What Causes Neuropathy?

What Causes Peripheral Neuropathy

Neuropathy is very common. It is estimated that about 25% of Americans will be affected. Yet more than a third don’t know what caused it. If you are one of them, you may be wondering what causes peripheral neuropathy. 

Neuropathy is a common condition that results from damage to any of the nerves outside of the brain and spinal cord. 

It isn’t a lone disease. At the root, there is always a cause — some other condition or problem of sorts. In fact, there are over 100 known causes 1. And the phrase “known cause” is used because there are still many more causes of neuropathy that are more or less unknown

When the cause of nerve damage cannot be traced, it’s given the term idiopathic, which literally just means “unknown cause,” and is used to describe about a third of all cases 2.

Understanding what can cause nerve damage can help you better understand the sensitive nature of nerves and get you thinking about some of the ways they may have become damaged, or are continuing to be damaged further.

And more importantly, ways you can begin to eliminate what causes nerve damage, where possible.

The cause of peripheral neuropathy for you may or may not be attributed to one specific cause. Rather, it may be a combination of factors that have compromised the health of your nervous system. 

Chronic Inflammation: The Common Factor

One common factor to nearly all causes of neuropathy is chronic inflammation. In fact, chronic inflammation is now being recognized as the underlying common denominator of nearly all modern diseases 3.

Inflammation is a normal response of the body’s immune and healing systems. It helps protect against disease and infection, and is responsible for healing the body when damage takes place.

When chronic, inflammation in the body can cause or accelerate disease, and prohibit healing. 

Next you’ll get an overview of known causes broken into two distinct categories: biological and mechanical. These are not intended to be complete lists (and remember not all causes have been identified).

However, they illustrate the complexity and difficulty for determining direct causes of nerve damage.  As well as show how peripheral neuropathy can develop as a result of multiple risk factors.

Biological Causes of Neuropathy

Biological Causes of Peripheral Neuropathy

The most common types of neuropathy are the biologically-caused, if for no other reason than the range of potential ways in which the body can become diseased. 

Biological causes of neuropathy are those that result from diseases.

Keeping current with routine physical screenings is important to identify and manage diseases early to avoid or minimize their damaging effects.

Diseases That May Cause Neuropathy

  • Diabetes, prediabetes, metabolic syndrome 4 5
  • Kidney disease 6
  • Liver disease 7
  • Thyroid disease 8
  • Bacterial or viral infections 9
  • Alcoholism 10
  • Atherosclerosis 11
  • Some cancers 12
  • Sarcoidosis 13
  • Guillain-Barre syndrome 14
  • Rheumatoid arthritis 15
  • Sogren’s syndrome 16
  • Chronic venous insufficiency 18
  • Vasculitis 19 20
  • Cytomegalovirus 21
  • Gastric bypass surgery 22
  • Lupus 23
  • Lyme disease 24
  • Peripheral artery disease 25
  • Heart diseases 26
  • Gut infections 27 28
  • Fabry’s Disease 29
  • Nutritional deficiencies 30
  • Vitamin toxicity 31
  • HIV 32
  • Excessive weight 33
  • Post-surgical inflammation 34
  • Shingles 35
  • Tumors 37
  • Connective tissue diseases 38
  • Vitamin deficiencies 40
  • Charcot-Marie-Tooth disease 41
  • Chronic inflammatory demyelinating polyradiculoneuropathy 42
  • Critical illness 43

Mechanical Causes of Neuropathy

Mechanical Causes of Peripheral Neuropathy

Mechanical causes of neuropathy involve the body being acted upon by an outside force or structural dysfunction. This typically means injury, constriction, compression, or other trauma that can result in nerve damage 44

Misaligned joints causing pinched nerves can result in conditions that may lead to long-term nerve damage if left untreated. Surgery can be another type of mechanical process that can cause peripheral neuropathy due to the cutting of nerves or post-surgical inflammation.

Examples of mechanical causes of peripheral neuropathy include:

  • Brachial plexus syndrome
  • Broken bone
  • Bunion
  • Carpal tunnel syndrome
  • Herniated discs
  • Joint trauma
  • Morton’s neuroma
  • Pinched (entrapped, compressed) nerves
  • Piriformis syndrome
  • Sciatica
  • Stenosis
  • Slipped disc
  • Spinal surgery
  • Spinal tumor
  • Surgical damage 45

Toxic Causes of Neuropathy

Toxic Causes of Peripheral Neuropathy

Chemicals, toxins, and poisons causing nerve damage are often referred to as toxic neuropathy 46. We encounter these nerve-damaging toxins in the form of pollutants in our environment, such as chemicals in the products we use in our homes and toiletries, chemicals we consume through foods, smoking, and even the medications we take. 

