Nerve Pain

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Nerve pain

Nerve pain (neuropathic pain) arises as a direct result of damage to “sensory fibers” in the nervous system. This can affect different tissues - often starting from the skin - or the spinal cord or brain. The complaints often occur at rest and can be easily triggered, for example by a light touch. Often there is also an increased pain sensitivity to pain-inducing stimuli.

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Painful nerve damage, ie neuropathic pain, is always to be assumed if the sensory disturbances correspond to the supply area of a sensory nerve in the tissue or a damaged nerve root, a section of the spinal cord or a brain area. Typical signs and symptoms are shooting, electrifying or burning pain, tingling and pins and needles, numbness and pain intensification from light touch (allodynia).

Possible triggers of nerve damage

Neuropathic pain can occur due to different forms of nerve damage. Common triggers include:

• Disc prolapse,
• Diabetes mellitus: disease of many nerves (polyneuropathy), e.g. in the legs,
• Shingles (herpes zoster),
• Nerve damage or severance in the course of accidents or operations,
• Bottleneck syndrome: caused by compressed nerves (e.g. carpal tunnel syndrome on the wrist).

How is the diagnosis made?

The diagnostic work-up is based on a physical and clinical-neurological examination with examination of skin sensitivity, reflexes and muscle strength. They can be supplemented with a pain drawing, pain questionnaires and other special tests. In addition, imaging methods (e.g. computed tomography, magnetic resonance tomography or electroneurography) are often used.

How is nerve pain treated?

Treating nerve pain - unless surgery to relieve the affected nerve is possible - is often difficult. Complete freedom from pain can only rarely be achieved. A realistic goal is to relieve pain by more than 30 to 50 percent, improve sleep and quality of life and maintain the ability to work. Different active principles, if necessary also combined, are used.

Medicinal pain therapy is intended to alleviate the symptoms until the damaged nerves have at least largely renewed (regenerated). The following are used:

• Preparations for oral or injection (oral or systemic therapy): especially opioids, anti-epileptics (eg gabapentin, pregabalin) and antidepressants (eg amitriptyline).
• Creams or medicated plasters (topical or local therapy): especially lidocaine, capsaicin.

Non-steroidal anti-inflammatory drugs (NSAIDs), however, have no effect on nerve pain.

Invasive procedures such as nerve blocks, infiltrations or electrical nerve stimulation can be used in addition to or in acute therapy to bridge the time until the above-mentioned drugs take effect.

Physical measures, occupational therapy and psychotherapy can be useful depending on the severity of the symptoms.

Note A certain amount of patience is required in the treatment of neuropathic pain. It can take a while to find the right drug or drug combination.