When should I consider referring a patient with peripheral neuropathy

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with peripheral neuropathy to a specialist if:

There is no identifiable cause after initial investigations including vitamin B12 deficiency, thyroid function, coeliac disease, renal function, blood glucose, ESR, and alcohol use assessment.
The patient has rapidly progressive (within hours to days) symmetrical numbness and weakness or imbalance, requiring urgent neurological assessment.
There are persistent, distally predominant altered sensations in the limbs with brisk deep tendon reflexes, suggesting possible brain or spine disease.
Symptoms are severe, significantly limit daily activities, or if treatment options available in primary care have been exhausted and symptoms remain significant.
There is poor control of neuropathic pain despite maximum tolerated doses of medication, or if treatment is poorly tolerated and alternative management is needed.
In children, if tingling is accompanied by other peripheral nervous system symptoms such as weakness, bladder or bowel dysfunction, or if episodic symptoms are not associated with nerve compression.

Referral is typically to a neurologist or specialist pain service depending on the clinical context and severity of symptoms.

References: , ,

When should I consider referring a patient with peripheral neuropathy to a specialist?