Nerve Pain: Causes, Treatment

Brief overview

  • Description: Pain caused by damage to or dysfunction of nerves.
  • Treatment: Therapy is based on the cause. Usually the physician treats the pain with medication. Physiotherapy, acupuncture, psychotherapy, surgery are also considered.
  • Symptoms: Typical symptoms are shooting, electrifying, stabbing or burning pain, tingling, numbness as well as increased pain caused by stimuli that do not actually trigger pain, e.g. touch (allodynia).
  • Causes: Common causes include injury (e.g., after an accident), bruising (e.g., herniated disc), inflammation (e.g., shingles), or disease (e.g., diabetes mellitus, multiple sclerosis).
  • Diagnosis: Discussion with the physician, neurological examinations (e.g. testing of nerve fibers for heat, cold, vibration, pressure).
  • Prevention: Healthy lifestyle (e.g. regular exercise, balanced diet, avoid stress)

What is nerve pain?

Nerve pain – also called neuropathic pain – is pain that occurs when nerves and their structures (e.g. nerve fibers, nerve cells) are irritated or damaged. The damage occurs, for example, as a result of inflammation of the nerves, but also as a result of injuries following an accident or a disease such as multiple sclerosis or diabetes mellitus.

The term “neuropathy” is an umbrella term for diseases of the nerves. A distinction is made between central neuropathies, i.e. those originating in the central nervous system (CNS for short: brain and spinal cord), and peripheral neuropathies. Here, nerves outside the CNS are the cause of pain. A neuropathy affects either single nerves (mononeuropathy) or multiple nerves (polyneuropathy).

How does neuropathic pain differ from other pain?

Neuropathic pain is different from other pain, such as headache or back pain. Here, the nerves are only the “transmitters” of the pain. In neuropathic pain, the nerves themselves are the triggers or at least in part the cause of the pain.

Who is affected?

Neuropathic pain is one of the most common causes of chronic pain, along with back pain and headaches.

What can be done about neuropathic pain?

The doctor treats neuropathic pain in different ways, depending on the cause. Often, a combination of several measures comes into question. These include, for example, medication, acupuncture, physiotherapy, psychotherapy, relaxation methods and patient training, as well as transcutaneous electrical nerve stimulation (TENS).

Treatment of the triggering cause

If a bacterial or viral infection (e.g., in the case of shingles) is responsible for the pain, the doctor administers antibiotics against bacteria or drugs against viruses (antivirals). Some diseases, such as carpal tunnel syndrome or certain tumor diseases, sometimes press on the nerves, pinching them or otherwise damaging them.

In such cases, surgery is needed to free the nerves from the pain trigger, such as when they are pinched. Sometimes the doctor will also eliminate the pain by sclerosing the affected nerves with medication.

Treatment with medication

Neuropathic pain is not easy to treat because many “classic” painkillers with the active ingredients acetylsalicylic acid, ibuprofen, diclofenac or naproxen (non-steroidal anti-inflammatory drugs, or NSAIDs for short), do not work or do not work sufficiently.

The doctor therefore usually uses the following painkillers for nerve pain, which are significantly more effective:

Tricyclic antidepressants (e.g., the active ingredients amitriptyline, imipramine or doxepin) as tablets, dragées, drops and as injections; have an analgesic effect, enhance the effect of painkillers

Selective serotonin-norepinephrine reuptake inhibitors (e.g., the active ingredients duloxetine, venlafaxine, milnacipran) as tablets, capsules or pellets; have an analgesic effect, inhibit sensitivity to pain

Opiates (e.g. the active ingredients tramadol, hydromorphone, fentanyl) in all possible dosage forms: Tablet, capsule, solution, patch, injection, infusion, nasal spray, effervescent tablet, lozenge, suppository or drops; have a strong analgesic effect, suppress the transmission as well as processing of pain stimuli

Local pain therapy (e.g., the active ingredients lidocaine, capsaicin, botulinum toxin) as ointments, plasters or injections; have an anesthetic and analgesic effect

Treatment without medication

In addition, treatments without medication also have a supportive effect against nerve pain. These include, for example:

Physical therapy: physical and/or occupational therapy helps relieve nerve pain in many cases. It includes exercises that strengthen muscles, massages and physical treatments (e.g., applications with heat, cold, light or electrical stimuli).

