Chronic inflammatory demyelinating polyneuropathy (CIDP) is a long-lasting disease of the peripheral nerves, which are the nerves outside the brain and spinal cord. In CIDP, the body’s own immune system wrongly attacks the “myelin,” which is the fatty coat that covers and protects these nerves. This damage slows or blocks nerve signals, so muscles become weak and feeling (sensation) is reduced, especially in the arms and legs.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a long-lasting autoimmune disease in which the body’s immune system attacks the myelin coating of peripheral nerves. This damage slows or blocks electrical signals, causing weakness, numbness, tingling, and balance problems in the arms and legs.[1]
Doctors classify CIDP as a treatable but often chronic condition. Many people need long-term treatment to control inflammation and protect nerves from further damage. First-line evidence-based treatments include intravenous or subcutaneous immunoglobulin (IVIG/SCIG), corticosteroids, and plasma exchange, which all aim to calm the immune attack on nerves.[2]
Doctors class CIDP as an autoimmune and inflammatory neuropathy. “Autoimmune” means the immune system attacks the body’s own tissues instead of germs. “Inflammatory” means there is swelling and irritation around the nerves. “Demyelinating” means the myelin covering is injured, while “polyneuropathy” means many nerves in different parts of the body are affected.
CIDP usually develops slowly over at least 8 weeks. Weakness and numbness often start in the feet and legs, then move upward and may later involve the hands and arms. Symptoms can stay the same, slowly get worse, or come and go in “relapses.” CIDP is rare but treatable, and early diagnosis helps prevent permanent nerve damage.
Another names
CIDP has several other names that doctors and books may use. These names all describe the same basic condition, but they highlight different parts of the problem, such as the long-term (“chronic”) nature or the involvement of nerve roots (“radiculo”).
Common other names include:
CIDP – short form for chronic inflammatory demyelinating polyneuropathy.
Chronic inflammatory demyelinating polyradiculoneuropathy – adds “radiculo,” meaning the nerve roots near the spinal cord are also affected.
Chronic relapsing polyneuropathy – used when symptoms come in repeated attacks or “relapses.”
Chronic acquired demyelinating polyneuropathy – stresses that the disease is acquired (not born with it) and affects the myelin.
Immune-mediated demyelinating polyneuropathy – focuses on the immune system as the main driver of nerve damage.
Types
Doctors now know that CIDP is not just one single pattern. There are several clinical types, or phenotypes. These types differ in which nerves are affected most (motor, sensory, proximal, distal, focal) and how symptoms appear.
Typical (classic) CIDP
In typical CIDP, weakness and numbness affect both sides of the body in a fairly even way. Legs and arms are both involved, often starting in the feet and moving upward. Reflexes (like the knee-jerk) are usually reduced or absent.Distal acquired demyelinating symmetric neuropathy (DADS)
In this type, problems are mostly in the far parts of the limbs, such as feet and hands. Sensory loss and tingling are common, sometimes with less severe weakness. It is often linked with abnormal proteins in the blood, such as monoclonal gammopathy.Multifocal CIDP / Lewis-Sumner syndrome
Here, symptoms are patchy and asymmetric. One arm or leg may be affected more than the others. People may notice weakness and numbness in certain nerve territories only, such as one hand. This pattern can look like multiple trapped nerves, so testing is very important.Pure motor CIDP
This form mainly affects the motor (movement) nerves. The person has weakness but little or no sensory loss. It can be confused with motor neuron disease, so nerve tests and other studies are important to show demyelination and treatable autoimmunity.Pure sensory CIDP
In this type, sensory symptoms like numbness, tingling, burning pain, and loss of balance are prominent, but muscle strength can stay normal or nearly normal. Walking may be difficult because position sense is poor, even though muscles are still strong.Acute-onset CIDP
Some people start with very fast symptoms that look like Guillain-Barré syndrome (GBS), but then the weakness continues or relapses for more than 8 weeks. In these cases, doctors may call the condition acute-onset CIDP.
Causes
No single clear cause has been found for CIDP. Instead, experts think many triggers and risk factors can push the immune system to attack the nerves in people who are vulnerable.
Autoimmune mis-direction
The main “cause” is that the immune system stops recognizing the myelin on peripheral nerves as safe. Immune cells and antibodies then attack myelin, causing inflammation and demyelination.Genetic susceptibility
Some people may carry genes that make their immune system more likely to develop autoimmune diseases. This does not mean CIDP is directly inherited, but genes may increase risk.Previous infections
A viral or bacterial infection before symptom onset may “wake up” the immune system. In some people, the response may mistakenly turn against nerve myelin through a process called molecular mimicry.Other autoimmune diseases
People with conditions like lupus, rheumatoid arthritis, autoimmune thyroid disease, or type 1 diabetes have an immune system that already tends to attack self tissues. This may raise the chance of developing CIDP.Diabetes mellitus
Diabetes is strongly linked with nerve damage. Some people with diabetes can also develop immune-mediated demyelinating neuropathy, and doctors must separate diabetic neuropathy from CIDP or recognize when both exist.Monoclonal gammopathy (abnormal proteins)
Abnormal antibodies in the blood, such as monoclonal proteins, can be toxic to nerves or may directly target myelin. Some CIDP-like neuropathies occur with these proteins and may overlap with CIDP criteria.Hematologic cancers (like lymphoma)
Blood cancers, especially certain lymphomas, can be associated with demyelinating neuropathies. The cancer may change the immune system and lead to nerve inflammation.Chronic infections (HIV, hepatitis, others)
Long-lasting infections can disturb the immune system for years. In some patients, these infections are linked to inflammatory neuropathies that behave like CIDP.Post-surgical immune changes
After major surgery, the immune system may change its balance. Rarely, a chronic demyelinating neuropathy can appear in the months after an operation, though this is not common.Chronic inflammatory disorders (bowel disease, etc.)
