What causes peripheral neuropathy?

Common causes include diabetes, autoimmune disease, alcoholism, chemotherapy or radiation, hereditary disorders and injury.

Which physiotherapy methods help neuropathic pain?

Evidence supports TENS, softlaser (photobiomodulation), PEMF/BEMER therapy and muscle stimulation (NMES/EMS) for symptom relief and support.

Is TENS safe and how should it be used for neuropathy?

TENS is generally safe for symptomatic pain relief. Use glove/sock electrodes with an adhesive electrode 3-5 cm away; safe intensity is usually 8-18 mA. Do not use with pacemakers, active thrombosis, epilepsy or on the head/neck; avoid abdominal use in pregnancy.

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Causes of Peripheral Neuropathy and Treatment Options

Peripheral neuropathy is damage to the peripheral nerve fibers that causes sensory and balance disturbances and instability. Its main symptoms are tingling, numbness, burning sensations and a vibration-like feeling. Pain often worsens at night, and touching the affected area or even temperature changes can increase it. Neuropathy is not currently curable, but symptom relief — albeit limited — is possible.

What does peripheral neuropathy mean?

Peripheral neuropathy is a type of damage to the peripheral nervous system. It affects the nerves that carry information from the brain and spinal cord (the central nervous system) to the rest of the body and back.

Neuropathy most commonly results from diabetes, autoimmune disease, or alcoholism. It can also be a frequent side effect of chemotherapy and radiation therapy. Some forms are hereditary, while others develop due to injury.

There are more than 100 types of peripheral neuropathy, each with its own symptoms and prognosis. They are classified into the following categories:

Motor neuropathy: Damage to the nerves that control muscles and movement — for example, affecting hand and arm movements or speech.
Sensory neuropathy: Nerves that transmit signals for pain, temperature or touch.
Autonomic neuropathy: Controls functions you cannot voluntarily influence, such as breathing and heartbeat.
Combined neuropathies: Two or three of the above types can be present at the same time. An example is sensorimotor neuropathy.

Symptoms of peripheral neuropathy

Symptoms depend on which type you have and which part of the body is affected. They can range from tingling and numbness to burning pain or even paralysis:

Burning, tingling pain, numbness, a "stinging" sensation
Muscle weakness, cramps, muscle twitching, muscle mass loss (atrophy)
Loss of bone mass
Changes in the skin, hair or nails
Loss of balance
Emotional disturbances, sleep disorders
Loss of pain sensation (dangerous — you may not notice injuries)
Inability to sweat, causing sensitivity to heat
Bladder control problems
Dizziness from loss of blood pressure regulation
Diarrhea, constipation
Eating or swallowing difficulties
In severe cases, breathing difficulty or irregular heartbeat

Diagnosis of neuropathy

The symptoms of peripheral neuropathy can resemble other conditions. Therefore, an accurate diagnosis is extremely important. If you suspect neuropathy, consult a neurologist! In many cases neuropathy is related to an underlying disease, so the physician may already expect its occurrence.

Prevention: the most effective approach

Lifestyle choices play a role in preventing peripheral neuropathy. You can reduce the risk by:

Avoiding alcohol consumption
Correcting vitamin deficiencies
Eating a healthy diet
Losing weight
Avoiding toxins
Exercising regularly

If you have kidney disease, diabetes or other chronic problems, lifestyle changes can delay or even prevent the development of neuropathy.

Treatment options: what does the research say?

Peripheral neuropathy is generally not curable, but progression can be slowed and symptoms can be alleviated. Drug treatments sometimes help and sometimes do not — it is a matter of trial. Below I review physiotherapy methods that have scientific evidence.

TENS treatment and neuropathy

What is TENS?

TENS (transcutaneous electrical nerve stimulation) is a pain relief procedure. It is important to emphasize: it provides symptomatic treatment — it does not repair damaged nerves, but helps reduce pain.

What do scientific studies say?

Diabetic neuropathy:

According to the American Academy of Neurology's (AAN) 2010 evidence-based review, TENS is "probably effective" in treating pain of diabetic peripheral neuropathy (Level B recommendation, based on 2 Class II trials).¹

A 2010 meta-analysis analyzing data from 78 patients found that the TENS group experienced significantly greater pain reduction than the placebo group during 4- and 6-week follow-up.²

Chemotherapy-induced neuropathy (CIPN):

A 2023 multi-center, double-blind, randomized clinical trial (142 participants) showed that daily home TENS treatment produced promising results in relieving painful CIPN symptoms. The researchers recommend further confirmatory studies.³

Cochrane review (2017):

The Cochrane systematic review found that TENS demonstrated a moderate pain-relieving effect compared with placebo for neuropathic pain in the short term. The quality of evidence was low, but the effect exceeded the minimally clinically important difference.⁴

How to apply TENS treatment?

