Neuropathic Pain

What is neuropathic pain?

Neuropathic pain is pain caused by injury to or deterioration of nerves.

How does it occur?

Neuropathic pain can be caused by:

inflammation
infections such as shingles (herpes zoster virus) or malaria
cancer chemotherapy
radiation therapy
surgery
nerve compression from tumors
irritation of the spinal nerves (such as by a bulging or herniated disk)
diseases such as diabetes, thyroid conditions, pernicious anemia, or folic acid deficiency
deterioration of the nerves themselves due to aging or hereditary conditions
brain injury, such as a stroke.

What are the symptoms?

Neuropathic pain feels different from most other types of pain. It is often described as sharp, stabbing, burning, or like an electric shock. It may be worse at night. The pain may be constant after a stroke or if you have diabetic neuropathy of the feet and legs. The pain may come and go if you have trigeminal neuralgia or sciatic pain with walking.

The kinds of neuropathic pain include:

Allodynia. This is pain due to something that does not usually cause pain such as a breeze blowing across your arm, or a sheet rubbing up against a leg.
Hyperalgesia. This is an increased or overly painful response such as bumping an arm and feeling like a searing iron touched it.
Dysesthesia. This is uncomfortable feelings without true pain such as pins and needles, feeling like your feet are swollen or very fat, or like worms are crawling on your skin.

How is it diagnosed?

Your health care provider will ask about your symptoms and medical history. He or she will examine you. Tests such as x-rays, blood tests, scans, and nerve conduction tests may be done to try to identify the specific cause of the pain. Your health care provider may also refer you to a neurologist, neurosurgeon, or physiatrist for additional testing.

How is it treated?

Nonprescription and prescription pain medicines can sometimes work well for neuropathic pain. If these medicines do not work well for you, your health care provider may prescribe antidepressants and antiseizure medicines that interfere with pain signals to the brain. They may be used alone or with other drugs even if you are not depressed or having seizures. These medicines take days or weeks to work, so you must take the medicine every day on a set schedule to reduce the pain. These medicines rarely take away the pain completely, but they can help reduce it to a level you can tolerate.

Other treatments may include:

massage
heat applied to the painful area
cold applied to the painful area
biofeedback (a method of controlling your body's responses with your mind)
electronic nerve stimulation devices
topical (applied to the skin) anesthetic patches such as menthol (without prescription) or lidocaine (prescription needed)
acupressure or acupuncture
shots of local anesthetics, steroids, or other chemicals to block pain signals or decrease inflammation
surgery.

Injection of drugs into or around the nerve can deaden the nerve, providing pain relief that is sometimes temporary and sometimes permanent. However, this may result in numbness in the area where the pain used to be. Injection of drugs such as steroids to reduce inflammation may also be done.

If medicine does not help your pain, your provider will most likely refer you to a pain specialist or pain clinic.

For some types of neuropathic pain, surgery may be considered to remove the root of the nerve. These include electrosurgery, microsurgery, and radio wave surgery.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File BRN3422F.HTM Release 9.0/2006