Systemic inflammatory diseases such as inflammatory bowel disease or sarcoidosis can be linked with neuropathies. Shared immune pathways may explain this connection in some CIDP patients.Vaccination (very rare association)
A few case reports describe CIDP after vaccines, but strong studies show this is rare. The benefit of vaccines is much higher than this very small possible risk.Older age
CIDP can occur at any age but is more common in middle-aged and older adults. Aging brings changes in immunity and nerve resilience that may increase risk.Male sex
Men are affected more often than women in many CIDP studies. The reason is not fully known, but hormonal and genetic factors may play a role.Chronic kidney or liver disease
Long-term kidney or liver problems can disturb immune function and metabolism of toxins, which may contribute to the development or worsening of neuropathies, including CIDP-like forms.Exposure to some drugs (rare)
A few immune-modifying drugs, such as certain biologic agents, have been linked in case reports to demyelinating neuropathies. These events are rare, but doctors consider them as possible triggers.Chronic alcohol misuse
Heavy alcohol use mainly causes axonal neuropathy and vitamin lack, but it can also disturb the immune system. In complex cases, alcohol may be one factor among several in nerve damage.Vitamin deficiencies (especially B vitamins)
Lack of vitamin B12 or other B vitamins usually causes axonal neuropathy, but in some patients it may coexist with immune-mediated demyelination and make symptoms worse.Chronic systemic infection or inflammation
Long-lasting inflammation anywhere in the body keeps the immune system “switched on.” This constant activity can sometimes spill over and harm nerves.Family history of autoimmunity
If close relatives have autoimmune diseases, a person may be more likely to develop CIDP or other immune-mediated conditions, even if the exact genes are unclear.Idiopathic (no known trigger)
In many people, no clear trigger is ever found. In such cases, doctors still label the disease as CIDP because the pattern of symptoms, tests, and response to treatment fits this diagnosis.
Symptoms
CIDP symptoms build up slowly over weeks or months. Many of them are due to poor conduction of signals in both motor (movement) and sensory (feeling) nerves.
Progressive leg weakness
The earliest symptom is often weakness in the feet and legs. People may find it hard to climb stairs, stand from a chair, or walk long distances. This happens because motor nerves to leg muscles cannot carry signals properly.Arm and hand weakness
With time, the arms and hands can also become weak. Tasks like opening jars, buttoning clothes, or gripping objects may be difficult, because hand muscles receive weaker nerve messages.Numbness in feet and hands
Many people feel “dead,” “cottony,” or numb areas in their toes and fingers. This numbness starts distally (farther away) and can slowly spread upward.Tingling or “pins and needles”
Tingling, buzzing, or “pins and needles” sensations (paresthesias) are common. These odd feelings reflect irritated sensory fibers whose myelin is damaged.Loss of reflexes
Reflexes like the knee-jerk and ankle-jerk are often reduced or absent. Doctors notice this when they tap the tendon and see a very small or no movement. This is a key sign that peripheral nerves are not working well.Poor balance and unsteady walking
Because position sense from the feet is reduced, people may feel unsteady, especially in the dark or with eyes closed. They can sway or lose balance easily when walking.Frequent tripping or falls
Weak foot muscles can cause “foot drop,” where the front of the foot drags. This makes tripping over small obstacles more likely and can lead to falls.Difficulty with fine hand tasks
Numbness and weakness in the hands can make writing, typing, using utensils, or doing up zips and buttons slow and clumsy.Neuropathic pain or burning
Some people feel burning, aching, or electric-shock-like pain in the feet or hands. This kind of pain comes from abnormal firing of damaged sensory nerves.Fatigue
Chronic nerve damage makes muscles work less efficiently, so everyday activities require more effort. Many people with CIDP feel very tired and may tire quickly when walking or doing chores.Sensory ataxia (clumsy movement due to loss of position sense)
When deep sensation is badly affected, people may have trouble knowing where their feet are without looking. This can cause a wide-based, stamping gait and difficulty with coordination.Cramps and muscle twitching
Muscle cramps and small flickers under the skin (fasciculations) may appear when nerves are irritated or trying to re-connect with muscles.Symptoms that fluctuate or relapse
Some people have periods when symptoms get worse, then better, instead of a slow steady change. These relapses are a key feature that separates CIDP from many other neuropathies.Mild autonomic symptoms (sometimes)
A few patients report dizziness when standing, bowel or bladder changes, or sweating problems. Strong autonomic symptoms are uncommon and suggest other conditions as well.Breathing or facial weakness (rare)
Very rarely, if nerve roots or certain cranial nerves are involved, breathing muscles or facial muscles can weaken. This is less common than in Guillain-Barré syndrome but must be watched carefully.
