcer without realising it. This is especially important for people with diabetes, because unnoticed foot injuries can become infected and, in severe cases, contribute to amputation. The American Diabetes Association notes that as many as half of cases of diabetic peripheral neuropathy may have no symptoms.
What causes neuropathy?
Diabetes is one of the most common causes, but it is certainly not the only one.
Diabetes
Persistently elevated blood glucose can damage nerves and the tiny blood vessels that supply them. The longer someone has diabetes, the greater the risk of developing diabetic neuropathy.
This is one reason good diabetes management and regular foot examinations are so important.
Vitamin deficiencies
Deficiencies of certain nutrients, particularly vitamin B12, can contribute to nerve damage. Identifying and treating the deficiency may help prevent further damage and, depending on the cause and extent of the problem, may improve symptoms.
Alcohol
Long-term excessive alcohol consumption can damage nerves directly and can also contribute to nutritional deficiencies.
Physical injury or pressure
Nerves can be damaged through accidents, surgery, compression or prolonged pressure.
Carpal tunnel syndrome is one familiar example of a nerve being compressed.
Infections
Certain infections can damage nerves or trigger prolonged nerve pain. Shingles is a well-known example. Some people develop postherpetic neuralgia, where burning or shooting nerve pain continues after the shingles rash has disappeared.
Autoimmune and inflammatory diseases
Conditions such as lupus, rheumatoid arthritis, Sjögren's syndrome and coeliac disease can be associated with nerve damage.
Kidney or liver disease
Chronic kidney or liver problems can contribute to neuropathy through metabolic changes and the accumulation of substances that affect nerve function.
Certain medications and toxins
Some chemotherapy drugs and certain other medicines can cause peripheral nerve damage. Exposure to toxins such as heavy metals can also damage nerves.
Inherited conditions
Some forms of neuropathy are genetic. Charcot-Marie-Tooth disease, for example, is an inherited neurological disorder that can affect the peripheral nerves.
Cancer and other diseases
Certain cancers and blood disorders can be associated with neuropathy.
Sometimes, there is no obvious cause
When doctors cannot identify an underlying cause, the condition may be described as idiopathic neuropathy.
This is one reason why unexplained numbness, tingling, weakness or nerve pain should not simply be ignored.
Not all nerve pain is the same
Neuropathy can affect nerves in different ways.
Peripheral polyneuropathy
This is the type many people associate with diabetic neuropathy. It usually affects multiple nerves, often beginning in the feet and gradually moving upwards. The hands may eventually become affected as well.
Mononeuropathy
Only one nerve is affected.
Carpal tunnel syndrome is a common example.
Autonomic neuropathy
The nerves controlling automatic body functions are affected. This can cause problems involving digestion, sweating, blood pressure, bladder function and other bodily processes.
Radiculopathy
Sometimes a nerve root becomes compressed or irritated where it leaves the spine. A slipped or bulging disc, spinal narrowing or other structural problems can cause symptoms that travel along the affected nerve — for example, down an arm or leg.
Postherpetic neuralgia
This is persistent nerve pain following shingles. It can cause burning, stabbing or hypersensitive skin in the area affected by the infection.
Trigeminal neuralgia
This affects the trigeminal nerve of the face and can produce sudden, severe, shock-like facial pain.
Phantom limb pain
For people who have undergone an amputation, the nervous system can continue to generate sensations or pain that seem to come from the missing limb.
This is an important reminder that pain is not always generated by damaged tissue at the location where the pain is felt. The nervous system itself plays a central role in how pain is experienced.
How is neuropathy diagnosed?
Because there are so many possible causes, finding the underlying reason is extremely important.
A healthcare professional may assess:
Medical and family history
Blood glucose
Vitamin levels, including B12
Kidney and liver function
Thyroid function
Medication and alcohol history
Muscle strength
Reflexes
Balance
Sensitivity to touch, temperature and vibration
Depending on the situation, additional investigations may include nerve-conduction studies, electromyography (EMG), imaging such as MRI or CT, autonomic testing, or occasionally nerve or skin biopsy.
The goal isn't simply to confirm that someone has neuropathy.
The goal is to find out why.
That distinction matters because some causes can be treated or controlled.
Can neuropathy be treated?
There is no single treatment that works for every type of neuropathy.
Treatment generally has two goals:
1. Address the underlying cause where possible.
2. Manage the symptoms, particularly pain and loss of function.
For example, correcting a vitamin B12 deficiency, improving glucose management in diabetes, treating an underlying autoimmune condition or addressing a medication-related cause may help prevent further nerve damage.
Unfortunately, established nerve damage cannot always be reversed.
That does not mean nothing can be done.
There are many ways of managing neuropathic pain and protecting quality of life.
Pharmaceutical treatments for nerve pain
Ordinary painkillers such as paracetamol or ibuprofen often don't provide adequate relief for neuropathic pain because nerve pain works differently from many other forms of pain.
Depending on the individual and the underlying condition, doctors may prescribe medicines such as:
Gabapentin or pregabalin
Duloxetine
Amitriptyline or other tricyclic antidepressants
Certain sodium-channel-blocking medicines
Topical treatments such as lidocaine or prescription-strength capsaicin in appropriate circumstances
These medicines can help, but they can also cause side effects and are not suitable for everyone.
The most recent international guidance emphasises that treatment should be individualised rather than assuming that one medicine will work for everyone.
Opioid medicines are generally not preferred for long-term neuropathic pain because of their risks, including dependence and other serious adverse effects.
Physical therapy and other non-drug approaches
Pain management doesn't have to mean medication alone.
