Symptoms | Nerve pain in the back

Symptoms

Nerve pain in general, but also nerve pain in the back, are very different. They can be burning, stabbing or drilling, can occur in attacks or be present as permanent pain. Usually there is no direct trigger for the pain.

Furthermore, the sensation of sensitivity, the perception of cold and heat, as well as the perception of pressure are significantly reduced. Frequently, tingling paresthesia (“formication”), itching or muscle cramps also occur. In general, affected persons have a hypersensitivity of the skin, so that they feel the strongest pain already on harmless touches or stimuli, which normally would not cause pain. This is also known as “allodynia”.

Diagnostics

For the diagnostic clarification of nerve pain in the back, a thorough anamnesis, the diagnostic findings, is very important.The more precisely the patient can describe his or her pain, the sooner the doctor can make a correct diagnosis. In the anamnesis, information about the exact localization of the pain, the pain quality, the frequency of pain attacks and the triggers are collected. Usually, special pain questionnaires are distributed for this purpose, which the patient can fill out at home and bring to the first session.

In addition, a complete neurological examination is carried out, where the sensation of sensitivity, temperature and pressure as well as motor functions are examined. By means of a neurography the nerve conduction speed can be determined. The QST (Quantitative Sensory Testing) is a new procedure that consists of a variety of different sensitivity tests.

Based on the measurement results and the comparison with healthy test persons, the QST decides whether neuropathic pain is present or not. In order to determine the intensity of a nerve pain, there are pain scales on which the patient can enter his subjectively felt pain. This is especially important for the therapy and the use of painkillers.

Imaging examination methods, such as MRI of the spine or skeletal scintigraphy, can also be used for certain forms of neuropathic pain (e.g. herniated disc). At the beginning of any therapy for nerve pain in the back, organic diseases must first be excluded or treated. For certain clinical pictures, such as a herniated disc, surgery is sometimes necessary.

In the case of shingles, an antiviral therapy should be initiated above all. In general, however, nerve pain should be treated as early as possible in order to achieve a good prognosis and to avoid a chronification of the pain. To treat nerve pain in the back, a multimodal therapy is usually used – a combination of painkillers, physical therapy and psychological treatment.

Basic drugs in pain management are opioids in addition to the classic painkillers, such as ibuprofen, diclofenac and novalgin. As co-painkillers, drugs from the group of anticonvulsants (antispasmodic drugs) or antidepressants are often used. These drugs have the advantage that they act on certain channels in the nervous system and can directly block the transmission of pain.

The full effect of the drugs is only achieved after about two to four weeks, so it is important that those affected remain patient and do not stop taking the drugs on their own beforehand. The use of capsaicin or lidocaine patches can also help. Capsaicin patches can cause nerve endings to become unexcitable due to heat build-up, thus providing quick relief from nerve pain.

Lidocaine is a local anesthetic that enters the skin locally and anesthetizes overexcited nerves, thus counteracting pain. With the help of physical therapy, painful muscle tensions can be relieved and the functionality of the muscles can be maintained. Other physical measures that can lead to an alleviation of pain are acupuncture, TENS or sports such as yoga. With the help of psychological therapy, patients are relieved of their fear of pain and their sparing behaviour is combated. Trainings such as autogenic training or progressive muscle relaxation are often helpful here.