Dr. Stuart Himmelstein, DC, a Philadelphia-based chiropractor, examines how peripheral neuropathy is evaluated in clinical practice, emphasizing symptom variability, underlying causes, and the role of conservative assessment before treatment decisions are considered.
PHILADELPHIA, PA — January 27, 2026 —Peripheral neuropathy is a condition that affects millions of people in the United States and worldwide, according to the National Institute of Neurological Disorders and Stroke. The term refers to damage or dysfunction of peripheral nerves, which can lead to symptoms such as tingling, numbness, burning sensations, or weakness, most commonly in the hands and feet. While often associated with diabetes, peripheral neuropathy can arise from a wide range of causes, making evaluation complex and highly individualized.
Clinicians note that neuropathic symptoms can significantly interfere with daily activities, including walking, sleeping, and maintaining balance. The Mayo Clinic reports that symptoms may develop gradually or appear suddenly, depending on the underlying cause. Because these sensations overlap with other neurological or musculoskeletal conditions, identifying the source of nerve-related pain is often more challenging than patients expect.
Dr. Stuart Himmelstein is a chiropractor based in Philadelphia who has spent decades evaluating patients with spinal and nerve-related complaints. He explains that neuropathy is not a single disease but a descriptive term for nerve dysfunction. “One of the most important steps is understanding why the nerves are irritated or damaged,” Himmelstein said. “Symptoms alone don’t tell the whole story, and different causes can require very different considerations.”
In clinical settings, professionals typically begin by reviewing a patient’s health history, symptom pattern, and progression over time. According to MedlinePlus, neuropathy may be linked to metabolic conditions, autoimmune disorders, infections, injuries, medication side effects, or mechanical nerve compression. Because of this variability, evaluation often focuses on distinguishing whether symptoms stem from systemic disease, localized nerve involvement, or structural stress affecting nerve pathways.
Lifestyle and environmental factors can also influence nerve health. Prolonged sitting, repetitive motion, poor footwear, or sustained pressure on certain nerves may contribute to symptoms in some individuals. Mayo Clinic guidance notes that alcohol use, nutritional deficiencies, and occupational exposures can also play a role. These factors are typically reviewed alongside medical findings to form a more complete picture of what may be contributing to nerve irritation.
Himmelstein notes that uncertainty is common when patients first seek care for neuropathic symptoms. “People often want a clear answer right away, but nerve-related conditions don’t always present in a straightforward way,” he said. “Careful assessment helps rule out serious causes while identifying patterns that can inform next steps.” He adds that evaluation is often an ongoing process rather than a single visit or test.
After an initial assessment, individuals with peripheral neuropathy typically consider a range of conservative options depending on the suspected cause and severity of symptoms. Public health sources emphasize that early identification of contributing factors may help slow progression and support daily function. However, outcomes vary widely, and no single approach is appropriate for every person experiencing neuropathic pain.
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Dr. Stuart Himmelstein, DC
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