[IMAGE]
When patients arrive at the doctor’s office with nerve pain — also known as neuralgia or neuropathic pain — they don’t always know the culprit behind the pain. But that doesn’t mean their pain can’t be diagnosed and treated.
By talking to your doctor about your symptoms and following up with recommended tests and medical evaluations, they can help you figure out what is causing your nerve pain and what you need to do to feel better.
What Is Nerve Pain?
Your nerves are integral to feeling any kind of pain, as well as other sensations. So, sometimes, it can be difficult to differentiate between nerve pain and other types of pain.
Dr. Ryan Jacobson, a neuromuscular neurologist at Rush University Medical Center in Chicago, explains that nerves send pain signals — of any kind — to the brain, which then interprets them. When pain is caused by an injury to the nerves themselves, it is referred to as nerve pain or neuropathic pain.
“Sometimes that can be an injury to one particular nerve, like carpal tunnel syndrome,” Jacobson says. “Other times, it’s a more widespread nerve injury or peripheral neuropathy.”
Peripheral neuropathy is a type of nerve damage that impacts the extremities, such as the hands or, most often, the feet.
Nerve pain can also co-occur with other medical conditions, such as diabetes, autoimmune diseases, and disorders affecting the muscles, joints, bones and connective tissues, making a diagnosis even more challenging.
[How to Reduce Nerve Pain and Sciatica With Self-Massage]
Types of Nerve Pain
— Peripheral neuropathy is the most common type of nerve pain and affects the nerves in the limbs.
— Proximal neuropathy affects the nerves that are closest to the trunk of the body, causing pain and weakness in the hips, thighs, buttock and shoulders. It’s a rare form of neuropathy linked to Type 2 diabetes.
— Autonomic neuropathy affects the nerves that control involuntary functions of the body, such as heart rate, blood pressure, temperature control and digestion. Individuals may develop heart problems, such as an irregular heartbeat, digestive issues like constipation or difficulty controlling blood sugar levels. This type of neuropathy is mainly associated with diabetes.
— Cranial neuropathy affects the nerves that control the eyes, ears, face and scalp. Symptoms include double vision, eye pain, hearing loss and facial weakness. Bell palsy, which affects the facial nerve, and spinal stenosis are examples.
— Focal neuropathy is a type of nerve pain that affects one specific nerve or a specific area of the body. Carpal tunnel syndrome is an example of a focal neuropathy.
[READ: What Is Spinal Stenosis? Causes, Symptoms, Treatments and Prevention]
Symptoms of Nerve Pain
People can experience nerve pain in different ways and in different parts of the body. While not all sensations are the same, there are some signs and symptoms that can be indicative of nerve pain.
Some descriptions people may use to describe what nerve pain feels like include:
— Numbness
— Pins and needles
— Tingling
— Burning
— Electrical shocks
— Sharpness
— Ice-pick sensations
— Ice-cold sensations
— Stinging
Dr. Ilan Danan, a sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, says in contrast to musculoskeletal-type pain, which tends to have an “aching, pulsating-type characteristic” to it, nerve pain may feel acute, or come on suddenly.
Danan adds that people may also associate nerve pain with feelings of extreme temperature — like burning or tingling sensations connected to heat, or “ice-pick type” sensations connected to coldness. Some people use words like “sharp” or “electrical” to describe their nerve pain, too.
Nerves are located almost everywhere in the body, so there are multiple body parts where a person can feel nerve pain.
“Oftentimes, while the characteristics may be similar, distributions obviously can vary depending on which nerves are being affected,” Danan says.
For example, people who experience the condition carpal tunnel may feel nerve pain in their hands or their forearms, whereas people with an impingement from the spine may feel pain in their neck, lower back or elsewhere in the body, he says.
For some patients, the pain is constant, whereas for others, it comes and goes. Pain may also feel more aggressive when you’re lying down, and it can worsen at night, impacting sleep. Others may notice reduced deep tendon reflexes.