Diagnostic tests
Doctors diagnose CIDP by combining clinical signs with several tests. No single test proves CIDP alone, but together they show a pattern of demyelinating neuropathy and help rule out other diseases.
Physical exam tests
Full neurological examination
The neurologist checks strength, sensation, reflexes, and coordination. In CIDP they often find symmetric weakness, reduced feeling, and absent reflexes in arms and legs.Reflex testing with a hammer
The doctor taps tendons at the knee, ankle, elbow, and wrist. In CIDP, these tendon reflexes are usually decreased or absent because nerve impulses do not travel well.Gait and balance assessment
Walking patterns are observed, including heel-toe walking and turning. Problems like wide-based gait, foot drop, or needing support can suggest peripheral neuropathy and guide further tests.Sensory mapping on the skin
Using light touch, pinprick, vibration (with a tuning fork), and temperature, the examiner maps where feeling is reduced. A “glove and stocking” pattern supports a polyneuropathy like CIDP.Strength grading of individual muscles
Each major muscle group is tested against resistance and graded. CIDP often shows symmetric weakness, especially in hip flexors, knee extensors, ankle dorsiflexors, and hand muscles.
Manual bedside tests
Romberg test
The patient stands with feet together and then closes the eyes. Extra sway or falling when eyes are closed suggests loss of deep sensation from the feet, which is common in CIDP.Heel-to-toe (tandem) walking
Walking in a straight line placing one foot directly in front of the other tests balance and coordination. Difficulty with this maneuver supports sensory ataxia from neuropathy.Manual muscle testing (MMT)
The examiner resists the patient’s movements with their hands and grades strength. Repeated exams over time can show progression or improvement of weakness, which helps track CIDP.Timed up-and-go or chair-rise tests
Simple function tests, such as timing how long it takes to stand up and walk a short distance, give a practical measure of disability. They help monitor the effect of treatment.
Lab and pathological tests
Basic blood tests
Blood tests check for diabetes, kidney and liver disease, vitamin levels, thyroid problems, and other causes of neuropathy. This helps rule out or treat other problems that might mimic or worsen CIDP.Autoimmune and inflammatory markers
Tests for autoimmune diseases (like ANA, rheumatoid factor) or inflammatory markers (ESR, CRP) may be done. They do not prove CIDP, but they can show associated autoimmune conditions.Serum protein electrophoresis and immunofixation
These tests look for abnormal proteins (monoclonal gammopathy) in the blood. Their presence may point to certain CIDP variants or to other immune-mediated neuropathies that need special treatment.Cerebrospinal fluid (CSF) analysis by lumbar puncture
A small amount of fluid is taken from the lower back. In CIDP, CSF often shows high protein but a normal cell count, a pattern called “albuminocytologic dissociation,” which supports the diagnosis.Nerve biopsy (usually sural nerve)
In unclear cases, a small piece of a sensory nerve may be removed and studied under a microscope. The pathologist may see segmental demyelination, inflammation, and “onion bulb” changes typical of chronic demyelinating neuropathy.Specific infection and metabolic screens
Tests for infections like HIV or hepatitis, and for rare metabolic or genetic causes, help exclude other neuropathies that might look similar to CIDP.
Electrodiagnostic tests
Nerve conduction studies (NCS)
This is the key test for CIDP. Small electrical pulses are applied to nerves, and responses are measured. CIDP typically shows slowed conduction, prolonged distal latencies, conduction block, and temporal dispersion, all signs of demyelination.Electromyography (EMG)
A fine needle electrode is placed in muscles to record electrical activity. EMG helps show whether weakness is due to nerve or muscle problems and can reveal chronic denervation from long-standing neuropathy.Somatosensory evoked potentials (SSEPs)
SSEPs measure how sensory signals travel from the limbs to the brain. Delayed responses may indicate demyelination of sensory pathways and can support a diagnosis of CIDP in complex cases.
Imaging tests
MRI of spinal roots and plexus
Magnetic resonance imaging can show thickened, enhancing nerve roots or plexuses, which suggest inflammation and demyelination. MRI also helps exclude structural causes like tumors or disc disease.Nerve ultrasound (neuromuscular ultrasound)
High-resolution ultrasound can show enlarged or irregular peripheral nerves and plexuses in CIDP. It offers a non-invasive way to support the diagnosis and monitor changes over time.
