Peripheral neuropathy can cause burning, tingling, numbness, electric pain, weakness, balance changes, or autonomic symptoms affecting daily function.
Peripheral neuropathy can cause numbness, tingling, burning, and weakness in the hands and feet. Dr. Siefferman explains the many possible causes of nerve damage and why identifying the underlying condition is essential for effective treatment.
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Hi, I’m Dr. Jason Seifferman, medical director at Manhattan Pain Medicine. Peripheral neuropathy is a very generic term that we use to refer to a neuropathic process in the peripheral nerves.
Not spinal nerves, not cranial nerves, but generally the nerves that go into the hands and feet. And generally we think of peripheral neuropathies as occurring with a number of metabolic issues such as diabetes, infectious issues such as HIV or autoimmune issues like chronic inflammatory demyelinating polyneuropathy. With peripheral neuropathy, the first course of action is to understand why it’s happening. And there is a long list of possible reasons.
We will go through this list with you. We want to understand why it’s happening because that’s ultimately what we have to treat to make it better. We can give you medications to treat the symptoms, but without understanding why it’s happening, it generally will not improve.
Peripheral neuropathy occurs when nerves outside the brain and spinal cord are damaged or not functioning normally. It can cause burning, tingling, numbness, electric shocks, stabbing pain, weakness, sensitivity, balance problems, or pain in the hands and feet. Some neuropathies may also affect autonomic functions such as sweating, temperature regulation, blood pressure, digestion, urination, or heart rate.
Because peripheral neuropathy can have many causes, including diabetes, autoimmune disease, vitamin deficiency, medication effects, chemotherapy, infection, nerve compression, spine-related nerve pain, or small fiber neuropathy, diagnosis-first evaluation is essential before treatment is recommended.
At Manhattan Pain Medicine (MPM), evaluation begins by understanding the pattern, severity, and possible source of nerve symptoms.
For patients seeking peripheral neuropathy treatment in Manhattan, MPM evaluates neuropathic pain in context, including nerve distribution, sensory changes, autonomic symptoms, diabetes or metabolic risk, autoimmune or inflammatory history, prior chemotherapy, medication exposure, post-viral symptoms, spine contributors, nerve entrapment, hypermobility, and chronic pain sensitization.
Care may include medication management, coordination with neurology or other specialists, sympathetic blocks in selected cases, spinal cord stimulation, peripheral nerve stimulation, and other pathway-specific options when clinically appropriate.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Luis Aranguren, MD
Interventional Pain Management
Tayyaba Ahmed, DO
Physical Medicine & Rehabilitation | Pelvic Pain
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Peripheral neuropathy is not one single condition. It is a broad category of nerve dysfunction that can affect sensory nerves, motor nerves, autonomic nerves, or a combination. Some patients have burning feet, numb hands, night pain, sensitivity to touch, balance difficulty, or symptoms that spread over time. Others may have autonomic symptoms such as dizziness, sweating changes, temperature intolerance, digestive symptoms, urinary changes, or heart rate changes.
Testing may include bloodwork, neurologic examination, EMG or nerve conduction studies, imaging, skin biopsy, or additional specialty evaluation, depending on the suspected cause. In some patients, especially with small fiber neuropathy, standard nerve conduction testing may be normal even when burning pain or autonomic symptoms are present.
MPM’s role is to evaluate the pain pattern, identify possible pain drivers, and coordinate care when neurologic, autoimmune, autonomic, metabolic, or musculoskeletal factors overlap.
Peripheral neuropathy connects with several MPM Zones of Expertise, including Autonomic dysfunction, Autoimmune and Inflammatory, Hypermobility, and Musculoskeletal issues. Some patients have nerve pain with autonomic symptoms such as dizziness, sweating changes, temperature intolerance, gastrointestinal symptoms, urinary changes, or heart rate changes. Others may have autoimmune inflammation, small fiber neuropathy, post-viral symptoms, or connective tissue-related nerve vulnerability.
MPM evaluates these overlaps carefully. The goal is to determine whether the patient’s symptoms are driven by peripheral nerve damage, nerve irritation, autonomic involvement, inflammatory disease, spine-related nerve pain, nerve entrapment, hypermobility-related mechanics, or central pain processing. This helps guide safe, coordinated, and appropriately targeted treatment.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Peripheral neuropathy is damage or dysfunction of nerves outside the brain and spinal cord. These nerves help control sensation, movement, pain signals, and automatic body functions. When peripheral nerves are affected, patients may experience burning, tingling, numbness, electric pain, stabbing pain, weakness, sensitivity, or balance problems. Some neuropathies also involve autonomic symptoms such as sweating changes, blood pressure changes, heat intolerance, digestion issues, urinary changes, or heart rate regulation problems.
