Neuropathic Pain: Symptoms, Causes, Types, Diagnosis, Complications, Treatment, Outlook and Overview

Also known as nerve pains, they affect many people today, thus affecting their daily lives.

The pain has been described as a burning , stinging , or electric shock sensation, and there are often other sensations, such as numbness or pins and needles that accompany neuropathic pain.

There are several specific types of neuropathic pain, including:

  • Trigeminal neuralgia.
  • Painful diabetic neuropathy.
  • Post-herpetic neuralgia (a complication of shingles).

Neuropathic pain is often severe, ongoing (chronic), and can be difficult to treat.

What happens when you have nerve pain?

Pain is usually felt when nerve endings sense that something is wrong in your body and send pain signals to the spinal cord and brain .

Neuropathic pain occurs when the nerves themselves are damaged by disease or injury, causing them to fire and send pain signals to the brain.

Symptoms of neuropathic pain

Neuropathic pain is often described as a stabbing, stabbing, or burning. Sometimes it feels like an electric shock, and it is usually worse at night than during the day.

The pain can be constant or it can come and go. It may be accompanied by tingling sensations (such as pins and needles), itching, or numbness.

People with neuropathic pain are often extremely sensitive to normal painful stimuli, meaning they feel pain more intensely than other people.

They may also be more sensitive to touch or cold, and may perceive non-painful stimuli, such as a light touch or gentle brushing of the skin, as painful.

What Causes Neuropathic Pain?

Neuropathic pain is caused by damage to the somatosensory nervous system , the part of the nervous system that feels pain and other sensations, such as touch and temperature.

The damage can be caused by disease or injury, and can affect the brain, spinal cord, or nerves in the rest of the body (the nerves in the face, arms, legs, and torso).

While doctors are sometimes unable to identify the exact cause of neuropathic pain, there are several known causes, including:

  • Injury.
  • Spinal cord damage.
  • Diabetes.
  • Nerve compression (trapped nerve), as in carpal tunnel syndrome or sciatica.
  • Nerve invasion by a tumor.
  • Infections such as shingles and HIV / AIDS.
  • Multiple sclerosis.
  • Some types of chemotherapy.
  • Vitamin B12 or thiamine (vitamin B1) deficiency.

Specific types of neuropathic pain

Some examples of neuropathic pain include the following:

Painful diabetic neuropathy

Having diabetes and high blood sugar levels can damage your nerves, especially those in your legs and feet. This condition, diabetic neuropathy, can cause pain, as well as numbness and tingling.

Neuralgia trigeminal

Trigeminal neuralgia is a disorder of the trigeminal nerve – the nerve that provides sensation to the face and controls some of the muscles involved in chewing.

People with trigeminal neuralgia have episodes of severe facial pain that last from a couple of seconds to several minutes.

Neuralgia postherpética

About one in 5 people with shingles (a painful rash also known as shingles) develops postherpetic neuralgia – ongoing pain in the area affected by the rash.

It occurs when the shingles virus damages the underlying nerves, and the resulting pain can last for months or years.

Phantom limb pain

This condition affects people who have had an arm or leg amputated, causing pain or discomfort in the area of ​​the now-lost limb.

The exact cause of phantom limb pain is unknown, but it is believed to be due to changes in the nerves in the affected limb and in the central nervous system (brain and spinal cord) after amputation.

How is neuropathic pain diagnosed?

If your doctor suspects that you may have neuropathic pain, they will ask about your pain and any other sensations you experience, such as pins and needles or numbness. Your doctor will also want to know about any events or illnesses that may have caused it.

Your doctor will perform a physical exam, testing the nerves in the affected area. They may touch the skin in the affected area with cotton wool, sticks, or hot or cold objects as part of the exam.

If your symptoms and physical exam suggest that you have neuropathic pain, your doctor may prescribe specific treatment for this type of pain.

To make a definitive diagnosis of neuropathic pain, the underlying cause of the pain must be found.

Your doctor may recommend tests that include:

  • Blood test.
  • Nerve conduction studies (to measure how quickly nerves can carry electrical signals).
  • An MRI.

Sometimes a biopsy (tissue sample) can help with the diagnosis. A skin biopsy (looking for a reduced density of nerve fibers in the skin) or a nerve biopsy (looking for nerve fiber abnormalities) may be recommended.

Complications

Having ongoing pain can have a significant effect on your entire life. It can cause trouble sleeping, affect your ability to work and attend social events, and even lead to depression and anxiety.

Proper treatment of neuropathic pain and learning coping strategies are very important to ensure that you maintain a good quality of life.

Who treats neuropathic pain?

Your general practitioner (GP) is probably the first person to see about your pain. General practitioners can diagnose and treat neuropathic pain, but some people may benefit from a referral to a pain specialist or pain clinic.