Non-pharmacological treatments (therapies and others)
Supervised physiotherapy and strengthening exercise
A neuro-physiotherapist can design gentle strengthening, stretching, balance, and walking programs to keep muscles active without over-tiring them. Supervised sessions 3–4 times per week for 45–60 minutes have been shown to improve fatigue, walking, and fitness in people with CIDP and related conditions.[4]Occupational therapy for daily activities
Occupational therapists help you adapt daily tasks such as dressing, writing, keyboard use, and cooking. They may suggest different ways to move, pacing strategies, and energy-saving methods, plus equipment like special cutlery or pens to protect weak hands and arms.[5]Gait training and balance rehabilitation
Because CIDP often affects leg strength and sensation, many people develop an unsteady walk. Gait training focuses on safe walking patterns, step length, turning, and stair practice. Balance exercises lower the risk of falls and improve confidence when moving indoors and outdoors.[6]Aerobic exercise (walking, cycling, swimming)
Low-to-moderate intensity aerobic exercise, such as short walks, stationary cycling, or swimming, can improve stamina, reduce fatigue, and support heart health. For CIDP, experts recommend starting with short, easy sessions and avoiding exercise to the point of exhaustion.[7]Assistive devices and orthotics (braces, splints, canes)
Braces for ankles, wrists, or hands can stabilize weak joints and reduce the effort needed for walking or gripping. Canes, walkers, and wheelchairs can prevent falls and allow longer distances with less fatigue, especially during disease flares or early recovery phases.[8]Energy conservation and activity pacing
Learning to plan the day, group tasks, rest before getting too tired, and avoid long periods of standing can reduce exhaustion. Therapists often teach “pacing”: doing a bit less than the maximum you feel you can do, so you have energy left for the whole day and next day.[9]Pain psychology and cognitive-behavioural strategies
Chronic neuropathic pain affects mood, sleep, and motivation. Psychological therapies like cognitive-behavioural therapy (CBT) teach coping skills, relaxation, and ways to reduce pain-related anxiety. This does not mean the pain is “in your head”; it means your mind is used as a tool to manage real nerve pain.[10]Mind–body practices (yoga, tai chi, gentle Pilates)
Slow, controlled movement with breathing and relaxation can improve flexibility, balance, and body awareness. Early evidence suggests that gentle mind–body exercise can support mood and reduce fatigue in people with long-term neurological disease, as long as movements are tailored and safe.[11]Respiratory training in severe weakness
In advanced or rapidly progressive cases, weakness can involve breathing muscles. Respiratory therapists may prescribe breathing exercises, incentive spirometers, and positions to improve ventilation, helping prevent chest infections and maintain oxygen levels.[12]Ergonomic changes at home and work
Changing chair height, desk set-up, computer equipment, and kitchen layout can reduce strain on weak limbs. Simple adjustments like grab bars, non-slip mats, and good lighting can reduce falls and make it easier to live independently with CIDP.[13]Education and self-management training
Understanding how CIDP behaves over time helps patients notice relapses early and seek care quickly. Education on symptoms, triggers, medicines, and exercise improves adherence to treatment and reduces unnecessary fear about mild fluctuations.[14]Sleep hygiene and fatigue management
Pain, anxiety, and muscle cramps often disturb sleep. Good sleep routines, comfortable bedding, and timing of medicines and physiotherapy can improve rest. Better sleep then reduces pain sensitivity and daytime fatigue.[15]Weight management and healthy body composition
Extra body weight increases load on weak legs and joints, making walking harder and increasing fall risk. Balanced diet and mild exercise can help reach a healthy weight, supporting mobility and reducing cardiovascular risk from steroids.[16]Fall-prevention programs
Structured fall-prevention teaching includes home safety checks, balance training, footwear advice, and strategies for getting up safely after a fall. This is especially important in people with numb feet and poor reflexes.[17]Compression stockings and DVT prevention (when immobile)
If CIDP causes very limited mobility, doctors may suggest compression stockings, leg movements in bed, and sometimes blood-thinning injections to prevent deep vein thrombosis (DVT). This is usually done in hospital or under medical supervision.[18]Vocational rehabilitation and workplace adaptation
Specialists can help adjust work tasks, working hours, and tools so people with CIDP can stay employed longer. This might include remote work, lighter duties, or assistive technology for typing and phone use.[19]Peer support and patient groups
Support organisations for GBS/CIDP offer education, emotional support, and shared experiences. Talking to others with the same illness can reduce isolation and help patients pick up practical coping tips.[20]Heat/cold management and comfortable clothing
Some people with CIDP are more sensitive to temperature. Light, layered clothing, warm socks, and avoiding very hot baths may reduce symptoms like burning or tingling, although this is based mainly on patient reports rather than large trials.[21]Transcutaneous electrical nerve stimulation (TENS) for pain
TENS uses small electrical pulses on the skin to reduce pain signals. It may help some people with neuropathic pain, though evidence is mixed. It is usually tried as a low-risk add-on to medicine and physiotherapy.[22]Psychological support for anxiety and depression
Living with long-term weakness and pain can lead to low mood and anxiety. Counselling or therapy, sometimes combined with medicines, can improve quality of life and make it easier to follow rehabilitation programs.[23]
Drug treatments for CIDP
Important: Exact drug choice, dose, and schedule must be decided by a neurologist. Many medicines below are used “off-label” for CIDP and need expert monitoring. Information here is general, not a treatment plan.
