Symptoms
Depending on the location of the damage and its cause, nerve pain can take on different forms. If, for example, a motor nerve is damaged, symptoms such as paralysis can occur in addition to the nerve pain, caused by the functional failure of the affected nerve. In neuropathic pain, a distinction is made between neuralgiform and causalgiform pain.
Neuralgiform pain is of a short, violent, shooting character that can occur in a type of seizure. Causal algiform pain manifests itself as a persistent dull burning or tingling sensation. Chronification may occur especially in this type of pain.
Evoked pain is another symptom. Here, pain can also be evoked by stimuli that would not cause pain under normal circumstances (a so-called allodynia). Even wearing clothes on the skin is felt to be unpleasant.
The sensation of heat, cold or pressure can also be excessively increased, so that these stimuli are also perceived as painful (this is called hyperalgesia). Deafferentiation pain is often associated with an initial numbness that, in the course of time, turns into the neuropathic pain symptoms described above. In the case of phantom pain, the sensation of pain usually occurs at the site where the amputated limb was previously located.
The pain that occurs can manifest itself in different ways. A burning sensation that does not occur continuously from time to time is possible. Sensations such as heat, cold or a tingling sensation are also possible.
Sometimes the nerve pain is also felt like itching or bruising. The sensations that occur can also be intensified by external influences such as stress, changes in weather and temperature or fear. Central nerve pain can also manifest itself in different ways.
If the location of the damage is in the thalamus, brain stem or spinal cord, it is often burning and accompanied by discomfort, especially in the arms and legs. However, drilling or tearing can also occur. In addition, where the nerve pain is manifested, overactivity of the sympathetic nervous system is often observed.
This can lead to excessive sweating and reddening of the skin. The pain often occurs over a large area and can be felt both superficially and in depth. Another symptom is evoked pain.
Here, pain can also be evoked by stimuli that would not cause pain under normal circumstances (a so-called allodynia). Even wearing clothes on the skin is perceived as unpleasant. The sensation of heat, cold or pressure can also be excessively increased, so that these stimuli are also perceived as painful (this is called hyperalgesia).
Deafferentiation pain is often associated with an initial numbness that, in the course of time, turns into the neuropathic pain symptoms described above. In the case of phantom pain, the sensation of pain usually occurs at the site where the amputated limb was previously located. The pain that occurs can manifest itself in different ways.
A burning sensation that does not occur continuously from time to time is possible. Sensations such as heat, cold or a tingling sensation are also possible.Sometimes the nerve pain is also felt like itching or bruising. The sensations that occur can also be intensified by external influences such as stress, changes in weather and temperature or fear.
Central nerve pain can also manifest itself in different ways. If the location of the damage is in the thalamus, brain stem or spinal cord, it is often burning and accompanied by discomfort, especially in the arms and legs. However, drilling or tearing can also occur.
In addition, where the nerve pain is manifested, overactivity of the sympathetic nervous system is often observed. This can lead to excessive sweating and reddening of the skin. The pain often occurs over a large area and can be felt both superficially and in depth.
The treatment of nerve pain usually depends on its cause, as far as it is known. If the pain is caused by an infection, antibiotics or antivirals are the first choice, depending on the causative pathogen. If a vitamin deficiency is the cause of the nerve pain, even supplementation can alleviate the symptoms.
In the case of nerve pain caused by diabetes, the correct adjustment of the blood sugar level can already cause the nerve pain to subside. If the nerve pain is caused by intoxication (poisoning), even the omission of the harmful substance often leads to an improvement in symptoms. If the cause is of mechanical origin, e.g. a circulatory disorder caused by pressure as a result of an injury or, as in the case of a herniated disc, a narrowing of the spinal canal, this is usually treated surgically.
This generally brings rapid relief, although the individual risks of surgery must be taken into account. Surgical measures can also improve the symptoms of other nerve pain whose cause lies in a disturbed processing and transmission of stimuli in the nervous system. These include blockages of the sympathetic nervous system, for example in thalamus pain, or directly in the pain pathways if the actual location of the nerve pain cannot be clearly determined.
If the cause of the nerve pain is not known, symptomatic therapy can provide relief. This includes above all drug treatment, but also alternative healing methods to analgesia (pain relief) such as acupuncture or psychotherapy. Here, patients are taught through specific training how to deal with their own perception of pain and, for example, how to repress it to a large extent through targeted distraction.
This method is mainly used for long-lasting nerve pain such as phantom pain. In drug therapy there are a number of possible substances. Morphines, which are otherwise the most effective painkillers, are, however, less of a choice for nerve pain.
Since central pain or seizure-like nerve pain such as multiple sclerosis directly affects structures of the central nervous system, drugs that act on these structures are preferred. These include anticonvulsants for seizure-like, shooting nerve pain and antidepressants for permanent pain. Anticonvulsants are anticonvulsant substances and above all drugs for treating epilepsies, but they are also used in pain therapy.
The active ingredients regulate the transmission and transfer of impulses by binding to structures that are overexcited both in epilepsies and in nerve pain. These include gabapentin and carbamazepine. Antidepressants are primarily used in the treatment of depression, but they also have pain-relieving effects depending on their mechanism of action.
By inhibiting pain-conducting signal substances or preventing the breakdown of pain-relieving messengers, the transmission of pain impulses is disrupted. Commonly used agents in this context are amitriptyline, clomipramine, imipramine and doxepin. Another possibility for the treatment of nerve pain is electrical stimulation, the so-called transcutaneous electrical nerve stimulation (TENS), which is used for phantom pain and as deep brain stimulation for central pain, among other things. Here, electrodes are used to generate light stimuli in the form of current pulses and transmit them to nerve fibers. This suppresses the transmission and thus also the perception of pain.