Health professionals who can help with pain management include occupational therapists, psychologists, nurses, and physical therapists.

Treatment

Neuropathic pain is different from other types of pain, so different medications are needed to treat it. There are several medications available in Australia that can be used to relieve this type of pain.

Unfortunately, neuropathic pain is often not fully controlled by medications, so other treatments are generally recommended to help you manage pain and improve your quality of life as well.

These include psychological therapy, meditation, and physical activity. Treating the underlying cause of the pain is also important.

Medicines

Medications that are generally most effective for treating neuropathic pain are:

  • Antidepressant medications.
  • Anti-seizure drugs (the same drugs that are used to control seizures in people with epilepsy ).

These medications can be used for all causes of neuropathic pain, but some medications are preferred over others for specific types of neuropathic pain.

When deciding which medication to prescribe, your doctor will consider:

  • The cause of your pain.
  • Your overall health.
  • Other medications you are taking.
  • The cost of medicine.
  • The secundary effects.

Medications for neuropathic pain are usually started at a low dose and gradually increased if necessary; it may take a few weeks for the medicine to take effect.

Your doctor will closely monitor your response to the medicine and any side effects you are experiencing.

Antidepressant medications

Tricyclic antidepressants are a type of antidepressant that has been found to relieve neuropathic pain in many people.

These medications have an analgesic effect that is separate from their antidepressant effect and can be especially helpful in relieving constant, burning pain.

Amitriptyline is the most widely used tricyclic antidepressant to treat neuropathic pain. Doxepin or nortriptyline can be used as alternatives. Side effects of tricyclics can include constipation , dizziness, tiredness, and dry mouth.

However, when used in low doses, as recommended for neuropathic pain, the side effects are less troublesome.

Another class of antidepressant medications, serotonin and norepinephrine reuptake inhibitors (SNRIs), can also relieve neuropathic pain.

Duloxetine (examples of brand names include Andepra and Cymbalta) is the SNRI that is generally prescribed to treat neuropathic pain, such as painful diabetic peripheral neuropathy.

Venlafaxine is another SNRI that specialists can use to treat neuropathic pain.

Side effects of SNRIs can include nausea, diarrhea, poor appetite, headaches, and sexual dysfunction (including decreased libido and difficulty having an orgasm).

Anticonvulsant medications

Anti-seizure medications can also be effective in treating neuropathic pain, and they work by slowing or blocking uncontrolled pain signals. Anticonvulsants may be better than tricyclics for treating shooting acute neuropathic pain.

Gabapentin (for example, Gantin, Neurontin, Nupentin, Pendine) and pregabalin (for example, Lypralin, Lyrica, Lyzalon) are anti-seizure medications that can relieve neuropathic pain.

They have been found to be useful in treating painful diabetic neuropathy and postherpetic neuralgia. Side effects of these medications can include tiredness, dizziness, and weight gain.

Carbamazepine (eg, Tegretol, Teril), another type of anti-seizure medication, is often the first choice of medication for treating trigeminal neuralgia.

Other medicines

If antidepressants and anticonvulsants do not relieve your pain, your doctor may suggest that you try another type of medicine, which may need to be prescribed by a pain specialist.

Local anesthetics (for example, lidocaine (lignocaine) cream or skin patches) and capsaicin cream (which contains a substance extracted from red chili peppers) can be effective in treating some types of neuropathic pain, such as neuralgia posherpetic.

These medications, which are applied directly to the skin, can have side effects such as local pain, redness, and irritation.

Pain relievers such as tramadol (eg Tramal, Tramedo, Zydol) may be prescribed short-term in some cases where the pain is severe. The side effects of tramadol include:

  • Dizziness
  • Dry mouth.
  • Fatigue.
  • Sickness.
  • Constipation.

Strong opioid pain relievers (such as morphine) are generally not recommended because they are not very effective in the long term, and there are safety concerns with these medications.

Simple pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are generally not effective for neuropathic pain.

A combination of several medications can be effective for some people, especially those who have a partial response to one or more medications.

More research is needed to find out how effective and safe combination treatments for neuropathic pain can be.

Other treatments

Other treatments that can help manage neuropathic pain include the following:

Relaxation and meditation techniques, which are used to reduce muscle tension that contributes to pain.

Psychological treatments, such as cognitive behavioral therapy (CBT), which can help you gain a sense of control over pain and reduce distress. CBT involves identifying and challenging negative thinking patterns and developing different ways of thinking and responding.

Transcutaneous electrical nerve stimulation (TENS), which uses mild electrical currents (from electrodes attached to the skin near the pain site) to block the transmission of pain sensations to your brain.

TENS machines can be purchased at drug stores and TENS can be made at home.