Intravenous immunoglobulin (IVIG)
High-dose IVIG is one of the main first-line treatments for CIDP and is the only drug that had long-standing formal approval for this disease in several regions. It is given through a vein over hours and supplies pooled antibodies from healthy donors that modulate immune cells, block harmful antibodies, and protect myelin.[24]Subcutaneous immunoglobulin (SCIG – e.g., Hizentra)
Hizentra (immune globulin 20% liquid) is approved by the FDA as maintenance therapy for adult CIDP to prevent relapse of neuromuscular disability. It is given under the skin in smaller, more frequent doses and allows home therapy. The immune effect is similar to IVIG but with steadier antibody levels.[25]Efgartigimod alfa/hyaluronidase-qvfc (Vyvgart Hytrulo)
In June 2024, the FDA approved Vyvgart Hytrulo, a neonatal Fc receptor (FcRn) blocker, for adults with CIDP. Weekly subcutaneous injections reduce IgG levels, including harmful autoantibodies, and significantly lower relapse risk compared with placebo in clinical trials, with a safety profile similar to previous uses.[26]Oral prednisone (corticosteroid)
Prednisone is a widely used first-line immune-suppressing tablet. It reduces inflammation by broadly dampening immune cell activity. It can improve strength and sensation but has side effects such as weight gain, osteoporosis, diabetes, mood change, and infection risk, so doctors aim for the lowest effective dose.[27]Pulsed intravenous methylprednisolone or high-dose oral dexamethasone
Instead of daily steroids, some neurologists use high-dose “pulses” of IV methylprednisolone or oral dexamethasone for a few days each month. This can give similar benefit with possibly fewer long-term side effects, although evidence is mixed and regimens vary between centers.[28]Plasma exchange (plasmapheresis)
Although technically a procedure, plasma exchange is often grouped with drug therapies. It removes plasma (the liquid part of blood) and filters out autoantibodies and immune complexes, then returns the blood cells with replacement fluid. It can give rapid but usually short-term improvement in weakness.[29]Azathioprine (steroid-sparing immunosuppressant)
Azathioprine is an oral antimetabolite that reduces lymphocyte proliferation. In CIDP it is used as a long-term add-on to lower steroid doses in patients who respond but need ongoing immune suppression. Benefits may take months to appear, and monitoring for bone-marrow suppression and liver toxicity is essential.[30]Mycophenolate mofetil
Mycophenolate decreases T- and B-cell activity by blocking purine synthesis. It is often used as a third-line agent in CIDP when first-line treatments are not enough or cause side effects. Evidence comes mainly from case series and retrospective studies, so it is reserved for specialist care.[31]Cyclophosphamide
Cyclophosphamide is a potent cytotoxic agent that strongly suppresses immune cells. It may be used in severe, treatment-resistant CIDP when other drugs fail. Studies suggest benefit in a proportion of refractory patients, but the risks (infertility, infections, malignancy) are significant, so it is used cautiously.[32]Cyclosporine
Cyclosporine inhibits calcineurin, reducing T-cell activation. Small studies suggest it may help some refractory CIDP patients or allow lower steroid or IVIG doses. It requires close monitoring of blood pressure and kidney function.[33]Rituximab (anti-CD20 monoclonal antibody)
Rituximab targets CD20 on B cells and depletes these cells for months. It is used off-label in CIDP, especially in patients with particular autoantibodies or those who fail standard treatments. Recent prospective data suggest rituximab can be effective and reasonably safe in selected refractory cases.[34]Methotrexate (low-dose immunomodulator)
Low-dose weekly methotrexate is sometimes used as another steroid-sparing immunosuppressant. Evidence for CIDP is limited and mixed, so it is considered only after better-supported options and with routine blood tests to monitor liver and bone-marrow function.[35]Tacrolimus
Tacrolimus, another calcineurin inhibitor, reduces T-cell activation and has been reported in small series for immune neuropathies when other agents fail. It needs careful monitoring for kidney toxicity, tremor, and high blood pressure, so it is reserved for specialists.[36]Symptomatic gabapentin for neuropathic pain
Gabapentin is a first-line medicine for neuropathic pain in many guidelines. It binds to calcium channels in nerve cells and reduces pain signal transmission. It does not treat the underlying CIDP but can improve burning, shooting, or electric-shock-like pain from damaged nerves.[37]Pregabalin for neuropathic pain and sleep
Pregabalin is closely related to gabapentin and is also widely recommended for neuropathic pain. It can reduce pain, improve sleep, and ease anxiety in some patients. Dose adjustments are needed in kidney disease, and dizziness and weight gain are common side effects.[38]Duloxetine (serotonin–noradrenaline reuptake inhibitor)
Duloxetine is licensed for painful diabetic neuropathy and used off-label in other neuropathic pain syndromes. It increases serotonin and noradrenaline in the spinal cord, which strengthens natural pain-blocking pathways. It may also help with low mood in chronic illness.[39]Amitriptyline (tricyclic antidepressant)
Amitriptyline at low doses is a classic first-line drug for neuropathic pain. It works by enhancing descending pain-modulating pathways and blocking sodium channels. Sedation, dry mouth, constipation, and heart rhythm effects limit its use in some patients, especially older adults.[40]Topical lidocaine patches