For neuropathy treatment, put on the glove or sock electrode for your hand or foot. You can use it dry, but the treatment may be more effective if you moisten it — dip it in lukewarm water, squeeze out the excess and put it on while still damp.

Stick an adhesive electrode above your wrist or ankle, 3–5 cm away from the edge of the glove/sock.

Connect the cable to the TENS device (suggestions below):

Positive (red) cable end → glove/sock electrode
Negative (black) → adhesive electrode

Start program 1 and increase the intensity gradually.

⚠️ Warning: In severe neuropathy, due to damaged sensory nerve endings, you may not feel the electric prick of the current!

Safe intensity: Generally 8–18 mA is sufficient. Currents above 50 mA can cause skin burns — which you might not feel because of the neuropathy!

The same application method can also help reduce pain from rheumatoid small joint inflammation.

Which TENS devices are suitable?

For relieving neuropathic pain, the simplest TENS devices are also suitable. There is no need for expensive, high-priced machines.

Recommended devices:

Required accessories:

Softlaser therapy and neuropathy

What is softlaser (photobiomodulation)?

Softlaser therapy — scientifically called photobiomodulation (PBM) — uses low-energy laser beams to stimulate tissues. Red and near-infrared light are absorbed in the mitochondria of cells, increasing ATP production, modulating reactive oxygen species, and potentially supporting nerve regeneration processes.

What do scientific studies say?

2019 systematic review (Diabetes & Metabolic Syndrome):

Analysis of 6 trials concluded that softlaser therapy showed a positive effect in controlling painful diabetic neuropathy. The studies used pain scales, nerve conduction velocity and quality-of-life questionnaires.⁵

2022 BMJ Open protocol:

A comprehensive systematic review and meta-analysis protocol examining 8 databases evaluates the effectiveness and safety of laser/photobiomodulation in diabetic peripheral neuropathy.⁶

2025 case report:

In an 81-year-old diabetic male, softlaser treatment resulted in significant pain reduction and improvement in sensation.⁷

Overall: The available evidence is promising, although researchers emphasize the need for further randomized, controlled trials to optimize protocols.

How to apply softlaser treatment?

Laser treatment should be performed on the painful area, proceeding point by point. Treatment time depends on the device power, laser beam diameter and the size of the treated area.

Perform the treatment once daily.

Recommended softlaser devices

Personal Laser L400 – ideal for home use
Energy Laser L500 – higher power, faster treatment

PEMF (pulsed electromagnetic field) therapy and neuropathy

What is PEMF?

PEMF (Pulsed Electromagnetic Field) therapy uses low-frequency, pulsed electromagnetic fields. The therapy aims to restore cellular electrical potential, reduce inflammation, and improve microcirculation.

What do scientific studies say?

2023 double-blind randomized trial (182 participants):

A study published in the Journal of Diabetes Science and Technology showed that PEMF treatment produced a 30% clinically meaningful pain reduction in patients with diabetic symmetric peripheral neuropathy (DSPN) compared with placebo. Skin perfusion pressure (SPP) showed a trend toward improvement.⁸

2009 large trial (225 participants):

Weintraub and colleagues did not find significant pain reduction with the applied dose, but epidermal nerve fiber density (ENFD) analysis showed promising neurobiological effects. The researchers recommended higher doses (3000–5000 G) and longer treatment duration.⁹

Indian clinical trial:

In a study of 121 diabetic polyneuropathy patients, Musaev and colleagues found that PEMF treatment improved peripheral nerve conduction function and led to regression of main clinical symptoms.¹⁰

2025 review (MDPI):

Clinical trials consistently show that PEMF therapy has anti-inflammatory and edema-reducing properties, improves microcirculation, and can reduce neuropathic pain.¹¹

How does PEMF work in neuropathy?

Restoration of cell membrane potential: Supports healthy cell function and regenerative capacity
Inflammation reduction: Lowers pain related to inflammation
Improvement of microcirculation: Enhances oxygen and nutrient supply to tissues

Recommended PEMF devices

For neuropathy treatment, a PEMF device with general tissue regeneration or anti-inflammatory protocols is suitable:

BEMER therapy and neuropathy

What is BEMER?

