Neuropathic pain is caused by damage or injury to the nerves. This can be down to a condition such as diabetes, infections such as Lyme disease and HIV, trauma to the nerves, and more.
Unlike other types of pain, it doesn’t usually respond to ordinary over-the-counter medicines such as paracetamol or ibuprofen. Neuropathic pain is usually a long-term condition, often experienced by people with peripheral neuropathy. It can’t always be prevented or avoided, as trauma to the nerves can be unpredictable and rapid such as in the cases of some spinal cord injuries, but the pain can be managed with certain medications.
Antiepileptic drugs and Antidepressants are commonly used to reduce the pain signals in the body, improving symptoms for many patients. Whilst they work in different ways, the goal of each medication is to reduce the amount or severity of pain. Non-medicinal treatments such as TENS machines are also available to use in conjunction with the medications mentioned above
Nerve damage can’t often be fully repaired even when the underlying condition has been treated, but symptom management is an option for those who still struggle with burning, stinging, shooting or prickling pain associated with neuropathy.
“Neuropathic pain can be extremely frustrating and an extremely exhausting part of peripheral neuropathy. It is caused by damage or injury to nerves as a result of a condition, trauma, or surgery. Whilst the underlying cause that’s responsible for the pain can be treated, nerve damage can’t always be reversed. This type of pain rarely responds to painkillers such as paracetamol and ibuprofen, so anticonvulsants and antidepressants are often prescribed to reduce the severity of pain in patients suffering with Neuropathy”
What is Neuropathic Pain?
Neuropathic pain is the result of pressure, damage, or trauma to the nerves that transfer information to the brain and spinal cord from all of the other parts of the body. Pain caused by nerve damage can be part of a condition called peripheral neuropathy. Patients diagnosed with this may also feel a loss of sensation and loss of coordination and ability to balance.
There are many reasons that someone may suffer with peripheral neuropathy or pain caused by damaged nerves, such as the following:
- Excessive alcohol consumption over a long period of time
- Physical damage to the nerves such as a trauma or as a result of surgery
- Certain infections such as shingles, lyme disease and HIV
- Some types of cancer
- Autoimmune diseases
- Side effect of medication
When nerves become damaged, they can often send false signals, meaning that you feel pain more intensely, or without a reason at all. Neuropathic pain is usually chronic, meaning that sufferers will live with the condition for a long amount of time, but the symptoms may come and go.
There are three main types of neuropathy:
- Allodynia: feeling pain from an external stimulus that wouldn’t usually cause you to feel pain. For example, bedsheets lightly touching your skin may feel like shards of glass or be absolutely unbearable.
- Hyperalgesia: feeling pain more intensely from a mildly painful stimulus such as a slight pinprick or scratch.
- Dysesthesia: this can cause an impairment in sensation. People with this type of neuropathic pain may experience numbness as well as feeling different degrees of pain without any stimulus at all – also called spontaneous pain.
What does it feel like?
There isn’t a one-size-fits-all explanation of what nerve pain feels like, as its highly personal and unique to each sufferer, however, many people that have been diagnosed with peripheral neuropathy have described pain feeling like:
- Pins and needles
- Shooting pain
Whilst not all neuropathic pain has a reason (such as dysesthesia), some people may find that they have certain triggers which can induce pain. Because of the uniqueness of the condition depending on each person, anything could trigger an acute episode of nerve pain. Some sufferers report that their pain is worse at night due to lying down.
The condition can worsen over time, usually starting in the extremities such as the hand and feet, but then later progressing further into the body such as in the arms and legs. Unlike many conditions, treating the underlying cause of neuropathic pain (for example diabetes or a major trauma) won’t necessarily eliminate the pain, as nerve damage is more complicated and long lasting, usually resulting in symptom management rather than a cure. Many types of nerve damage are unfortunately irreversible, but symptoms can be reduced with both medication and non-medicinal treatments.
Can I avoid nerve pain?
In some instances, you can reduce your chances of experiencing nerve pain, such as cutting down on your alcohol intake, however, it’s a condition that doesn’t discriminate against who gets it and who doesn’t. For example, some traumas such as spinal cord injuries can happen in a car accident through no fault of your own, or you could be born with HIV or an autoimmune disease. Unfortunately, these things can’t be helped, but the good news is that should you experience this type of pain, a wide range of treatments are available to ease your symptoms.
How is it Treated?
There aren’t currently any medications that have been developed specifically for targeting nerve pain. However, other families of medicines such as antiepileptic drugs and antidepressants have been proven to reduce symptoms and increase the quality of life in those that suffer from nerve pain.
Gabapentin and Pregabalin are examples of antiepileptic medications that are often prescribed to patients with neuropathic pain. These medications work in a similar way, essentially by controlling certain chemicals in the brain and interfering with pain signals, ultimately reducing the amount or severity of pain that you feel as a result.
Whilst they work in similar ways, Pregabalin is more often prescribed to patients that haven’t responded to other treatments, particularly in Scotland where the medication is restricted.
Being prescribed antiepileptic drugs doesn’t mean that you have epilepsy, though if you’ve been previously diagnosed with it, the medications listed above may interact with something you normally take.
Amitriptyline and Duloxetine are the two antidepressants most commonly prescribed for nerve pain. Although the medications work differently, they are both used to treat depression as well as nerve pain, and have the same end goal of reducing pain in patients with neuropathy. Amitriptyline works by increasing the amount of serotonin in the brain, where Duloxetine works by enhancing the nerve signals in the central nervous system that are responsible for obstructing pain.
If you’re prescribed antidepressants to help reduce the symptoms of neuropathic pain, it doesn’t mean that you have depression, though if you’ve been previously diagnosed with a mental health condition, these medications may interact with anything you’re already taking.
Alternative/Non–medicinal pain relief
There are some treatments out there that don’t contain any medicine that may relieve symptoms of neuropathic pain such as TENS units, which work via electrode pads placed at the site of the pain that fire electric impulses. The theory behind this kind of pain relief is that the impulses block pain messages being sent to the brain. If you haven’t ever used a tens machine before, it can feel strange at first due to the electricity. It is recommended that you increase the intensity of the impulses to a point where you can feel them, but not so that it’s uncomfortable as this can actually increase the amount of pain you feel. It is also important that you don’t use the machine if:
- You have reduced sensitivity in the area you want to place the pads
- Your skin is broken, damaged or irritated where you want to place the pads
- You are in water such as in the shower, bath or swimming pool
- You are driving
- You have a pacemaker
- You are pregnant (unless otherwise advised)
- You have epilepsy
You should also not place the electrodes anywhere near the neck or face, and wherever possible, try not to place directly over a bony area but opt for an area where there is plenty of flesh.
These medications and pain relief methods may not necessarily eliminate the pain completely, but they have been shown to improve symptoms in patients that have been using the treatments. It is also worth noting that these medications may not alter other symptoms of peripheral neuropathy such as loss of sensation, motor nerves or automatic functions.