Ask the questions that force the visit to name a cause. The three that matter most are “What pattern do my symptoms follow?”, “What is this evaluation ruling in and ruling out?”, and “What would each test change about my plan?” Neuropathy is a category, not a diagnosis, so an evaluation that ends at the word “neuropathy” has not finished its job.
Peripheral neuropathy presents with varying degrees of numbness, tingling, aching, burning sensation, weakness of the limbs, hyperalgesia, allodynia and pain.1 That range is exactly why the symptom label alone cannot direct treatment, and why the questions below are organized around finding the driver instead.
It is worth asking, because careful evaluation identifies an underlying cause in roughly 50 to 75 percent of patients presenting with peripheral neuropathy.2 The rest of this checklist is what “careful” looks like from the patient’s side of the table.
Start with the pattern, not the label
Where symptoms started, how they spread, and whether they are symmetrical are the first pieces of evidence a clinician works from. Your job is to describe that pattern precisely rather than summarize it as “my feet hurt.”
Questions that establish the pattern
- Where did this start, and in what order did it spread?
- Is it burning, numbness, weakness, or a combination?
- Are both sides affected equally, or is one side worse?
- What makes it worse and what makes it better across a normal day?
- Do I have balance changes, falls, or a change in how I walk?
A symmetrical, feet-first pattern that creeps upward points in a different direction than a sudden, one-sided, or rapidly progressive one. Say which of those describes you, and say it early in the visit.
Questions that make the evaluation commit
- What category are you most concerned about today?
- What finding would change your mind about that?
- What is this evaluation trying to rule in, and what is it trying to rule out?
- If this is small fiber involvement, how would you confirm it?
If you have diabetes, ask about classification and testing purpose
Diabetes being present does not settle the question. It raises a second one: is diabetes the whole driver, or one of several stacked on top of each other?
Peripheral neuropathy is primarily diagnosed clinically, through history and neurological assessment — small fiber sensation with temperature or pinprick, large fiber sensation with vibration, and ulceration risk with 10 g monofilament pressure testing.1 Nerve conduction studies and intraepidermal nerve fiber density testing are indicated for patients with atypical clinical features, such as rapid symptom onset, severe neuromotor impairment, or asymmetrically abnormal sensation.1
Questions about testing purpose
- Does anything about my presentation count as atypical?
- When would electrodiagnostic testing change what we do, rather than just confirm what we already suspect?
- If my nerve study is normal but my symptoms persist, what does that mean for the next step?
- How do my glucose history, A1c trend and kidney function change your concerns?
Regenerve performs electrodiagnostic testing (EMG/NCS) on site, which means the result is read against your history in the same building rather than mailed back weeks later as a number without a plan.
Do not stop at diabetes: ask about the other drivers
Nutritional, autoimmune, toxic and structural drivers can sit alongside a metabolic one, and they frequently do. If you have ever been told “nothing else explains it,” the useful follow-up is to ask what specifically was checked.
Hidden-driver questions
- Besides diabetes, what drivers are you actively considering today?
- Could nutrient absorption be contributing, and how would you test that?
- Could a medication, alcohol history, or an occupational exposure be involved?
- Did this begin after chemotherapy, surgery, or a shingles episode?
- If serum B12 is reported as normal, does that fully exclude a B12-related driver?
Our longer discussion of the contributors that get missed is in the hidden drivers of peripheral neuropathy, and it is a reasonable list to bring with you to any evaluation, here or elsewhere.
Bring your history in writing
The highest-yield questions come out of your own timeline. A clinician can map mechanism far faster when the specifics are on paper instead of being reconstructed from memory in a fifteen-minute visit.
What to write down before you go
- The month and year symptoms began, and anything that happened around that time.
- Every prescription, over-the-counter medicine and supplement, with doses.
- Prior surgeries, particularly abdominal or bariatric procedures.
- Alcohol history, stated honestly, because it changes the differential.
- Any prior nerve testing, lab work, or imaging, with the actual reports if you have them.