Lidocaine 5% patches are applied to areas of focal neuropathic pain. They numb superficial nerves and can reduce burning or allodynia (pain from light touch) with minimal systemic side effects, though they are less helpful for deep, widespread pain.[41]Short-term tramadol for rescue pain relief
Guidelines suggest tramadol only as short-term rescue treatment when first-line neuropathic pain medicines are not enough. It acts on opioid receptors and monoamine reuptake, so it can cause dependence, nausea, dizziness, and should be used cautiously under medical supervision.[42]Bone-health medicines with long-term steroids
When steroids are used for months, doctors may prescribe calcium, vitamin D, and sometimes bisphosphonates to protect bone density. These do not treat CIDP directly but prevent steroid-related fractures and are an important part of safe long-term treatment.[43]
Dietary molecular supplements (supportive, not cures)
Vitamin B12
Vitamin B12 is essential for making myelin and healthy red blood cells. Deficiency can itself cause peripheral neuropathy and worsen nerve damage. Correcting low B12 with tablets or injections can improve nerve function and pain, especially when deficiency is present.[44]B-complex vitamins (with safe B6 levels)
B-group vitamins (B1, B2, B3, B6, B9, B12) support energy production in nerves. Carefully dosed B-complex supplements may help in people with poor diet or malabsorption, but very high doses of vitamin B6 can actually cause neuropathy, so products should stay within safe daily limits.[45]Alpha-lipoic acid (ALA)
ALA is an antioxidant that may reduce oxidative stress and improve blood flow in peripheral nerves. Studies in diabetic neuropathy suggest some benefit in symptoms and nerve function, although results are mixed and mainly in diabetes, not CIDP specifically.[46]Coenzyme Q10 (CoQ10)
CoQ10 supports mitochondrial energy production and acts as an antioxidant. Experimental and early clinical studies in neuropathy suggest CoQ10 may protect nerves, reduce oxidative stress, and support regeneration, but evidence in CIDP is still indirect.[47]Omega-3 fatty acids (EPA/DHA)
Omega-3 fats from fish or supplements have anti-inflammatory effects and may protect peripheral nerves in animal models. Clinical data in neuropathy are mixed, so omega-3s are best seen as a heart-healthy dietary support rather than a proven CIDP treatment.[48]Vitamin D
Vitamin D helps immune regulation, bone health, and muscle function. Many people with chronic illness have low levels. Correcting deficiency can support muscle strength and bone density, and may modestly influence immune-mediated diseases, though data specific to CIDP are limited.[49]Magnesium
Magnesium is involved in nerve transmission and muscle relaxation. In people with low magnesium or on drugs that deplete it, supplements can reduce cramps and improve comfort. High doses can cause diarrhoea or be unsafe in kidney disease, so dosing should be guided by a clinician.[50]Curcumin (from turmeric)
Curcumin has antioxidant and anti-inflammatory properties in experimental models, including nerve injury. Human data for neuropathies are limited, and absorption is low unless formulated with enhancers, so it should be considered an experimental adjunct, not a primary treatment.[51]Acetyl-L-carnitine
Acetyl-L-carnitine supports mitochondrial energy use and has been studied in some neuropathies. Some trials show modest benefits in pain and nerve function, but evidence is not specific to CIDP, so it should only be used after discussion with a doctor to avoid interactions.[52]Probiotic and gut-support supplements
Many CIDP patients use long-term immune drugs and steroids, which can affect gut health. Probiotics and fibre can support a healthy microbiome and bowel function, but their direct effect on CIDP is unknown. They are best used as part of overall digestive health care.[53]
Immunity-modulating and regenerative / stem-cell–related approaches
Efgartigimod (FcRn blocker with regenerative potential via antibody reduction)
By lowering circulating IgG, including harmful autoantibodies, efgartigimod may allow damaged myelin to repair more effectively in CIDP. Clinical trials show reduced relapses and improved disability scores, suggesting that stopping the immune attack can give nerves a chance to recover.[54]Rituximab-based B-cell depletion
Rituximab removes CD20-positive B cells, reducing autoantibody production. In small studies, some patients with severe, refractory CIDP show meaningful improvement after rituximab, especially those with particular antibody profiles, which may reflect immune “resetting” that permits nerve repair.[55]Cyclophosphamide-facilitated immune “reboot”
High-dose cyclophosphamide, sometimes combined with stem-cell collection, can strongly suppress the immune system, aiming to “reboot” it and stop ongoing nerve damage. It is reserved for life-altering, treatment-resistant CIDP because of serious risks, but can lead to durable remissions in selected patients.[56]Autologous hematopoietic stem-cell transplantation (AHSCT)
In rare, severe cases, centers may use AHSCT, where a patient’s own stem cells are collected, the immune system is wiped down with chemotherapy, then stem cells are returned. Evidence in CIDP is limited to small series, and the procedure carries significant risk, so it is strictly experimental and only done in specialist centres.[57]High-dose IVIG as an immunomodulatory “booster”