BEMER (Bio-Electro-Magnetic-Energy-Regulation) is a specific PEMF technology that primarily focuses on improving microcirculation. It enhances vasomotion — the rhythmic contraction and relaxation of vessel walls — in the small vessels (precapillary microvasculature).

What do studies say?

2013 clinical study (658 patients):

A study published in the Journal of Complementary and Integrative Medicine showed significant improvements in sleep, pain and quality of life among patients with various conditions after 6 weeks of BEMER use.¹²

CRPS-I study (30 participants):

In a randomized, controlled, double-blind pilot trial, BEMER therapy combined with rehabilitation produced better results in pain reduction and functional improvement for both upper and lower limbs.¹³

How can BEMER help in neuropathy?

By improving microcirculation:

More oxygen and nutrients reach the tissues
Harmful substances and metabolic waste are removed more quickly
It may support regeneration of nerve tissue

Note: The BEMER device is not cheap. However, those who can afford it may not only reduce neuropathy symptoms but also support any condition caused by reduced circulation.

Muscle stimulation (EMS/NMES) and neuropathy

Why is it important to talk about muscle stimulation?

One serious complication of peripheral neuropathy is muscle wasting (atrophy). Muscles lose mass and strength. Sensory disturbance can also affect joint position receptors (proprioception), resulting in an unstable, stumbling gait.

What do studies say about muscle stimulation?

Cochrane and systematic reviews:

Neuromuscular electrical stimulation (NMES) effectively prevents loss of muscle mass and strength during immobilization.¹⁴

2014 Acta Physiologica study:

In 24 healthy young subjects, NMES (twice daily, 40 minutes each) prevented muscle mass loss during 5 days of immobilization. The control group experienced a 3.5% reduction in cross-sectional muscle area, while the NMES group did not.¹⁵

2024 Frontiers review:

NMES can preserve muscle mass, prevent atrophy, and to some extent improve gene expression. It is particularly valuable for those unable to perform regular exercise.¹⁶

Practical advice

The most effective prevention of muscle strength loss is regular exercise: at least 30–40 minutes of walking or cycling. If you cannot do these, use a muscle stimulation device.

Muscle stimulation does not replace movement, but it helps:

Slow down or stop muscle strength loss
With appropriate frequency, aid in regaining muscle strength

You can find muscle stimulators here.

In my article on strengthening the thigh muscles I present a program and suitable devices.

Other supportive methods

Relaxation, meditation, yoga

Relaxation techniques can help alleviate emotional and physical symptoms. For those living with chronic pain, stress management is an important part of comprehensive therapy.

Before you start treatment

To ensure safe use, know the contraindications.

When NOT to use?

Contraindications for TENS treatment:

Implanted pacemaker or defibrillator
Pregnancy (on the abdominal area)
Active thrombosis
Epilepsy
Treatment on the head/neck area (carotid)

Contraindications for softlaser treatment:

Direct irradiation into the eyes is prohibited
Malignant tumor at the treatment site
Active bleeding
Pregnancy (on the abdominal area)

Detailed information on contraindications: Contraindications of softlaser therapy

Contraindications for PEMF/BEMER treatment:

Implanted pacemaker
Active bleeding
Severe cardiac arrhythmia
Pregnancy

Contraindications for muscle stimulation:

Implanted pacemaker
Active thrombosis
Treatment over the heart area

Possible side effects

The listed therapies are generally safe and well tolerated. Rare side effects may include:

TENS: Skin irritation under electrodes, muscle fatigue
Softlaser: Mild warming sensation, temporary skin redness
PEMF: Headache, dizziness (rare)
Muscle stimulation: Muscle fatigue, soreness-like sensation

Further softlaser applications

Softlaser therapy can support the treatment of many other diseases and complaints. For an overview of all home application areas, read the Softlaser therapy at home – Treating diseases article.

If you are not familiar with the basics of softlaser therapy, start with the Comprehensive guide to softlaser therapy article.

Summary – Quick overview

What is this article? A comprehensive guide to the causes, symptoms and evidence-based treatment options for peripheral neuropathy.

Who is it for? People with neuropathy, diabetics, those who have undergone chemotherapy, and their caregivers.

Main message: Peripheral neuropathy is currently not curable, but symptoms — especially pain — can be alleviated with several physiotherapy methods. TENS, softlaser, PEMF/BEMER therapy and muscle stimulation all have scientific backing and can be used safely at home.

Scientific sources

The information in this article is for informational purposes only. Home therapeutic devices are intended to complement medical treatment, not replace specialist care. Consult a physician before starting treatment!

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