Neuropathic Pain

What is neuropathic pain (nerve pain)?

Neuropathic pain is nerve pain that can happen if your nervous system malfunctions or gets damaged. You can feel pain from any of the various levels of your nervous system, including your peripheral nerves, your spinal cord and your brain. Your central nervous system consists of your spinal cord and brain. Peripheral nerves are the ones that spread throughout the rest of your body to places likes organs, arms, legs, fingers and toes.

Damaged nerve fibers send the wrong signals to pain centers in your body, resulting in neuropathic pain. Nerve function may change at the site of nerve damage and in areas in your central nervous system (central sensitization).

Neuropathy is a disturbance of function or a change in one or several nerves. About 30% of neuropathy cases occur due to diabetes, but hundreds of other diseases — like shingles, HIV/AIDS and alcohol use disorder — can cause it, too.

What are the symptoms of neuropathic pain?

Neuropathic pain symptoms may include one or more of the following:

• Pain that happens for no apparent reason (spontaneous pain): This might include a burning, stabbing, or electric shock-like pain, tingling, numbness, or a “pins and needles” feeling.
• Allodynia: This occurs when normally painless stimuli — like cold, pressure or brushing against your skin — causes you to feel pain. It’s an extreme sensitivity to touch.
• Hyperalgesia: This happens when normally painful stimuli — like heat or pinpricks — cause an extreme or increased pain sensation. (For example, the pinprick hurts more than it should.)
• Hypoalgesia: This occurs when a normally painful stimulus results in a decreased pain response. (For example, the pinprick should hurt but it doesn’t.)
• Dysesthesia: This refers to any unexpected sensations that feel strange, unpleasant or painful.
• Insomnia: Difficulty sleeping. You may also have emotional stress due to disturbed sleep and pain.

What causes neuropathic pain?

Causes of neuropathic pain can include:

• Alcohol use disorder.
• Diabetes.
• Facial nerve conditions.
• HIV/AIDS.
• Central nervous system disorders like stroke, Parkinson’s disease and multiple sclerosis (MS).
• Complex regional pain syndrome.
• Shingles.

Other causes of neuropathic pain include:

• Chemotherapy drugs (cisplatin, paclitaxel, vincristine).
• Radiation therapy.
• Amputation, which can cause phantom limb pain.
• Spinal nerve compression or inflammation.
• Trauma or surgeries with resulting nerve damage.
• Tumors that press on nerves.

How do healthcare providers diagnose neuropathic pain?

Your healthcare provider will review your medical history and do a physical exam. If your provider knows or suspects you have nerve injury, they’ll recognize typical neuropathic pain symptoms. Then they’ll try to find the underlying cause.

How do healthcare providers treat nerve pain?

Neuropathic pain treatment depends on the underlying cause and what works for your unique symptoms. Your provider will create a personalized plan based on those factors.

The goals of treatment are to:

• Treat any underlying disease (for example, radiation therapy or surgery to shrink a tumor that’s pressing on a nerve).
• Provide pain relief.
• Maintain functionality.
• Improve your quality of life.

In most cases, you’ll need a combination of treatments to manage neuropathic pain. These treatments might include:

• Over-the-counter (OTC) pain relievers. These include medications like acetaminophen and ibuprofen.
• Antiseizure medications. Experts don’t know why antiseizure medications work so well for some people with neuropathic pain. Some believe these drugs interfere with pain signals in your body.
• Antidepressants. Anxiety and depression can make neuropathic pain worse. Antidepressants have proven successful in providing neuropathic pain relief. Experts believe these medications treat pain as well as anxiety and depression symptoms.
• Topical treatments. Lidocaine or capsaicin may help ease neuropathic pain. You can apply these creams, ointments or patches directly to the affected areas.
• Nerve blocks. These injections can provide temporary pain relief. A healthcare provider will give you the injection close to the affected nerve or group of nerves.
• Physical therapy. This approach helps relieve soreness, stiffness and discomfort that results from neuropathic pain. It can also encourage your body to produce more natural pain-relieving chemicals. Physical therapy may include various types of massage and exercise.
• Surgery. In some cases, surgery can help ease neuropathic pain symptoms. A surgeon may be able to release, repair or even remove certain nerves to reduce or eliminate pain.
• Psychological counseling. In addition to medical treatment, you may benefit from psychological counseling. Therapy can help you cope with the emotional stress of neuropathic pain.

If these treatments don’t relieve neuropathic pain, your healthcare provider may recommend spinal cord stimulation, peripheral nerve stimulation or brain stimulation. Your healthcare provider can talk with you about the pros and cons of this type of treatment.

Can I prevent neuropathic pain?

You can’t always prevent nerve pain from happening. But there are some things you can do to reduce your overall risk:

• Stop smoking.
• Find a regular exercise routine that works for you.
• Eat lots of fresh fruits, veggies, whole grains and lean proteins.
• Limit your intake of beverages that contain alcohol.
• If you have diabetes, monitor your blood sugar closely and take extra good care of your feet.

What’s the outlook for people with neuropathic pain?

Neuropathic pain can be difficult to treat but it’s usually not life-threatening. You’ll get the best results from combining rehabilitation with support for your emotional, social and mental well-being. The goal is to manage your pain and improve your quality of life with the help of a pain specialist by using some of the methods mentioned above.

When should I see my healthcare provider?

Call your healthcare provider if you develop nerve damage symptoms like:

• Numbness.
• Tingling.
• Muscle weakness.
• Uncontrolled twitching.
• Frequently dropping objects that you’re holding.

When should I go to the ER?

If you have severe pain, numbness or weakness that’s quickly getting worse, you should head to your nearest emergency room. These symptoms could indicate nerve damage. Other serious symptoms may include:

• Fast or irregular heart rate.
• Changes in your bathroom habits (like having trouble peeing).
• Dizziness or fainting.

What does neuropathic pain feel like?

People commonly describe nerve pain like a stabbing, shooting or burning sensation — kind of like an electric shock.

What is the most common neuropathic pain?

While there are many types of nerve pain, diabetes-related neuropathy makes up about 30% of all cases.

A note from Cleveland Clinic

Neuropathic pain can wax and wane, or it can be persistent and relentless. It might be mild or severe, and it can affect any area of your body. While nerve pain isn’t usually dangerous, it can have a serious negative impact on your quality of life. If you have severe nerve pain or pain that doesn’t go away, talk to your healthcare provider. They can help you figure out what’s causing it and recommend appropriate treatment.