Although already listed as first-line treatment, high-dose IVIG can also be viewed as an immune “booster” that supplies healthy antibodies and anti-inflammatory effects. In some patients, it stabilises disease sufficiently that nerves can remyelinate and strength gradually improves over months.[58]Experimental mesenchymal stem-cell therapies
Mesenchymal stem-cell infusions have been explored for autoimmune diseases because they can secrete anti-inflammatory factors and support tissue repair. For CIDP, data are extremely limited and mostly from small, early-phase studies, so this approach should only be considered within regulated clinical trials, not commercial “stem-cell clinics.”[59]
Surgeries and invasive procedures
Long-term vascular access (port or central line)
People who need frequent IVIG or plasma exchange may have a port or central venous catheter placed. This minor surgical procedure provides reliable access to veins, reducing repeated needle sticks, but carries infection and clot risks, so strict care is needed.[60]Surgical tendon transfer or orthopaedic correction for severe deformity
In long-standing CIDP with fixed contractures or severe foot drop, orthopaedic surgeons may perform tendon transfers or corrective surgery to improve foot position and walking mechanics. This is rare and done only when bracing and therapy are not enough.[61]Spinal cord stimulator implantation for chronic pain
For extremely resistant neuropathic pain, pain specialists may offer spinal cord stimulation. Electrodes are placed near the spinal cord to modify pain signals. This does not treat CIDP itself but can help some people with severe, disabling nerve pain who have tried many medicines.[62]Nerve decompression surgery (for overlapping entrapment syndromes)
Some patients with CIDP also have nerve entrapments, such as carpal tunnel syndrome. Decompression surgery relieves pressure on those nerves and can improve local symptoms like hand numbness or weakness, separate from CIDP treatment.[63]Autologous stem-cell transplantation procedures
As mentioned above, AHSCT involves several surgical-like steps: insertion of central lines, stem-cell collection, and reinfusion. It is considered an intensive, high-risk procedure and is used only in very selected, severe cases within research or specialised programs.[64]
Prevention and long-term self-care
Seek early diagnosis and treatment
The sooner CIDP is recognized and treated with evidence-based therapies, the better the chance of preventing permanent nerve damage and disability.[65]Keep regular follow-up with a neurologist
Scheduled visits allow your doctor to adjust doses, detect relapses, and monitor side effects from immune drugs, steroids, and pain medicines.[66]Stay up-to-date with vaccines (as advised)
Vaccines reduce the risk of infections that could trigger CIDP relapses or be more severe in people on immunosuppressive therapy. Vaccine schedules should be planned with your neurologist.[67]Avoid smoking and limit alcohol
Smoking and heavy alcohol use harm blood vessels and nerves and increase infection risk. Avoiding them gives your nerves the best chance to heal.[68]Protect feet and hands from injury
Because sensation is reduced, burns, cuts, or pressure sores may go unnoticed. Daily skin checks, well-fitting shoes, and avoiding walking barefoot help prevent complications.[69]Manage other health problems
Good control of diabetes, blood pressure, and cholesterol makes it easier for nerves to recover and reduces cardiovascular risk from treatments like steroids.[70]Follow an exercise plan, but avoid over-exertion
Regular, supervised exercise maintains strength and fitness, but pushing to exhaustion can delay recovery. Listen to your body and your therapist’s advice.[71]Take medicines exactly as prescribed
Irregular dosing of immune therapies can lead to flares or side effects. Use reminders or pill boxes and talk to your doctor before changing or stopping medicines.[72]Monitor for side effects and report them early
Weight gain, mood swings, unusual infections, bruising, or new pain should be reported quickly so treatment can be adjusted.[73]Look after mental health and social support
Support from family, friends, peers, and mental-health professionals helps people cope better with chronic illness and follow their treatment plan.[74]
When to see doctors
You should see a doctor urgently (emergency or same day) if you have CIDP and notice suddenly worse weakness, trouble standing, walking, breathing, or swallowing, new bladder or bowel problems, high fever, or confusion. These may signal a relapse, serious infection, or another emergency that needs immediate care.[75]
You should arrange a prompt appointment with your neurologist if you have gradual worsening of numbness, tingling, pain, or weakness over days to weeks, new falls, or if regular treatments seem to stop working. Early adjustment of therapy can often prevent long-term damage.[76]
Routine follow-up visits are usually scheduled every few months to review symptoms, check blood tests, monitor side effects, and plan long-term treatment goals. Never change or stop immune drugs or steroids without discussing it with your doctor.[77]
What to eat and what to avoid
Eat: Plenty of colourful vegetables and fruits
These provide antioxidants, vitamins, and fibre that support general health, weight control, and possibly lower chronic inflammation.[78]Eat: Lean protein (fish, poultry, beans, lentils)
Protein helps maintain muscle mass, which is especially important when nerves are weak. Fatty fish also supply omega-3 fats that may support nerve and heart health.[79]Eat: Whole grains and high-fibre foods