If patients feel less pain but more numbness and weakness, this may signify nerve dysfunction — which should be evaluated by a doctor.
[READ Pain and the Mind-Body Connection]
When to See a Doctor About Nerve Pain
If you are experiencing symptoms of nerve pain, it can’t hurt — no pun intended — to seek medical attention.
Particularly if you feel that your nerve pain is negatively impacting your day-to-day life, you should talk to a health professional. A doctor may be able to evaluate your symptoms and conduct tests or exams to see if you need to be diagnosed for any health conditions. Notably, nerve pain is a symptom and not an official diagnosis.
“Nerve pain is your body’s way of telling you that something’s wrong,” Danan says. “It still comes down to what that pain is stemming from” — and a doctor can help discover this.
Experts generally recommend starting with your primary care doctor if you think you’re experiencing nerve pain. Many patients may also need to see a neurologist — a doctor who specializes in muscles and nerves — to determine the cause of nerve pain.
Getting evaluated is important because nerve pain can indicate a myriad of health conditions, which can require different treatment interventions. Depending on what someone is diagnosed with and how far their condition has progressed, treatment may or may not be possible. With that in mind, early intervention can be crucial to protect the body and stop your condition from getting worse, Danan says.
Still, he adds that he also likes to remind patients that nerve pain isn’t always a reflection of damage, either. Sometimes, the body just hurts.
Causes of Nerve Pain
While it is not a stand-alone diagnosis, nerve pain may be able to tell you something about your health. At times, it may indicate that you are experiencing another health condition, or be a side effect from medications or unhealthy lifestyle habits.
Some causes of nerve pain can include:
— Lupus
— Vasculitis, which is an inflammation of the blood vessels
— Cancer
— Vitamin deficiencies
— Lyme disease
— Multiple sclerosis
— Certain medications
— Environmental exposure to heavy metals, organic solvents or mold
— Heavy alcohol use
— Complex regional pain syndrome
— Some chemotherapy drugs
— Obesity
— Shingles
— Smoking
— Diabetes
— Injuries
Where in the body a person is experiencing the pain, whether it’s local or more generalized — “all over” — can at times give you insight to the cause. For instance, nerve pain in the legs, hands and feet, can be connected to diabetes — which is a leading cause of nerve pain.
Diabetes and nerve pain
The leading cause of nerve pain today — and specifically chronic peripheral neuropathy — is diabetes. High blood sugar levels can cause nerve damage, undermining the nerves’ ability to send signals and function properly.
“At least half of individuals with diabetes have neuropathy,” says Feldman.
Those with high blood sugar that isn’t yet full-blown diabetes but instead the precursor, prediabetes, also have an elevated risk.
Specifically, diabetes is the leading cause of chronic peripheral neuropathy, which causes damage to the peripheral nervous system. This can occur if high blood sugar levels cause nerve damage, undermining the nerves’ ability to send signals and function properly. Research has shown than more half of people with diabetes develop neuropathy.
Studies have also associated prediabetes — a condition characterized by high blood sugar that shows warning signs for but is not yet full-blown diabetes — with neuropathy.
Sports injuries also can be to blame for nerve pain. Sports injuries can at times cause a type of nerve pain called a “stinger,” which involves a bundle of nerves between the neck and spine called the brachial plexus. Conversely, nerve injury or trauma can lead to rare disorders like complex regional pain syndrome.
However, despite the abundance of potentials, not all causes of nerve pain are obvious or quickly discovered.
“It is not uncommon that we have to monitor patients to determine the cause,” says Dr. Suraj Muley, a neurologist and medical director of neurology at the Bob Bove Neuroscience Institute at HonorHealth in Arizona.
In some cases, the cause is never known, so it’s important to have a frank discussion about additional medical visits or testing. Seeking medical attention and having follow-up appointments with a neurologist every three to six months can be especially important to determine a cause of the pain, Muley says.