Depending on the person's condition, treatment may include:
Physiotherapy
Strength and balance exercises
Occupational therapy
Mobility training
Appropriate stretching
TENS or other electrical stimulation
Psychological approaches to chronic pain
Mindfulness and relaxation techniques
Acupuncture
Carefully structured physical activity
There is growing recognition that chronic nerve pain affects the whole person — physically, emotionally and socially. Exercise and movement can help people maintain strength, function and independence, although the appropriate type and intensity will depend on the individual's health and abilities.
For someone whose mobility is already compromised, even small amounts of safe movement can be meaningful.
The goal isn't necessarily to run a marathon.
Sometimes the goal is simply to keep moving safely for as long as possible.
What about surgery?
Surgery isn't necessary for most forms of peripheral neuropathy.
However, it may have a role when nerve damage is caused by something that can be physically corrected — such as significant nerve compression, certain structural problems, tumours or some traumatic nerve injuries.
This is another reason why getting an accurate diagnosis matters.
A person shouldn't assume that every case of nerve pain is "just neuropathy."
Natural and complementary approaches
Many people living with chronic nerve pain look for natural or complementary ways to support their treatment.
Some approaches have shown promise, including:
Carefully selected topical treatments
Capsaicin-based products
Acupuncture
Physical activity
Relaxation and mindfulness techniques
Certain nutritional supplements in specific circumstances
Capsaicin is particularly interesting because it has been studied as a topical treatment for painful diabetic neuropathy. Research suggests that topical capsaicin can reduce symptoms in some people, although burning and skin irritation can occur and results are not universal.
Alpha-lipoic acid has also been studied for diabetic neuropathy, although supplements can have side effects and may interact with medications or affect blood glucose.
The important word here is complementary.
Natural does not automatically mean safe, and natural therapies should not replace appropriate medical diagnosis or treatment. Anyone taking prescription medication — particularly people with diabetes or multiple chronic conditions — should discuss supplements and topical preparations with their healthcare professional.
Can neuropathy be prevented?
Not every case can be prevented.
Genetic conditions, unavoidable injuries and some medical treatments are examples where prevention may not be possible.
But there are things we can do to reduce risk and, particularly in diabetes, help slow progression.
Keep blood glucose under appropriate control
For people with diabetes, glucose management is one of the most important tools for preventing or delaying diabetic neuropathy. The ADA recommends optimising glucose management and also paying attention to blood pressure, weight and blood lipid levels.
Look after your feet
This cannot be emphasised enough for people with diabetes or reduced sensation.
Check your feet regularly for:
Blisters
Cuts
Cracks
Redness
Swelling
Burns
Pressure areas
Changes in skin colour
Sores that aren't healing
Wear appropriate, comfortable footwear and avoid walking barefoot if you have reduced sensation.
If you cannot easily inspect your feet yourself, ask someone to help.
Keep moving
Appropriate physical activity supports circulation, muscle strength, balance and general health. Exercise may also help people living with neuropathic pain maintain function.
Don't smoke
Smoking damages blood vessels and can compromise circulation — something particularly important when nerve health and foot health are already at risk.
Limit excessive alcohol
Long-term heavy alcohol consumption is a recognised contributor to peripheral neuropathy.
Eat for overall health
There is no single "neuropathy diet", but a balanced diet that provides adequate vitamins, minerals, protein, fibre and healthy fats supports overall metabolic health.
For people with diabetes, dietary choices should also form part of their individual diabetes-management plan.
Look after your whole body
Blood pressure, cholesterol, kidney health, weight, sleep and general cardiovascular health all matter.
Your nerves don't exist in isolation from the rest of your body.
And then there is the emotional side
One aspect of neuropathy that is sometimes overlooked is what chronic pain does to a person's emotional wellbeing.
Constant pain can make sleep difficult.
Poor sleep makes pain harder to tolerate.
Reduced mobility can lead to isolation.
Loss of independence can affect confidence.
And when pain continues for months or years, it can become exhausting.
The American Diabetes Association specifically notes that painful diabetic neuropathy can affect sleep, mobility and quality of life.
This is why treatment shouldn't focus only on reducing a pain score.
The bigger goal is helping someone live their life.
Our reason for developing Avobetic
Danie's experience with diabetes and neuropathy was one of the reasons I wanted to create something that could provide topical support without requiring another tablet to be swallowed.
That journey eventually led to Avobetic, our topical diabetic-support and nerve-pain formulation.
It was never about believing that one lotion could "cure" nerve damage.
It was about looking for another option — something that could be applied directly to areas of discomfort and used as part of a broader approach to managing everyday wellbeing.
And that distinction is important.
Note: A topical product cannot replace diabetes management, medical treatment, wound care, appropriate medication or professional advice.
But for someone living with chronic discomfort, having another tool in the toolbox can be valuable.
There is hope
Neuropathy can be frightening.
The words nerve damage can make people immediately think about everything they might lose — their mobility, their independence, their ability to work, or their quality of life.
Danie's story has taught me that the journey can be incredibly difficult.
But it has also taught me something else.
A diagnosis is not the end of the story.
There may be an underlying cause that can be treated. There may be ways to slow progression. There may be medication, physiotherapy, lifestyle changes, topical therapies or other approaches that can reduce symptoms or improve function.
And sometimes progress isn't measured by eliminating every bit of pain.
Sometimes progress is sleeping a little better.
Walking a little further.
Having enough comfort to enjoy a conversation.
Being able to get through the day.
Finding a way to do something you thought you could no longer do.
If you are experiencing unexplained burning, tingling, numbness, weakness or shooting pain, don't simply accept it as something you have to live with.
Listen to your nerves. Get them checked. Find the cause. Protect what sensation and mobility you have. And don't give up looking for ways to live well alongside the condition.
Because even when neuropathy changes the path we expected to take, there can still be a path forward.
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