Neuropathy symptoms aren't easy to ignore, but knowing the underlying cause of neuropathy and the best treatment for it are essential steps in properly managing the condition. It also helps to be aware of the lifestyle factors and behaviors that can aggravate symptoms of neuropathy.

"You don't see as acute of flare-ups with neuropathy as with lupus or inflammatory arthritis, but there are certain times and conditions that can certainly make symptoms worse," says Dr. Mary Vo, a neurologist at Houston Methodist who specializes in treating neuropathy. "While this isn't necessarily an indication that neuropathy is getting worse, it can greatly disrupt your day-to-day life."

Here's everything you need to know to help keep neuropathy symptoms at bay.

What is neuropathy?

Neuropathy occurs when nerve damage prevents nerves from accurately detecting external stimuli. "Nerves aren't coordinating the appropriate sensations. This can result in a range of sensations, from numbness to burning and shooting sensations," as Dr. Vo describes it.

Left untreated, neuropathy can eventually cause permanent nerve damage, leading to loss of function in the body. This highlights the importance of early diagnosis.

The condition has many potential causes — hundreds, in fact — though the majority are rare. The most common causes of neuropathy include diabetes, vitamin deficiencies (vitamin b12 deficiency, most prominently), chemotherapy, toxin exposure, alcoholism, certain infections (like hepatitis and HIV) and genetic conditions. These issues cause cumulative damage to nerves and, over time, take a toll.

"Even prediabetes and metabolic symptoms can cause painful neuropathy symptoms," adds Dr. Vo. "It's a slow moving, indolent process. This gradual progression often takes years."

(Related: Are There Early Warning Signs of Neuropathy?)

What does nerve pain feel like?

Neuropathy tends to develop in the longest, most distal parts of the nerves, and most often first felt in the feet.

"It begins with strange sensory symptoms or even pain in the balls of the feet that eventually spreads to the entire sole, wraps over the top of the foot and eventually moves upward the legs," says Dr. Vo.

Neuropathy symptoms include:

• Persistent tingling or numbness
• Increased sensitivity to touch
• Decreased sensitivity to temperature
• Reduced coordination and balance
• Neuropathic pain, which can feel sharp, burning or throbbing
• Muscle weakness

These symptoms can range from a nuisance to debilitating. Many patients struggle with nighttime symptoms that can cause insomnia and impact daytime activities because of disrupted sleep.

What causes neuropathy to flare up?

"Patients with established neuropathy can have fluctuating symptoms, as their nerves are even more vulnerable to factors that typically cause neuropathy, such as poor glycemic control or excessive alcohol consumption," Dr. Vo explains. "Any secondary factor — even something very small — can aggravate symptoms."

With hypersensitive nerves, it's important to be aware of the factors you're now more vulnerable to, most of which are related to the causes of neuropathy in the first place.

Common neuropathy triggers include:

• Poorly controlled (or untreated) diabetes
• Drinking alcohol
• Vitamin B12 deficiency
• Vitamin B6 imbalance (too little or too much)
• Certain infections such as Lyme disease and viral infections

"One of the most common reasons for neuropathy to become aggravated is poor glycemic control," says Dr. Vo. "Patients with either a long history of diabetes and those with very high hemoglobin A1c develop more severe, painful neuropathy. It is imperative for patients with diabetic neuropathy to strive for strict glucose control to mitigate progression of their neuropathy and risk of many other complications."

Vitamin B6 imbalance is an interesting trigger since it causes issue at both ends of the spectrum.

"Vitamin B6 deficiency is associated with causing and exacerbating neuropathy," says Dr. Vo.. "Interestingly, taking too much vitamin B6 can lead to painful neuropathy, too. This is important to understand because many of the supplements purported to treat neuropathy are chalked full of vitamin B6, and people unknowingly make their neuropathy worse."

Neuropathy can also fluctuate with time of day and is usually worst during the night, causing insomnia.

Tips for reducing neuropathy symptoms

Taking steps to reduce the triggers above — controlling blood sugars, limiting alcohol, correcting vitamin deficiencies — can help manage symptoms, but it's also important to eat a healthy diet and stay active.

"One of the most important things you can do is exercise regularly and focus on balance exercises," says Dr. Vo. "Balance exercises help to both compensate for sensory loss and protect against falls."

Exercises like Pilates, yoga and Tai Chi are particularly effective for maintaining balance.

"For my neuropathy patients, it's not so much about high-impact exercises," says Dr. Vo. "It's those targeted exercises that help strengthen your core, challenge your balance and promote proper neuromuscular alignment that I see make the biggest difference."

As you stay active, consider your footwear. A common symptom of neuropathy is a feeling that your shoes are too tight by the end of the day. This often leads people to look for orthopedic footwear, but this isn't necessary.

"The issue isn't mechanical, and you don't need a fancy shoe purported to alleviate neuropathy," says Dr. Vo. "The key features to look for are shoes with a wider toe box and good support."

One last tip: Avoid shoes with high midsole cushioning as they can actually be a trip hazard for someone with neuropathy who cannot feel where their feet are in space.