Evaluating Nerve Pain
To understand what might be causing your nerve pain, doctors may ask about symptoms, take a thorough medical history and examine the patient.
In an exam, a physician may also conduct testing, including bloodwork, to better understand what’s behind the pain. This may include a test called a hemoglobin A1c to check your average blood sugar levels to see if you may have diabetes or be at risk for it. Your doctor may also check if your vitamin B12 level is low, which can cause nerve dysfunction and numbness.
Dr. Eva Feldman, a professor of neurology and director of the NeuroNetwork for Emerging Therapies at the University of Michigan in Ann Arbor, says, “A physician may also test a patient for sensory loss using, among other means, a pinprick. If the patient doesn’t feel that and other things like a cotton wisp or tuning fork on the big toe, foot or ankle, that may point to the presence of neuropathy.”
Do I Need an EMG Test?
One test that’s worth asking about is an EMG, or electromyogram, which is an electrical test that’s useful for detecting injury to the peripheral nerves. The peripheral nerves are located outside the brain and spinal cord.
An EMG can help in multiple ways. First, it may help narrow down whether the pain is related to the injury of a specific nerve or nerve root or if it relates more broadly to all the nerves, as with peripheral neuropathy. It can also help physicians assess the health of nerves, diagnose the cause of nerve pain and determine what other tests might be needed if the cause still isn’t clear.
An EMG test involves inserting small needles with electrodes into muscles to detect electrical signals given off by the muscle. Though it can be uncomfortable, doctors say most patients are able to tolerate it. However, it’s important to let your doctor know if you’re experiencing significant pain during or after the procedure. This test generally takes around an hour, but it can be as short as 30 minutes or as long as 90 minutes.
Both EMG testing and nerve conduction studies can show how the body’s electrical signals are traveling. An EMG test measures the signals muscles make when they are resting versus when they are being used. In contrast, a nerve conduction study measures how fast the signals travel.
Whether or not you’ll need other tests after an EMG can depend on your symptoms and risk factors for different conditions. The next level of tests might include screening for autoimmune diseases or inflammatory diseases, looking at hormone function or identifying other metabolic and nutritional markers. Other advanced tests may include imaging, genetic testing or a nerve biopsy.
If you are concerned that your doctor is ordering too few, or too many, tests to evaluate your symptoms, it could be a good idea to go to a neurologist for some expert advice.
Because neurologists are specialists at treating nerve pain, they can help you avoid unnecessary tests and feel confident in your treatment plan.
[READ A Patient’s Guide to Pain Management]
Treatment for Nerve Pain
The most effective treatment for nerve-related pain includes:
— Medication
— Nerve stimulation therapies
— Physical therapy and exercise
— Alternative treatments
— Lifestyle changes
Medication for nerve pain
For some patients whose symptoms affect their quality of life and function, taking daily medication to reduce their levels of pain may be effective.
“There are a number of different medications that are useful for nerve pain or neuropathic pain,” Jacobson says. “Most of those medications were invented or developed for other purposes first, such as epilepsy or mood.”
Besides anticonvulsants and antidepressants, pain relievers may also help.
Ask your doctor how long it may take for medication to be effective. “Many of the medications are effective within a few days,” Jacobson says. “Others take many days or weeks to have an effect. Often a slow increase in the dose is needed.”
Whatever medication you are taking, it is important to talk to your doctor about associated risks you should be aware of. Side effects will vary depending on the medication prescribed.
“As all of these medications work on the nervous system, some amount of sedation or fatigue are fairly common side effects to several of the medications that are considered,” Jacobson explains.
Nerve stimulation therapies
Some doctors may recommend you try nerve stimulation therapies, such as TENS (transcutaneous electrical nerve stimulation) or PNS (peripheral nerve stimulation) to ease your nerve pain. These treatments both use low-voltage electrical currents to help relieve your pain. However, while a TENS unit delivers electrical currents through your skin, PNS delivers them from within.
