Burning feet, numb hands and nerve pain deserve a cause, not just a prescription for the symptom.
Peripheral neuropathy is extremely common and frequently under-investigated. Patients are often told it is simply age or diabetes and given gabapentin. That is sometimes correct — but a meaningful proportion of neuropathies have another cause entirely, and several of those causes are treatable if they are found.
B12 deficiency, thyroid disease, monoclonal gammopathy, coeliac disease, chronic inflammatory demyelinating polyneuropathy and medication toxicity all present as neuropathy and all change management once identified. A structured workup finds a cause far more often than the reputation of the condition suggests.
Nerve conduction studies and EMG are performed here in the office. These tests establish whether the problem is in the nerve, the nerve root or the muscle, and whether it is a demyelinating or axonal process — distinctions that direct the entire rest of the evaluation.
Weakness that spreads over hours or days, particularly if it begins in the legs and rises, may indicate Guillain-Barré syndrome and is a medical emergency. Seek emergency care immediately for rapidly worsening weakness, difficulty breathing, or new loss of bladder or bowel control.
“Patients are often told neuropathy has no cause worth chasing. A careful workup finds a treatable one far more often than that suggests.”