Whole grains, oats, brown rice, and pulses help stabilise blood sugar and support gut health, which is important if you take steroids or pain medicines that affect digestion.[80]Eat: Foods rich in B vitamins (eggs, dairy, fortified cereals, leafy greens)**
These foods help supply B12 and other B vitamins that support nerve health, especially if you do not use many supplements.[81]Eat: Calcium and vitamin-D-rich foods
Low-fat dairy products, fortified plant milks, and safe sunlight exposure or supplements, as advised, help protect bones during long-term steroid therapy.[82]Avoid or limit: Highly processed, salty, and sugary foods
Regular fast food, sugary drinks, and salty snacks can worsen weight gain, blood pressure, and blood sugar, all of which make CIDP management harder.[83]Avoid or limit: Excess alcohol
Alcohol is directly toxic to nerves and can damage the liver, which is important for processing many medicines used in CIDP.[84]Avoid: Smoking and vaping nicotine
Nicotine harms blood vessels and reduces oxygen supply to nerves and muscles, slowing recovery and increasing cardiovascular risk.[85]Use caution with: High-dose single-nutrient supplements
Very high doses of certain vitamins, such as vitamin B6, can actually cause neuropathy. Always check labels and speak with your doctor before starting strong supplements.[86]Discuss: Fish-oil or omega-3 capsules with your doctor
Omega-3 supplements can help some people but high doses may increase bleeding or heart-rhythm risks in others. Your doctor can help decide if they are safe and useful for you.[87]
Frequently asked questions (FAQs)
Is CIDP the same as Guillain-Barré syndrome (GBS)?
No. GBS is usually a one-time, fast-developing illness, while CIDP is long-lasting or relapsing. They share some features, but CIDP progresses more slowly and usually needs long-term management.[88]Can CIDP be cured?
At present there is no guaranteed cure, but many people achieve remission or stable low-level disease with treatment. Some can gradually reduce or stop medicines under supervision if they stay well for a long time.[89]Will I need treatment forever?
Not always. Some people need life-long therapy, while others can slowly taper doses once they have been stable for months or years. Doctors often test lower doses to find the minimum needed to keep symptoms controlled.[90]Is exercise safe if I have CIDP?
Yes, when it is supervised and paced. Studies show structured exercise programs can improve fatigue, function, and fitness in CIDP, but over-exertion should be avoided.[91]Can diet alone treat CIDP?
No. Diet can support overall health, weight, bone strength, and cardiovascular risk, but it does not replace immune-modifying treatments such as IVIG, steroids, or efgartigimod.[92]Are supplements like alpha-lipoic acid or CoQ10 proven for CIDP?
Evidence for these supplements mainly comes from studies in diabetic neuropathy or animal models, not CIDP. They may be considered as add-ons after medical advice, but they should never replace standard CIDP treatments.[93]What are the newest treatments for CIDP?
Recent advances include FcRn blockers such as efgartigimod (Vyvgart Hytrulo), which lower IgG levels and reduce relapses. Subcutaneous immunoglobulin regimens have also expanded options for home-based maintenance therapy.[94]Is it safe to get vaccines while on CIDP treatment?
Most inactivated vaccines are safe and recommended, especially against influenza and pneumonia, but timing with immune therapies matters. Live vaccines are usually avoided in people on strong immunosuppressive drugs. Always ask your neurologist before vaccination.[95]Can stress make CIDP worse?
Stress does not directly cause CIDP, but it can worsen fatigue, pain perception, sleep, and coping. Managing stress with relaxation, counselling, and support can indirectly improve how you feel and function.[96]Can children get CIDP?
Yes, but it is rarer in children. Diagnosis and treatment are broadly similar but must be led by paediatric neurologists who are experienced with immune neuropathies in young people.[97]Will CIDP affect my life expectancy?
With modern treatment and good management of infections and other health problems, many people with CIDP have normal or near-normal life expectancy. The main impact is on mobility and quality of life rather than survival.[98]Is pregnancy possible with CIDP?
Many people with CIDP have successful pregnancies, but treatment plans may need adjusting before conception and during pregnancy and breastfeeding. Some drugs are unsafe in pregnancy, so specialist counselling is essential.[99]Can CIDP come back after remission?
Yes, relapses can occur even after a period of stability. This is why regular follow-up and early reporting of new symptoms are important, so treatment can be restarted or adjusted quickly.[100]Are stem-cell therapies ready for routine use?
No. Hematopoietic stem-cell transplantation and mesenchymal stem-cell therapies for CIDP are still experimental, reserved for trials or very special circumstances because of significant risks and limited long-term data.[101]What is the most important thing I can do right now?
The most important steps are to work closely with a neurologist experienced in CIDP, start evidence-based treatment early, follow your treatment and exercise plan, and ask for help—medical, physical, and emotional—whenever you notice changes or feel overwhelmed.[102]
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 24, 2026.