1. TENSA TENS unit is medical device that is placed on the skin in areas where you are experiencing nerve pain. The device is battery powered and sends out electrical currents that travel through the skin and toward impacted nerves — helping to block your feelings of pain. It can be handled by a medical provider, in office or you can receive a prescription to take home a TENS unit of your own. Many are small enough to be portable and fit inside your pocket.
2. PNSPNS is a medical procedure through which an electrical device, or electrode, is surgically inserted near the nerves by your brain or spinal chord — which are known as the peripheral nerves. The electrode is controlled by a generator, which (after testing things out externally, first) is also inserted into the body. The generator is similar to a pace maker in the way it delivers electricity to the implanted electrode or electrodes. Once everything is in place, you may notice that you feel tingling sensations in areas that you previously felt pain. That’s because the device works by sending electrical pulses in the body, known as paresthesia, replacing sensations of pain.
Physical therapy and exercise
Staying active and following a prescribed exercise regimen may help to ease nerve pain. Home exercises, for instance, such as sciatica or arm pain exercises, may be effective, depending on where you have nerve pain.
Another example: For neuropathy, moderate aerobic activity for 150 minutes per week, after getting clearance from or under the supervision of a physician, can be beneficial. “This can include activities such as brisk walking — at least 2 1/2 miles per hour — swimming or biking less than 10 miles per hour,” Feldman says.
Others with radiculopathy — or pain due to a compressed or pinched nerve in the spine — may be able to relieve symptoms with physical therapy. “This physical therapy focuses on the area of the pain with specific exercises for the neck or back done under the supervision of a physical therapist,” Feldman notes. For example, you might do a controlled head turn or neck bend for a pinched nerve in the neck.
“Physical activity in general is often helpful,” Jacobson adds. He notes that it can improve symptoms and also be preventive by staving off conditions like diabetes that can cause nerve pain.
Alternative treatments
Depending on the type of nerve pain that you’re experiencing, there are many different approaches that may treat your pain.
For instance, acupuncture is often recommended for treating neuropathy, and some patients have reported pain relief. However, the data is somewhat limited regarding this therapy, which involves inserting thin needles into the body at strategic points for nerve pain. A 2017 Cochrane analysis of available research found there isn’t enough to support or refute acupuncture for neuropathic pain. However, a 2022 review in Frontiers of Neuroscience argued that acupuncture provides an “alternative or adjunctive therapy for neuropathic pain.”
Another alternative treatment for nerve pain is spinal cord stimulation, which studies show can help relieve pain for patients with diabetic neuropathy.
Given the options offered for nerve pain, experts recommend first talking to your doctor about any approach you’re considering to manage your pain. It’s important to determine upfront what evidence might support any suggested treatment as well as any potential risks. It’s also important to check with your insurance plan to see what coverage you have for both traditional and alternative therapies.
Lifestyle changes
Lifestyle changes, again depending on the cause of the pain, may be able to lessen the pain.
For example, properly managing diabetes is key to preventing diabetic neuropathy. That’s all the more important given how many people with chronic conditions suffer from nerve pain. “It’s a very common, prevalent problem in a very common, prevalent disease,” Feldman reiterates.
Experts emphasize the critical importance of also addressing prediabetes to prevent diabetes and reduce the risk of nerve damage. That means making sure to follow recommended lifestyle changes, such as eating a healthy diet, exercising regularly and losing weight.
In general, paying attention to the three pillars of health — sleep, diet and exercise — can be helpful in lessening discomfort.
More from U.S. News
Ranking the Most Painful Medical Conditions
How to Describe Medical Symptoms to Your Doctor
Questions to Ask Your Doctor About Nerve Pain Management originally appeared on usnews.com
Update 08/27/24: This story was previously published at an earlier date and has been updated with new information.