With the help of therapy, patients learn that it is possible to move even with pain. The main goal is to work with the patient and his or her family, relatives and environment (e.g., workplace) to encourage movement and participation in an active life.

Acupuncture: Acupuncture also helps with nerve pain. To do this, the acupuncturist sticks fine disposable needles into specific skin points on the body. This causes very little pain. They remain there for about 20 to 30 minutes and develop their pain-relieving effect while the patient relaxes on the couch.

Transcutaneous electrical nerve stimulation (TENS): TENS is also sometimes said to help people with nerve pain. It uses skin electrodes to transmit electrical pulses to affected parts of the body. The current irritates the nerves located in the tissues, causing the brain to release chemical substances that dull the perception of pain.

Cold therapy: Cold measures such as cooling sprays, cold packs or cold compresses also promise relief for many people with nerve pain. Often a stay in a cold chamber also helps. To do this, first stand in a bathing suit or bikini for half a minute in an antechamber at minus 60 degrees Celsius, then for about two and a half minutes in a chamber at minus 110 degrees Celsius.

You should only go into the cold chamber after a medical check and on the recommendation of your doctor. It is important that you are healthy and feel well.

Psychotherapy: Accompanying psychological support (e.g. psychotherapy) also has a supportive effect against nerve pain. Patients learn how to cope with the pain and find ways to lead a fulfilled and satisfied life despite the pain (pain acceptance). As a result, many pain patients significantly reduce their intake of pain medication.

These measures can at best supplement, but not replace, conventional medical treatment. Talk to your doctor about how you can best support the therapy.

Tips and home remedies

Some people with nerve pain report that certain home remedies provide them with relief. According to this, heat and/or cold in particular can help against the pain. Cooling compresses are suitable for cold applications, while warm baths or heating pads are suitable for heat applications. Some people also benefit from alternating baths in warm and cold water.

A healthy diet that contains many B vitamins is also helpful for nerve pain. Above all, the body needs vitamins B6 and B12 for optimal nerve supply. These are found primarily in animal products such as meat, fish, eggs and milk, but also in whole grain products and legumes.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse despite treatment, you should always consult a doctor.

Herbal and homeopathic remedies

Herbal remedies, medicinal herbs or homeopathic remedies such as globules are also said to help some people with nerve pain. Taken or applied in the form of teas, extracts, tinctures, ointments, capsules or compresses, they are said to have analgesic and anti-inflammatory effects. The bark of the silver willow, frankincense, chili (contains capsaicin), devil’s claw, comfrey and arnica, for example, are said to be especially effective against nerve pain.

The concept of homeopathy and its specific efficacy are controversial in science and not clearly proven by studies. Also note that herbal remedies can also cause side effects such as allergic reactions. Use them only after consulting your doctor!

In principle, nerve pain should be clarified and treated by a doctor at an early stage!

Surgery

If the neuropathic pain cannot be sufficiently alleviated despite various therapeutic approaches, surgery is the only way to combat the nerve pain, depending on the cause.

For this purpose, the physician performs neuromodulation, for example. Here, he surgically inserts electrodes near the spinal cord. These emit special electrical impulses that significantly reduce the neuropathic pain. Often, those affected are then able to reduce their intake of painkillers by up to 50 percent.

If a nerve is pinched, the doctor exposes the nerve through surgery to remove the pressure that is causing the pain.

With neuropathic pain, there is a risk that the body will develop what is called pain memory and the pain will become chronic. To prevent this, it is important for a doctor to treat the nerve pain as early and effectively as possible

How does neuropathic pain manifest itself?

Symptoms in people with neuropathic pain can vary significantly and can be sometimes more, sometimes less intense over time.

Affected people often describe the painful symptoms as:

  • burning
  • tingling (e.g., formication)
  • stabbing
  • shooting in
  • electrifying

Other symptoms include:

  • Reduced perception of vibrations
  • Reduced sensation of temperature
  • Tingling to numb sensation (hypesthesia) in the affected area
  • @ Weakness up to paralysis

Since neuropathic pain is difficult to treat on the one hand, and particularly stressful for those affected on the other, the risk of the pain becoming chronic is high.

