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Neuropathic Pain

(Pain, Neuropathic; Nerve Pain; Pain, Nerve)

Definition

Neuropathic pain is a painful sensation that occurs due to damaged or abnormally working nerves. It may also occur because of abnormalities in the central nervous system's interpretation of the signals it is receiving from these nerves. The pain may be long-lasting.
Nervous System
CNS and PNS
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Causes

This condition may caused by damaged nerve fibers that send pain signals to your brain. This can happen even when there is no event to trigger the pain. For example, a person with neuropathic pain may have a feeling of pins and needles when putting on socks.
Nerve damage may be caused by:
  • Physical damage
  • Chemicals
  • The nerve not getting the vital nutrients needed to function
  • Infection
  • The body’s immune system attacking the nerves
Sometimes the cause of the nerve pain is unknown.

Risk Factors

Certain conditions increase your risk of getting neuropathic pain, such as:
Other risk factors include:
  • Back surgery
  • Chemotherapy
  • Exposure to toxins or metals
  • Certain medications

Symptoms

Neuropathic pain may cause sensations of:
  • Burning
  • Stabbing
  • Electrical shock
  • Pins and needles/tingling
  • Numbness
This pain may be constant or occur off and on during the day. The condition can get in the way of daily activities, including sleep. In some cases, even the touch of a bed sheet can cause pain.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
You may be referred to a neurologist. This is a doctor who specializes in disorders of the nervous system. This doctor will do a neurological exam and other tests.
Depending on your condition, you may also be referred to a pain specialist who can help you manage your pain.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

There are a number of medications that are effective for treating neuropathic pain. Some of these, like antidepressants, were created to treat other conditions. They have also been found to be useful for treating nerve pain.
Examples of medications used to treat symptoms of peripheral neuropathy include:
  • Anticonvulsants
  • Antidepressants
  • Opioid pain relievers
  • Over-the-counter pain relievers, such as acetaminophen and ibuprofen
  • Topical creams applied to the skin or patches, such as capsaicin cream or a patch with lidocaine
It may take a while for your doctor to find the right medication for you. You may need to take a combination of medications for pain relief.

Other Options

  • Ask your doctor to recommend a safe exercise program. Being active will help your overall health.
  • Work with a therapist to help cope with chronic pain. Joining a support group may also be helpful.
  • Talk to your family and friends about your condition. They can offer help and understanding.
  • Learn relaxation techniques, such as meditation, to reduce stress.
  • If you have an underlying condition, like diabetes, be sure to get proper treatment for it.

Procedures

Your doctor may advise nerve decompression. If pressure on the nerve is causing pain, surgery can relieve it. This can help decrease the pain or make it go away.
If you are not getting relief from other treatments, your doctor may recommend:
  • An injection of a nerve block—An anesthetic is injected into the painful area to block pain signals.
  • Pain pump installation—A pain pump can be implanted into your body to deliver pain medication.
  • Nerve stimulators—This device is attached to the nerve and delivers electrical signals to control pain.
  • Surgery can be done to block the damaged nerves from sending signals.

Prevention

You can reduce your chance of developing neuropathic pain by getting proper treatment for any chronic conditions, such as diabetes.

RESOURCES

American Chronic Pain Association http://www.theacpa.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca

Canadian Pain Coalition http://www.canadianpaincoalition.ca

References

Botez SA, Herrmann DN. Sensory neuropathies, from symptoms to treatment. Curr Opin Neurol. 2010;23(5):502-508.

Rezania K, et al. Impaired glucose tolerance and metabolic syndrome in idiopathic polyneuropathy: the role of pain and depression. Med Hypotheses. 2011;76:538-42.

Types of neuropathic pain. The Neuropathy Association website. Available at: http://www.neuropathy.org/site/News2?news%5Fiv%5Fctrl=-1&page=NewsArticle&id=7775. Accessed May 30, 2014.

Understanding nerve pain. American Chronic Pain Association website. Available at: http://www.theacpa.org/uploads/Final%5FBrochure.pdf. Accessed May 30, 2014.

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