Nerve Pain (Neuropathic Pain)

Nerve pain, also called neuropathic pain, is pain caused by damage to or irritation of the nerves themselves, rather than injury to muscles or bones. It often feels different from ordinary pain and is described as burning, shooting or like an electric shock. One well-known type is trigeminal neuralgia, which causes sudden, severe pain in the face.

Symptoms

• Burning, shooting, stabbing or electric-shock-like pain
• Tingling, pins and needles or numbness
• Pain from light touch that would not normally hurt, such as clothing or a breeze
• Pain along the path of a nerve, for example down the leg (sciatica) or down the arm
• In trigeminal neuralgia: brief, intense attacks of pain on one side of the face, set off by touching the face, chewing, talking, brushing the teeth or a cold wind

Causes

• Pressure on a nerve root in the spine from a slipped disc or narrowing of the spinal canal
• Nerve compression at the wrist or elbow, such as carpal tunnel syndrome
• Diabetes, which commonly damages nerves in the feet and hands
• Shingles (herpes zoster)
• Vitamin B12 deficiency, alcohol, kidney disease and some medicines
• Injury or previous surgery affecting a nerve
• In trigeminal neuralgia, most often a blood vessel pressing on the nerve near the brainstem; less often multiple sclerosis or a tumour

Diagnosis

Diagnosis is based on a careful description of the pain and a neurological examination. Blood tests for sugar, vitamin B12 and thyroid function may be needed. Nerve conduction studies may be advised. An MRI of the spine is done when a disc or spinal cause is suspected, and an MRI of the brain is advised in facial pain to look for blood vessel compression, a tumour or other causes.

Treatment

Most nerve pain is first treated with medicines and by treating the underlying cause, such as good control of diabetes or correcting a vitamin deficiency. Ordinary pain relievers often work poorly for nerve pain, so specific medicines that calm overactive nerves are commonly used. Physiotherapy and, in selected cases, spinal injections can help. For trigeminal neuralgia, anti-seizure medicines are usually the first treatment and often control the pain well.

If medicines do not work or cause troublesome side effects, surgery may be considered. For pain from a slipped disc or narrowed spine that does not improve, decompression surgery, often by minimally invasive methods, can relieve pressure on the nerve. For trigeminal neuralgia, options include microvascular decompression, an operation that separates the blood vessel from the nerve, or procedures that reduce pain signals carried by the nerve. The choice depends on examination, scans and overall health.

When to Seek Urgent Care

• Sudden weakness of an arm or leg, or a foot that drags or slaps while walking
• Loss of bladder or bowel control, or numbness around the private parts
• Severe pain after a fall or injury
• Nerve pain with fever, unexplained weight loss or a history of cancer
• Rapidly spreading numbness or weakness in both legs or arms
• Facial pain with numbness of the face, facial weakness, double vision or hearing loss

If you notice any of these, go to the nearest emergency immediately.

If nerve pain or facial pain is not settling with treatment, consult Dr. Prashant Sharma for an evaluation of the cause and the options available.

Related Conditions

• Paralysis (Weakness of Limbs)
• Unconsciousness (Loss of Consciousness)
• Vertigo
• Head Injury
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