Because of its intensity, nerve pain often leads to other complaints in sufferers, such as sleep disorders, concentration problems, anxiety and depression.

Where does the pain occur?

How does nerve pain develop?

Nerve pain has a variety of different causes. They arise, for example, from injuries, bruises, infections, inflammations or diseases. Damaged or dysfunctional nerves continuously transmit pain signals to the brain, and the sensation of pain is heightened.

Even clothing on the skin or normal touching may then be experienced by those affected as excruciatingly painful. Depending on where the cause lies, a distinction is made between two classes of nerve pain:

Peripheral neuropathy.

In this case, the pain originates in the peripheral nervous system. This refers to all nerves that lie outside the brain and spinal cord. For example, they connect the head, face, eyes, nose, muscles, and ears to the brain.

Examples of peripheral neuropathies include:

  • Post-zoster neuralgia: Severe nerve pain that persists after shingles.
  • Phantom limb pain: the sufferer perceives pain in a part of the body that is no longer there, usually as a result of an amputation.
  • Trigeminal neuralgia: sudden severe pain in the face
  • Diabetic neuropathy (polyneuropathy): high blood sugar levels in people with diabetes mellitus damage nerves in various parts of the body, causing burning pain, often in the feet, among other things.
  • Bannwarth syndrome: pain (e.g., head, face, or abdominal pain) that occurs after a Lyme disease infection.
  • Impingement syndrome: pain when nerves are compressed or constricted. It often occurs in the shoulder.
  • Carpal tunnel syndrome: A narrowing in the tendon compartment of the wrist pinches the median arm nerve in this case.

Central neuropathy

Pain originates in the central nervous system (spinal cord and brain).

  • Stroke (cerebral infarction)
  • Neurological diseases, such as multiple sclerosis (MS)
  • Inflammations and abscesses
  • Injury to the spinal cord and vertebrae (e.g., herniated disc)
  • Tumors
  • Injuries of the nerves (e.g. nerve pain due to accidents or after operations)

Furthermore, tension, psychologically induced stress, alcohol abuse, medication (e.g. chemotherapy or age-related wear and tear) are possible causes of nerve pain.

Which doctor makes the diagnosis? And how?

For nerve pain, the primary care physician is the first point of contact. If necessary or for further examinations, he or she will refer the patient to a specialist. The diagnosis of nerve pain is made by a neurologist.

The most important measures for a reliable diagnosis are a discussion with the doctor (medical history) and a neurological examination. Above all, it is important to find the cause of the pain in order to initiate the appropriate therapy as quickly as possible.

Conversation with the doctor

Neurological examination

The neurological examination is used to detect typical neuropathic symptoms such as numbness, signs of paralysis or allodynia (pain on gentle touch), of which the affected person is often not even aware. Using quantitative sensory testing (QST), the physician uses thermal (e.g., heat, cold) and mechanical (e.g., pressure, vibration) stimuli to examine the skin and underlying areas for pain fiber function.

The physician then measures nerve conduction velocity (neurography) and, if necessary, takes a small sample from the affected nerve (biopsy) to examine the nerve tissue for changes (neurohistological examination).

In addition, he often uses imaging techniques such as computer tomography (CT) or magnetic resonance imaging (MRI). These make nerve damage directly visible. In addition, the physician examines the blood of the affected person.

Can nerve pain be cured?

The earlier nerve pain is treated by a doctor, the better the chances of recovery. Conversely, the later therapy begins, the higher the risk that the pain will become chronic. If an underlying disease triggers the pain, however, it is often possible to cure it and with it the pain.

With chronic pain, it is important for the physician to discuss realistic treatment goals with the patient prior to therapy. For example, a realistic goal might be to reduce pain by more than 30 to 50 percent, improve quality of sleep and quality of life, and keep sufferers able to work.

How long does nerve pain last?

How can nerve pain be prevented?

Basically, nerve damage cannot be completely prevented, as there are many possible causes. However, the risk of nerve pain can be reduced by adopting a healthy, mindful lifestyle. To do this, it is important, for example, that you eat a balanced diet, exercise regularly, and avoid stress and the risk of accidents.