The way toxins affect the nervous system is by causing a “dying back” of the nerve cells (neurons) that have the longest nerve fibers (axons) 47 48

Because the longest, and therefore most fragile, nerve fibers extend to the toes and fingers, symptoms often appear in these parts of your body first. As the nerve damage progresses, symptoms can move toward the central body.

Diseases of the liver and kidneys reduce your body’s ability to filter toxins, making the impact of toxic exposure more threatening. Be sure you are current on routine liver and kidney screenings.

Environmental Toxins that May Cause Neuropathy

Below are some of the more common toxins we encounter regularly:

  • Alcohol 49 50
  • Smoke 51 52
  • Vitamin toxicity 53
  • Indoor mold and mycotoxins 54
  • Arsenic (water, soil, contaminated foods) 55 56
  • Excitotoxins, like MSG and aspartame 57 58 59
  • Pesticides 60 61
  • Acrylamide 62
  • Heavy metals 63 64 65 (in some fish, contaminated soil)
  • Thallium 66 (in contaminated food and water, cigarettes)

Medications That May Cause Neuropathy

There are many medications that carry nerve damage warnings. Some of which are elective, such as acne medications, but others are necessary life-saving drugs, such as those for cancer. 

If you are taking a prescription that you are concerned about, do not stop the medication on your own. Talk to your doctor about your concerns. In some cases, there are alternatives.

Do not stop taking any prescribed medication without consulting with your doctor first.

The following medications with peripheral nerve damage warnings are combined from these resources:

Used for High Cholesterol

  • Altocor (lovastatin)
  • Crestor (rosuvastatin)
  • Lescol (fluvastatin)
  • Lipex (simvastatin)
  • Lipitor (atorvastatin)
  • Livalo (pitavastatin)
  • Pravachol (pravastatin)

Used for Blood Pressure

  • Amiodarone
  • Captopril
  • Enalapril
  • Flecainide
  • Hydralazine
  • Perhexiline

Used for Autoimmune Disorders

  • Arava (leflunomide)
  • Chloroquine
  • Enbrel (etanercept)
  • Golimumab (etanercept)
  • hydroxychloroquine
  • Infiximab (etanercept)
  • Remicade (infliximab)

Used for Infections

  • Aczone (dapsone)
  • Chloramphemicol
  • Chloroquine
  • Cipro (ciprofloxacin)
  • Ethambutol
  • Flagyl (metronidazole)
  • Isoniazid
  • Metronidazole
  • Nitrofurantoin
  • Savudine
  • Suramin
  • Thalidomide
  • Videx (didanosine)

Used for Rheumatic Diseases

  • Allopurinol
  • Colchicine
  • Etanercept
  • Gold
  • Indomethacin

Used for Cancer

  • Abraxane (paclitaxel)
  • Cisplatin
  • docetaxel
  • Matulane (procarbazine)
  • Misonidazole
  • paclitaxel
  • Platinol (cisplatin)
  • Revlimid (lenalidomide)
  • Suramin
  • vinblastine
  • vincristine

Drugs to Treat Seizures

  • Carbamazepine
  • Dilantin
  • Phenytoin
  • Phenobarbital

Anti-Alcohol Drugs

  • Disulfiram

Drugs to Fight HIV/AIDS

  • Emtriva (emtricitabine)
  • Truvada (tenofovir and emtricitabine)
  • Videx (didanosine)
  • Zerit (stavudine)


  • Colchicine (used to treat gout)
  • Arsenic
  • Gold
  • Lithium

Next Steps

The best treatment is prevention 67. Understanding what causes neuropathy can help to avoid nerve damage or to minimize the damage and symptoms once symptoms have started. Work with your doctor to manage underlying conditions. 

Self-care strategies that reduce chronic inflammation and improve general health is universally recommended for all cases of neuropathy, despite the cause.

Tami Winchell, BCPA CN

Cornell-Trained Clinical Nutritionist, Traditional Naturopath, Board-Certified Patient Advocate.

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