Peripheral neuropathy may feel like burning, tingling, pins and needles, numbness, electric shocks, stabbing pain, hypersensitivity, or pain from light touch. Some patients notice symptoms in the feet first, while others have symptoms in the hands, legs, arms, or more widespread areas. Pain may worsen at night or after activity. Motor nerve involvement may cause weakness, cramping, balance problems, or difficulty walking. Autonomic nerve involvement may affect sweating, digestion, urination, temperature tolerance, blood pressure, or heart rate.
Peripheral neuropathy can have many causes. These may include diabetes, autoimmune disease, inflammation, vitamin deficiency, infections, medications, chemotherapy, alcohol exposure, inherited disorders, trauma, nerve compression, spine-related nerve pain, kidney disease, thyroid disease, or idiopathic causes, meaning no clear cause is found. Because causes vary, evaluation may require bloodwork, neurologic testing, imaging, medication review, autoimmune assessment, metabolic review, and coordination with neurology, rheumatology, endocrinology, primary care, or other specialists.
Small fiber neuropathy affects small sensory and autonomic nerve fibers. It may cause burning pain, tingling, temperature sensitivity, allodynia, or pain in the feet, hands, or other areas. It may also contribute to autonomic symptoms such as sweating changes, dizziness, gastrointestinal symptoms, urinary symptoms, or heart rate changes. Standard EMG and nerve conduction studies can be normal in small fiber neuropathy, so additional testing such as skin biopsy or autonomic testing may be considered by the appropriate specialist.
Yes. Autoimmune and inflammatory conditions may affect peripheral nerves in selected patients. Some patients with autoimmune-related pain, connective tissue disease, vasculitis, Sjogren’s syndrome, lupus, or other inflammatory conditions may develop nerve pain, numbness, tingling, weakness, or autonomic symptoms. These cases often require coordinated evaluation with rheumatology, neurology, and other clinicians. MPM can help evaluate the pain pattern and support neuropathic pain management while disease-specific treatment is coordinated with the appropriate specialist.
Yes. When autonomic nerves are involved, peripheral neuropathy may affect automatic body functions. Symptoms may include abnormal sweating, heat or cold intolerance, dizziness, blood pressure changes, heart rate changes, digestion problems, constipation, diarrhea, urinary symptoms, or sexual function changes. These symptoms can overlap with dysautonomia, POTS-like symptoms, endocrine conditions, medication effects, and other medical issues. Careful evaluation is important to determine whether symptoms reflect autonomic neuropathy, another autonomic disorder, or a different medical condition.
Treatment depends on the cause, severity, and symptom pattern. Care may include treating the underlying cause when possible, medication management for neuropathic pain, topical therapies, physical function support, fall-risk reduction, lifestyle or metabolic support, and coordination with neurology or other specialists. In selected refractory neuropathic pain patterns, spinal cord stimulation, peripheral nerve stimulation, sympathetic blocks, ketamine therapy, lidocaine and ketamine infusions, or other advanced options may be considered after careful evaluation. These are not appropriate for every patient.
Spinal cord stimulation may be considered for selected patients with refractory painful neuropathy who have not improved enough with appropriate conservative care and medication management. It is not a treatment for every type of neuropathy and does not repair damaged nerves or treat the underlying cause. Evaluation usually includes diagnosis review, pain pattern analysis, risk discussion, prior treatment review, and a temporary trial before permanent implantation is considered.
Peripheral nerve stimulation is a neuromodulation approach that targets a specific peripheral nerve or nerve region to help modulate pain signals in selected chronic nerve pain conditions. It may be considered when symptoms are localized to a nerve distribution and other appropriate care has not provided enough relief. It is not a universal neuropathy treatment and does not reverse nerve damage. Patient selection depends on the pain pattern, diagnosis, anatomy, prior treatments, risks, and treatment goals.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Peripheral neuropathy occurs when nerves outside the brain and spinal cord are damaged, irritated, or not functioning normally. These nerves carry signals related to sensation, pain, movement, and automatic body functions. When they are affected, patients may experience burning, tingling, numbness, electric shocks, stabbing pain, sensitivity to touch, weakness, poor balance, or symptoms that feel worse at night.
Peripheral neuropathy most commonly affects the feet and hands, but it can involve other areas depending on which nerves are affected. Some patients feel burning feet, numb toes, tingling fingers, or a sensation that they are walking on padding. Others notice weakness, cramping, difficulty with balance, or pain from light touch.