Ask what each treatment is aimed at
Once a driver is named, the questions shift from diagnosis to mechanism. The single most clarifying question about any proposed treatment is what it is intended to change — the symptom, or the process producing the symptom.
Treatment questions worth asking
- What is the dominant driver in my case, and what does that imply for treatment?
- What is each proposed therapy targeting, and how will we know whether it worked?
- Which parts of this plan address the ongoing injury rather than the pain signal?
- How will the plan change if the driver map changes?
Regenerve offers class 4 photobiomodulation, class 3B cold laser, whole-body infrared, and metabolic and nutritional care. Orthobiologic injections (PRP and BMAC) are also offered, which is how they should be described to you before you agree to anything.
If shingles is in your history, ask about Qutenza specifically
Qutenza (capsaicin 8% patch) is FDA-approved in adults for neuropathic pain associated with postherpetic neuralgia and for neuropathic pain associated with diabetic peripheral neuropathy of the feet.3 Use for any other neuropathy driver is off-label, and a clinician proposing it for another indication should say so plainly.
Questions about the patch
- Does my diagnosis fall inside the approved indication, or would this be off-label?
- How long is the application, and how long is the visit?
- How often can it be repeated?
- What monitoring happens during and after the application?
It is applied in clinic by a clinician, never dispensed for home use, and repeated no more often than every three months.3
Questions that test the quality of the evaluation itself
The last set is about the clinic rather than your nerves. A good evaluation should be able to answer these without hesitating.
- How do you document which driver you believe is dominant, and what evidence supports it?
- What testing do you perform on site, and what gets sent out?
- When is the next touchpoint, and what should I bring to it?
- What would make you tell me this is not the right clinic for my problem?
Being evaluated in St. Louis
Regenerve is at 4477 Woodson Rd #104, St. Louis, MO 63134, minutes from St. Louis Lambert International Airport, and is led by Dr. Gurpreet Singh Padda, MD, MBA, MHP. The practice serves the St. Louis region, Missouri and Illinois.
Call or text (314) 886-5902, or email info@regenerve.com. Office hours are Monday through Thursday 9:00 to 16:00 and Friday 9:00 to 13:30.
If you want your answers organized before the visit, the Nerve Damage Score is a free five-question assessment that produces a large-print report you can hand to any physician.
Frequently asked questions
What should I ask if my main symptom is numbness rather than pain?
Ask which fiber types the numbness pattern implicates and what test would confirm it, then ask what protective-sensation loss means for foot care in the meantime. Numbness without pain still needs a driver named. See small fiber neuropathy symptoms and testing.
How do I prepare if my feet burn at night?
Write down when the burning starts, whether it is symmetrical, and what changes it, then ask which mechanism the clinician thinks is producing it. Bring that description rather than a single-word summary. See burning feet and nerve pain.
Is a nerve conduction study always necessary?
No. Peripheral neuropathy is primarily a clinical diagnosis, and nerve conduction studies are indicated for atypical features such as rapid onset, severe neuromotor impairment, or asymmetric sensory findings. Ask what the result would change before agreeing to it. See how to choose a neuropathy specialist.
What should I ask if I think a B12 problem was missed?
Ask how functional B12 status is assessed when the serum level reads normal, and what would be measured alongside it. Then ask what treatment decision that testing would drive. See functional B12 deficiency and neuropathy.
What if gluten or celiac disease is a possibility for me?
Ask whether a gluten-related driver is on your differential, what testing supports or excludes it, and what happens if celiac testing is negative but symptoms fit. See the gluten and neuropathy connection.
Sources
- Bodman MA, Dreyer MA, Varacallo MA. Diabetic Peripheral Neuropathy. StatPearls. StatPearls Publishing. 2024. NCBI Bookshelf NBK442009
- Peripheral Neuropathy: Asking the Right Questions. Practical Neurology. March–April 2009. practicalneurology.com
- Averitas Pharma, Inc. QUTENZA (capsaicin) topical system — full prescribing information. Updated July 2026. DailyMed