Percutaneous electrical nerve stimulation (PENS) is similar to TENS, but electrical currents are delivered through a needle electrode that is inserted under the skin. This treatment may be recommended by a pain specialist for people with neuropathic pain that is difficult to treat.

Some people have tried acupuncture to relieve neuropathic pain, but there is currently no evidence from clinical trials to show that acupuncture is effective for this type of pain. Several trials are in progress.

Pain specialists may also recommend more invasive treatment options if other treatments have not been effective. These can include injections, nerve blocks, or surgery. Your doctor can explain the options, their advantages and disadvantages, and whether they may be right for you.

Self care

Many people find that being as physically active as possible helps them cope with neuropathic pain.

Physical activity can help reduce stress and improve fitness. Gentle stretching and yoga can be good options. Be sure to control your pace and plan your activities carefully so you don’t overdo it.

Getting enough sleep and eating a healthy diet are also important. A healthy diet tends to reduce inflammation in the body and this can be helpful in neuropathic pain.

What’s the outlook for neuropathic pain?

While neuropathic pain can be ongoing for many people, there are treatments available to help relieve and control the pain. Treating the underlying cause of the pain, as well as the pain itself, is important as seeing a pain specialist sooner rather than later.

Clinical trials investigating neuropathic pain will help us better understand neuropathic pain and develop new and innovative treatments.

Neuropathic pain support groups

Living with neuropathic pain is often very challenging. Support groups can give you a chance to meet other people who are going through a similar experience.

Understanding others can help you feel less isolated, and you can also exchange tips on how to deal with pain and ways to manage it. Look online or ask your doctor about support groups for neuropathic pain.

Natural treatments for neuropathic pain

There are also a number of natural treatments to help reduce symptoms and peripheral neuropathy:

1. Vitamins

Some cases of peripheral neuropathy are related to vitamin deficiencies. Vitamin B is essential for the health of your nerves. A deficiency can lead to significant nerve damage.

While you can get vitamin B from your food, your doctor may also recommend taking a supplement. Follow the recommended dosage to prevent toxicity and worsening of symptoms.

Vitamin D can also help prevent nerve pain. Your skin normally produces vitamin D in response to sunlight. A deficiency can cause neuropathy pain. Taking a supplement can help reduce the symptoms of neuropathy.

2. Cayenne pepper

Cayenne pepper contains capsaicin, an ingredient in hot peppers that makes them hot. Capsaicin has been used in topical creams for its pain-relieving properties. Decreases the intensity of pain signals sent through the body.

Incorporating cayenne pepper into your diet or taking a capsaicin supplement can help reduce neuropathy pain.

Topical capsaicin ointments can also be used on the body. Although it may initially burn, continued use will gradually reduce the sensations of neuropathy.

Be sure to discuss this treatment method with your doctor before use to prevent adverse symptoms.

3. Stop smoking

Smoking affects blood circulation. Blood vessels narrow and less oxygenated blood can pass through. Without proper blood circulation, you may experience increased numbness and pain due to your peripheral neuropathy.

Eliminating smoking habits can help improve your symptoms. Let this motivate you to make positive changes.

4. Hot bath

Taking a hot bath can be calming and can also ease the pain symptoms of neuropathy. Warm water increases blood circulation throughout the body, decreasing symptoms of numbness pain.

If your sensory nerves are affected by peripheral neuropathy and you are not as sensitive to temperature, be careful not to make your bath too hot.

5. Exercise

Regular exercise can help fight pain and improve your overall health. Being active can lower your blood sugar, which, in turn, can reduce or lessen nerve damage.

Exercise also increases blood flow to your arms and legs and reduces stress. All of these are factors that help reduce discomfort and pain.

6. Essential oils

Some essential oils, such as chamomile and Roman lavender, help increase circulation in the body. They also have analgesic and anti-inflammatory properties that could enhance healing.

Dilute essential oils (a few drops) in 1 ounce of a carrier oil such as olive oil. Applying these diluted oils to the affected area can reduce the stinging and shooting pains of peripheral neuropathy.

7. Acupuncture

Acupuncture promotes natural healing by stimulating pressure points in the body. This technique causes the nervous system to release chemicals that can change the pain experience or threshold.

Acupuncture helps provide an energy balance to the body that can affect your emotional well-being.

Panorama

Prevention works much better than treatment. Keeping your blood sugar levels within the normal range will help prevent your neuropathy from getting worse. If your neuropathy is related to alcohol use, stop drinking now to prevent the condition from worsening.

Natural remedies have some success in relieving the pain symptoms of peripheral neuropathy. However, be sure to check with your doctor before engaging in a new treatment method.

If you start to experience irregular symptoms from natural remedies, or if your conditions worsen, visit a doctor immediately.