What You Should Know About Neuropathic Pain

Medically reviewed by Seunggu Han, MD on December 18, 2017Written by Kimberly Holland on December 18, 2017

Overview

Neuropathic pain is a chronic pain condition. It’s usually the result of, or accompanied by, an injury, disease, or infection. However, neuropathic pain is not the direct result of any one factor.

Typically, pain is due to an injury or illness. For example, if you drop a heavy book on your foot, your nervous system sends signals of pain immediately after the book hits. With neuropathic pain, no event or injury causes the pain. Instead, the body just sends pain signals to your brain unprompted.

People with this pain condition may experience shooting, burning pain. The pain may be constant, or it may occur randomly. A feeling of numbness or a loss of sensation is common, too. Neuropathic pain may get worse over time, or it may get better.

About 1 in 3 Americans experience chronic pain. Of those, 1 in 5 experience neuropathic pain. One study estimates as many as 10 percent of Americans experience some form of neuropathic pain.

Understanding the possible causes can help you find better treatments and ways to prevent the pain from getting worse over time.

What causes neuropathic pain?

The most common causes for neuropathic pain can be divided into four main categories.

Accidents

Injuries to tissue, muscles, or joints can cause neuropathic pain. Likewise, back, leg, and hip problems or injuries can cause lasting damage to nerves. While the injury may heal, the damage to the nervous system may not. As a result, you may experience persistent pain for many years after the accident.

Accidents or injuries that affect the spine can cause neuropathic pain, too. Herniated disks and spinal cord compression can damage the nerve fibers around your spine.

Infection

Infections are a common cause of neuropathic pain. People with HIV or AIDS may experience this unexplained pain. A syphilis infection can also lead to the burning, stinging unexplained pain. Shingles, which is caused by the chicken pox virus, can trigger long-lasting neuropathic pain.

Surgery

An uncommon form of neuropathic pain called phantom limb syndrome can occur when an arm or leg has been amputated. Despite the loss of that limb, your brain still thinks it’s receiving pain signals from the removed body part.

What’s actually happening, however, is that the nerves near the amputation are misfiring and sending faulty signals to your brain. In addition to arms or legs, phantom pain may be felt in the fingers, toes, penis, ears, and other body parts.

Disease

Neuropathic pain can be a symptom or a complication of several diseases and conditions. These include multiple sclerosis, multiple myeloma, and cancer. Not everyone with these conditions will experience neuropathic pain, but it can be an issue for some.

Diabetes is responsible for 30 percent of neuropathic cases, according to the Cleveland Clinic. Chronic diabetes can impact how your nerves work. People with diabetes commonly experience loss of feeling and numbness, following by pain, burning, and stinging, in their limbs and digits.

Long-term excessive alcohol intake can cause many complications, including chronic pain. Damage to nerves from chronic alcohol use can have long-lasting and painful effects.

Lastly, cancer treatment may cause neuropathic pain. Chemotherapy and radiation can both impact the nervous system and cause unusual pain signals.

Other causes

Other causes of neuropathic pain include:

What are the symptoms?

Each person’s symptoms of neuropathic pain may be different, but these symptoms are common:

  • shooting, burning, or stabbing pain
  • tingling and numbness, or a “pins and needles” feeling
  • spontaneous pain, or pain that occurs without a trigger
  • evoked pain, or pain that’s caused by events that are typically not painful, such as rubbing against something, being in cold temperatures, or brushing your hair
  • a chronic sensation of feeling unpleasant or abnormal
  • difficulty sleeping or resting
  • emotional problems as a result of chronic pain, loss of sleep, and difficulty expressing how you’re feeling

How’s it treated?

The first goal of neuropathic pain treatment is to identify the underlying disease or condition that’s responsible for the pain, and treat it, if possible. Then, your doctor will aim to provide pain relief, help you maintain typical capabilities despite the pain, and improve your quality of life.

The most common treatments for neuropathic pain include:

Over-the-counter pain medication

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve and Motrin, are sometimes used to treat neuropathic pain. However, many people find these medicines are not effective for neuropathic pain. Unlike pain caused by an injury or headache, neuropathic pain has no “target” for these medicines.

Prescription medication

Opioid pain medications can help some people, but they may not reduce pain from neuropathic pain as well as they reduce other types of pain. Plus, doctors may hesitate to prescribe them for fear that a person may become dependent.

Topical pain relievers can be used, too. These include lidocaine patches, capsaicin patches, and prescription-strength ointments and creams.

Antidepressant drugs

Antidepressant medications have shown great promise in treating symptoms of neuropathic pain. Two common types of antidepressant drugs are prescribed to people with this condition. They are tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. These may treat both the pain and symptoms of depression or anxiety caused by the chronic pain.

Anticonvulsants

Anti-seizure medications and anticonvulsants are sometimes used to treat neuropathic pain. Gabapentinoids are most commonly prescribed for neuropathic pain. It’s not clear why anti-seizure drugs work for this condition, but researchers believe the medications interfere with the pain signals and stop the faulty transmissions.

Nerve blocks

Your doctor may inject steroids, local anesthetics, or other pain medications into the nerves that are thought to be responsible for the wayward pain signals. These blocks are temporary, so they must be repeated in order to keep working.

Implantable device

This invasive procedure requires a surgeon to implant a device in your body. Some devices are used in the brain, and some are used in the spine. Once a device is in place, it can send electrical impulses into the brain, spinal cord, or nerves. The impulses may stop the irregular nerve signals and control symptoms.

These devices are typically used only in individuals who have not responded well to other treatment options.

Lifestyle treatments

Physical, relaxation, and massage therapies are all used to relieve symptoms of neuropathic pain. These forms of treatment can help ease muscles, which may reduce nerve problems.

Your healthcare provider can also teach you ways to cope with your pain. For example, some people with neuropathic pain may experience increased symptoms after sitting for several hours. This might make desk jobs difficult to perform. A physical therapist or an occupational therapist can teach you techniques for sitting, stretching, standing, and moving that may prevent pain.

How can this pain be managed?

If your doctor is able to identify an underlying cause for the neuropathic pain, treating it may reduce and even eliminate the pain. For example, diabetes is a common cause of neuropathic pain. Proper diabetes care, which includes a healthy diet and regular exercise, may eliminate or reduce neuropathic pain. Taking care of diabetes symptoms can also prevent worsening pain and numbness.

Multimodal therapy

Neuropathic pain isn’t one-size-fits-all, and a multipronged approach can be an effective way to manage the condition. A combination of medications, physical therapy, psychological treatment, and even surgery or implants may be used to bring about the best results.

Outlook

Neuropathic pain can negatively impact your life if you don’t take steps to treat it and prevent worsening symptoms. While the pain condition might get better on its own, it can also worsen. Over time, this can lead to serious disability and complications, including depression, problems sleeping, anxiety, and more.

Fortunately, researchers are learning more about why this condition develops and what can be done to effectively treat it. That’s leading to better treatment options. Finding the correct arrangement of treatment options for you can take time, but you and your doctor will work together to find relief from the symptoms of this painful condition.

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