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FREQUENTLY ASKED QUESTIONS about peripheral neuropathy and its treatment with answers provided by Alene Hoffman, DPM, PhD, medical advisor to Neuropathy Research Inc who has been practicing podiatry in San Francisco for more than 30 years. 

Dr Arlene Hoffman, DPM, PhD.

What is peripheral neuropathy?

By definition, peripheral neuropathy means damage to nerves that go to the extremities. Specifically, if there is peripheral neuropathy present, the person can experience pain, numbness, tingling or burning in the foot or toes. They also might feel like their socks are bunched or ants are crawling on their skin.

What are main causes peripheral neuropathy?

Peripheral neuropathy may be associated with people with diabetes, vitamin deficiencies, heavy alcohol use, or simply getting older. However, about 15% of cases are idiopathic, meaning there are many incidences where a person has peripheral neuropathy and we do not know the cause.

How big a problem are we talking about? How many people suffer from peripheral neuropathy?

Approximately 20 million Americans have peripheral neuropathy or related symptoms. It’s a big problem, partly because there are so many diabetics, pre- diabetics and older people in this country.

What factors can bring relief to peripheral neuropathy?

It’s been found that if blood flow to the peripheral nerves is improved, along with improved nerve nutrition and function, the symptoms of peripheral neuropathy are better controlled. The ingredients in well-researched neuropathy support products can help with this.

How does someone know if they have peripheral neuropathy?

Peripheral neuropathy should be diagnosed by your health practitioner. However, if you suspect that you have altered feelings in your feet, a simple test you can do is to take a sharp toothpick and tap the pointed end on against a non-calloused part of the bottom of your foot. And then compare it to the sensation you feel when you tap the blunt end of the toothpick against that same spot. You should easily be able to feel a significant difference. If you don’t feel a difference between the pointed end and the blunt end, you may have peripheral neuropathy.

What’s the usual treatment for peripheral neuropathy?

Peripheral neuropathy is often treated with prescription oral medications such as Neurontin, Lyrica, Gabapentin or Cymbalta. You see ads for these on TV. The problem with these medications is that they are generally NOT effective, and associated with unwanted side effects such as drowsiness, unsteadiness, weakness, dizziness, constipation, headaches, tremors, weight gain... and so on.

Are there non-prescription treatment choices?

Definitely. Dr. Robert Furchgott won the Nobel Prize in 1998 for his discovery of nitric oxide, first known to be a potent enhancer of microcirculation, which is blood flow to the smallest blood vessels. It was later discovered to enable nerves to transmit their signal more efficiently. Subsequently it was revealed that l-arginine is required in the formation of nitric oxide and that providing additional l-arginine enhances the production of nitric oxide.

L-Arginine is recognized as a key ingredient in non-prescription treatment of peripheral neuropathy. How does it work?

Yes. L-arginine is a naturally occurring amino acid found in the body – it is essential for nerve and circulatory health. So it occurred to me that a topical agent containing l-arginine would probably help peripheral neuropathy. This made sense because the nerves in the foot and ankle are close to the surface, right under the skin. Therefore, application of a nerve cream or lotion containing L-arginine could easily reach the nerves and improve the production of nitric oxide, which would improve the functioning of those nerves and alleviate the symptoms of peripheral neuropathy.

Do doctors use a topical agent in their practice?

Many health practitioners do when it comes to topical treatment of peripheral neuropathy. I myself looked for a topical L-arginine formulation and found Neuro One, an L-arginine cream with Vitamin B-12, which is also essential to nerve function. Neuro One easily penetrates the skin and is able to bring the L-arginine and vitamin B-12 to the peripheral nerves. I have used it on my patients suffering from peripheral neuropathy with extremely positive results.”

What is the proper methods patients should use to apply Neuro-One?

The beauty of Neuro One is that when it is applied to the foot and ankle, it is absorbed and able to reach the underlying nerves with peripheral neuropathy. And since it’s an amino acid found in most foods, there are no associated side effects. Patients should apply it in areas where the nerves are easily reached at the periphery; that is, to apply it to the entire ankle, foot and toes. Specifically, take a full squeeze of the pump and distribute Neuro-One evenly in a dot pattern and rub it in until absorbed, usually 20 seconds or so, making sure there are no dry spots and to apply it twice a day. Most patients notice an improvement within days. It can take effect in less than an hour... in some sometimes it takes weeks. In many cases, Neuro-One has been found to really help relieve symptoms.

Why is the foot generally the first place where peripheral neuropathy is identified?

Many physiologists have observed that the longer a nerve is, the more likely it will sustain the damage associated with peripheral neuropathy. And since the longest nerves in the body go to the feet and toes, it is in the feet and toes where the symptoms first appear. It can then progress to the feet, ankle and legs.

Are Health practitioners increasingly recommending a natural product that doesn’t require a prescription?

Yes. Many in the health care field who have identified patients with peripheral neuropathy want to improve both the blood flow to the nerves and nerve functioning. Science has shown L-arginine releases nitric oxide and that nitric oxide not only improves microcirculation but also improves nerve function. Since the nerves of the foot are near the surface of the skin, a patient using the application of Neuro One is able to support the restoration of functioning of the peripheral nerves and greatly decrease the discomfort of peripheral neuropathy.

Are there any other conditions for which Neuro One might help?

As physiologist Dr. Hoffman has determined, it is logical to utilize Neuro One for conditions where someone has skin pain such as shingles, carpal tunnel syndrome, digital numbness, among other types of nerve problems.

If Neuro One is used twice daily, does it remain effective over time?


Some people apparently take L-arginine pills for neuropathy. Does that work?

Research has not shown that taking L-arginine orally is effective in improving peripheral neuropathy. That's because the ingested l-arginine is dispersed throughout the blood stream. However, applying topical L-arginine externally to the affected area results in absorption in the specific places like the feet it is needed most. That makes a crucial difference.