Peripheral neuropathy can affect sensory nerves, motor nerves, autonomic nerves, or a combination. Sensory nerve involvement may cause pain, numbness, tingling, temperature sensitivity, or hypersensitivity. Motor nerve involvement may cause weakness, muscle cramping, loss of coordination, or difficulty walking. Autonomic nerve involvement may affect sweating, blood pressure, digestion, urination, temperature regulation, or heart rate.
Small fiber neuropathy is an important subtype because it can cause burning pain and autonomic symptoms even when EMG or nerve conduction testing is normal. In these cases, additional evaluation through neurology or autonomic specialists may be needed.
Peripheral neuropathy has many possible causes. Diabetes is a common cause, but it is not the only one. Neuropathy may also be related to autoimmune disease, inflammation, vitamin deficiency, thyroid disease, infections, chemotherapy, medication toxicity, alcohol exposure, inherited disorders, trauma, nerve compression, kidney disease, post-viral illness, or idiopathic causes.
Some patients have symptoms that overlap with autoimmune-related pain, autonomic dysfunction, POTS-like symptoms, post-COVID pain, EBV-related pain, EDS, hypermobility spectrum disorder, peripheral nerve entrapment, CRPS, fibromyalgia, or central pain syndromes. This overlap can make evaluation more complex.
Burning, tingling, numbness, electric pain, and weakness do not always come from generalized peripheral neuropathy. Similar symptoms may come from a focal nerve entrapment, such as cubital tunnel syndrome, tarsal tunnel syndrome, peroneal nerve entrapment, or carpal tunnel syndrome. Symptoms may also come from cervical or lumbar radiculopathy, spinal stenosis, myelopathy, or other spine-related nerve compression.
This distinction matters because treatment is different. A patient with small fiber neuropathy, diabetic neuropathy, autoimmune neuropathy, nerve entrapment, and lumbar radiculopathy may all describe nerve pain, but the care pathway may be very different.
MPM begins by reviewing the full symptom pattern, including location, duration, severity, triggers, sensory changes, weakness, balance issues, autonomic symptoms, medical history, medications, prior chemotherapy, diabetes or metabolic risk, autoimmune history, infection history, and prior testing.
The evaluation may include review of bloodwork, imaging, EMG or nerve conduction studies, neurologic findings, musculoskeletal contributors, and prior specialist notes. When nerve entrapment or focal nerve irritation is suspected, diagnostic ultrasound may be considered in selected cases. When systemic or progressive neuropathy is suspected, coordination with neurology, rheumatology, endocrinology, primary care, or another specialist may be needed.
Treatment depends on the cause and the dominant symptom pattern. When an underlying cause is identified, care should address that cause when possible. For example, neuropathy related to diabetes, vitamin deficiency, autoimmune disease, medication exposure, or chemotherapy may require disease-specific management with the appropriate clinician.
Pain-focused treatment may include medication management, topical treatments, physical function support, fall prevention, pacing strategies, and treatment of overlapping musculoskeletal or spine contributors. Pain psychology may help some patients manage sleep disruption, stress, fear of worsening symptoms, and the functional impact of chronic neuropathic pain.
Sympathetic blocks may be considered for selected sympathetically mediated or neuropathic pain patterns, but they are not standard treatment for every neuropathy presentation. The decision depends on the pain pattern, suspected mechanism, prior treatment response, and risk profile.
Spinal cord stimulation may be considered for selected patients with refractory painful neuropathy after appropriate evaluation and conservative treatment review. Peripheral nerve stimulation may be considered when pain is localized to a specific nerve distribution and the anatomy supports this approach. These treatments are designed to modulate pain signaling. They do not repair nerves, reverse neuropathy, or treat the underlying cause.
Patients should seek urgent evaluation for sudden weakness or numbness, facial droop, speech difficulty, vision loss, severe sudden headache, loss of bowel or bladder control, saddle anesthesia, rapidly worsening weakness, falls, infected foot wounds, severe swelling, fever, chest pain, shortness of breath, or symptoms after major trauma.
MPM approaches peripheral neuropathy through a diagnosis-first, coordinated model. The goal is to identify whether symptoms are driven by peripheral nerve damage, small fiber neuropathy, autoimmune inflammation, autonomic involvement, nerve entrapment, spine-related nerve compression, hypermobility-related nerve irritation, or central pain processing.
For patients looking for peripheral neuropathy treatment in Manhattan, MPM offers a careful pain medicine perspective focused on neuropathic pain, functional impact, diagnostic coordination, and selected treatment options. Care may include medication management, sympathetic blocks, spinal cord stimulation, peripheral nerve stimulation, and specialist coordination when appropriate. The goal is to clarify the source of symptoms and guide appropriate next steps without overpromising outcomes.
