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Neuropathy - Nerve Pain

Neuropathy, also referred to as neuralgia or neuritis, is a type of pain that involves the nerves.  Neuropathy results from nerve degeneration, pressure, inflammation, or infection.   There are several causes of neuropathy, including carpal tunnel syndrome, pinched nerves, spinal stenosis, and pressure from spinal discs. Nerve pain management is individualized.  Lifestyle changes including weight loss, regular exercise, and smoking cessation; and physical therapy can help relieve some types of pain.  People with more significant symptoms may need medication or surgery to help relieve and manage pain.

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Nerve pain originates in the central nervous system or the peripheral nervous system.  The central nervous system consists of the brain and spinal cord.  The spinal cord extends from the brain and through the middle of the spine.  The nerves that extend from the spinal cord and travel throughout the body, arms, legs, and head are the peripheral nervous system.  Your brain, spinal cord, and peripheral nervous system work together, constantly exchanging messages about your body. 

The peripheral nervous system divides into the sensory somatic nervous system and autonomic nervous system.  The sensory nerves send signals about what you feel, such as heat, cold, pain, and touch.  Motor nerves in the sensory-somatic nervous system transmit signals about muscle movements.  The autonomic nervous system controls involuntary body functions, such as blood pressure, heart rate, digestion, and body temperature.

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Neuropathy is a type of pain that occurs when nerves in the peripheral or central nervous system are compressed, pinched, trapped, or affected by disease.  Specific causes of neuropathy include:

• Nerve degeneration:  Stroke, brain bleeding, multiple sclerosis
• Nerve pressure:  Trapped nerve, pinched nerve
• Nerve inflammation:  Ruptured disc, slipped disc
• Nerve infection:  Shingles, viral infection

Common types of neuropathy include:

Entrapment Neuropathy
A trapped or pinched nerve at the neck, shoulder, elbow, wrist, hip, lower leg, or foot.  Common examples of nerve entrapment include carpal tunnel syndrome, thoracic outlet syndrome (neck), or piriformis syndrome (hip).

Peripheral Neuropathy
Peripheral neuropathy first develops in the longest nerves of the body in a "glove and stocking" distribution to the hands and feet.  There are numerous causes of peripheral neuropathy, including certain hereditary conditions, viral diseases, liver or kidney failure, and toxins, as well as diseases such as diabetes, vascular disease, and rheumatoid conditions.

Phantom Limb Pain
Phantom limb pain occurs in some people after the amputation of an arm or leg.  Although the exact cause of phantom limb pain is unknown, it appears to result when the nerves and memories in the brain send faulty signals as the circuitry attempts to "rewire" itself.

Post Herpetic Neuralgia (PHN)
Post herpetic neuralgia (PHN) is a type of nerve pain that can occur following a viral infection of herpes zoster "shingles" in the nervous system.  Post herpetic neuralgia aching or stabbing pain occurs in areas where the shingles rash developed.  The skin in such areas may feel extra sensitive, especially in white-colored scars.

Post Traumatic Neuropathy
Post Traumatic Neuropathy occurs after injury or medical procedures, such as surgery or injection.  Nerve pain symptoms may arise at the injury site and nerve path.

Trigeminal Neuralgia (TN)
Trigeminal neuralgia (TN) is a cause of severe pain in the face and jaw.  Shocking, electric "lightening" pains typically precede dull aching pain.  Trigeminal neuralgia usually affects only one side of the face.  The exact cause of trigeminal neuralgia is unknown, but it develops where the trigeminal nerve is compressed, pinched, or irritated. 

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The nervous system itself does not have its own receptors or system for pain.  Because it has no system for sending pain signals, the nerve sends faulty signals when it is injured. The brain misinterprets these signals as pain that feels sharp, shooting, burning, or hypersensitive.  Other symptoms of nerve malfunction include tingling, numbness, intense itching, weakness, and hypersensitivity to cold, heat, or vibration. 

Nerve pain can travel to locations where the nerve normally travels.  For example, sciatica is a type of nerve pain that originates in the lower spine.  Sciatica pain may travel down the sciatic nerve into a leg and foot. 

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A doctor can diagnose neuropathy and the source of pain by reviewing your medical history, conducting a medical examination, and asking you about your activities and symptoms.  Your doctor may ask you to perform certain tasks as part of a neurological exam.  Your doctor may use lab tests, nerve studies, or diagnostic imaging tests determine what is causing pain, depending on the condition that you may have.

Common studies to aid diagnosis include:
• Computed Tomography (CT) - Computed Tomography (CT) provide views in slices that a computer manipulates into 3D images of bones and dense tissues.
• Electromyography (EMG) - Electromyography (EMG) measures the nerve impulses in muscles to identify poor nerve input. 
• Magnetic Resonance Imaging (MRI) - Magnetic Resonance Imaging takes very detailed images of internal body structures.

• Nerve Conduction Velocity (NCV) - Nerve Conduction Velocity (NCV) measures how well a nerve works and can help identify the site of compression.

• X-rays - X-rays use radiation energy to create images of internal body structures.  X-rays do not provide as much detail as CT or MRI.

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Pain management for nerve pain is very individualized.  The type of treatments and techniques pain management doctors prescribe depends on the cause, location, and extent of your nerve pain. 

Stress and tension can increase pain.  You can learn techniques to help you relax.  Improving your lifestyle can help too.  It is beneficial to get plenty of sleep, lose weight and maintain a healthy weight, and eat a well-balanced diet.  You should avoid alcohol, cigarettes, and illegal drugs.

Weak muscles lead to more pain than healthy strong muscles do.  It is helpful to perform regular stretching and strengthening exercises.  Exercise can help relieve pain by stretching tight muscles and tissues.  Physical therapists and occupational therapists can set up an exercise program just for you.  Your therapists can also teach you how to use proper lifting techniques and postures to prevent injury.

For some people, rest is just as important as exercise is for others.  You may wear a splint, brace, or orthotic device to position and protect a joint while it rests.  Rest allows time for swelling to resolve and healing to take place.  Your therapists can suggest workplace modifications to help reduce pain caused by body positions or movements during job duties.

There are many types and strengths of medications to relieve pain.  Pain medication delivery methods vary, including pill form, liquids, and patches placed on the skin.  Medication may be injected into or near the source of the pain, such as with epidural injections or nerve blocks.

Surgical methods may be appropriate after considering other pain relief treatments.  There are several surgical methods for pain management.  Spinal cord stimulation involves the surgical placement of a small device in the back or abdomen.  The device transmits an electrical current to the spinal cord so that you feel a tingling sensation instead of pain.  Small pain pumps can be surgically placed under the skin to deliver a continuous flow of pain relieving medication.  Intradiscal electrothermal therapy (IDET) uses heat to treat injured discs and nerves.  Percutaneous stereotactic rhizotomy uses heat to destroy the nerves that cause pain. 

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