Understanding Nerve Pain (Neuropathic Pain)
Understanding Nerve Pain (Neuropathic Pain)
Expert insights from Dr. Mona Mubarak, Consultant in Chronic Pain Management. Neuropathic pain results from damage or disease affecting the somatosensory nervous system and requires specialized diagnosis and management.
What is Nerve Pain?
Neuropathic pain, commonly referred to as nerve pain, is a complex chronic pain state that is accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional, or injured. These damaged nerve fibers send incorrect signals to pain centers in the brain, resulting in a distorted pain experience.
Unlike nociceptive pain (the normal response to injury), neuropathic pain is a disease state of the somatosensory nervous system itself. The pain sensation can persist for months or years beyond the apparent healing of any damaged tissues, creating a chronic pain condition that requires specialized management.
Key Characteristics of Nerve Pain
- Burning or shooting sensations – Often described as “pins and needles” or electric shocks
- Spontaneous onset – Pain may occur without an obvious trigger
- Hyperalgesia – Increased sensitivity to pain stimuli
- Allodynia – Pain from stimuli that don’t normally provoke pain (like light touch)
- Persistent nature – Continues beyond normal healing time
How Nerve Pain Differs from Other Pain Types
| Feature | Nerve Pain (Neuropathic) | Tissue Pain (Nociceptive) |
|---|---|---|
| Source | Nervous system damage or dysfunction | Actual or potential tissue damage |
| Quality | Burning, shooting, electric, tingling | Aching, throbbing, pressure, sharp |
| Response to Treatment | Often resistant to standard painkillers | Usually responds to anti-inflammatories |
| Duration | Often chronic, persisting beyond healing | Typically resolves with tissue healing |
| Common Medications | Anticonvulsants, antidepressants, and topical agents | NSAIDs, paracetamol, opioids (short-term) |
Causes and Origins of Nerve Pain
Neuropathic pain can originate from various conditions that affect the peripheral or central nervous systems. Accurate diagnosis of the underlying cause is essential for effective treatment planning.
Common Causes of Neuropathic Pain
Post-Surgical Nerve Pain
Chronic nerve pain following surgeries such as hernia operations, mastectomies, joint replacements, or amputations. Nerve fibers may be damaged during surgery, leading to persistent neuropathic pain even after the surgical site has healed.
- Post-herniorrhaphy neuralgia
- Post-mastectomy pain syndrome
- Phantom limb pain
- Post-thoracotomy pain
Trauma and Injury
Physical trauma can damage nerves directly or through compression. This includes complex regional pain syndrome (CRPS), spinal cord injuries, and nerve compression from herniated discs.
- Spinal cord injuries
- Peripheral nerve injuries
- Complex Regional Pain Syndrome (CRPS)
- Herniated discs compressing nerves
Medical Conditions
Various diseases can cause nerve damage, leading to neuropathic pain. Diabetes is the most common cause, but many other conditions can be responsible.
- Diabetic neuropathy
- Multiple sclerosis
- Shingles (post-herpetic neuralgia)
- Cancer-related nerve compression
- HIV-associated neuropathy
Important Consideration
Many patients with neuropathic pain have more than one contributing factor. For example, a patient with diabetes might develop peripheral neuropathy and then experience additional nerve compression from spinal stenosis. A comprehensive assessment by a pain specialist is essential to identify all contributing factors.
Recognizing Nerve Pain Symptoms
Neuropathic pain manifests in various ways, and patients often struggle to describe their symptoms accurately. Recognizing these patterns helps in obtaining the correct diagnosis and treatment.
Common Symptoms of Neuropathic Pain
Positive Symptoms
Abnormal sensations present
- Spontaneous pain – Burning, shooting, stabbing
- Paresthesia – “Pins and needles” sensation
- Hyperalgesia – Increased pain from mild stimuli
- Allodynia – Pain from non-painful touch
- Electric shock-like sensations
Negative Symptoms
Loss of normal function
- Numbness – Reduced sensation
- Weakness – Muscle fatigue or paralysis
- Loss of reflexes
- Balance difficulties
- Muscle atrophy over time
Associated Symptoms
Common co-occurring issues
- Sleep disturbances
- Anxiety and depression
- Reduced quality of life
- Social isolation
- Difficulty with daily activities
Diagnostic Assessment
At our clinic, nerve pain diagnosis involves a comprehensive assessment including:
- Detailed medical history – Understanding the onset, pattern, and characteristics of your pain
- Physical examination – Testing reflexes, sensation, and muscle strength
- Neurological assessment – Evaluating nerve function
- Diagnostic tests – When indicated, nerve conduction studies, MRI, or blood tests
- Pain questionnaires – Standardized tools to quantify pain impact
Specialist Treatment Approaches
Effective management of neuropathic pain typically requires a multimodal approach. At our clinic, we develop personalized treatment plans that address both the physical symptoms and their impact on quality of life.
Medication Management
Unlike standard pain medications, neuropathic pain often responds better to specific classes of drugs:
| Medication Class | How It Works | Common Examples | Considerations |
|---|---|---|---|
| Anticonvulsants | Stabilize nerve membranes, reduce abnormal firing | Gabapentin, Pregabalin | First-line treatment requires dose titration |
| Antidepressants | Modulate pain pathways in the brain and spinal cord | Amitriptyline, Duloxetine | Effective even without depression; may take weeks for full effect |
| Topical Agents | Act locally with minimal systemic absorption | Lidocaine patches, Capsaicin cream | Good for localized pain; fewer side effects |
| Opioids | Modulate pain perception in the central nervous system | Tramadol, Oxycodone | Limited role due to side effects and tolerance; short-term use only |
Medication Safety Note
Neuropathic pain medications require careful management. Some medications need gradual dose increases (titration) and should not be stopped abruptly. Our pain specialists provide clear guidance on proper medication use, monitor for side effects, and adjust treatment based on your response.
Interventional Procedures
For appropriate candidates, targeted procedures can provide significant pain relief:
Nerve Blocks
Injection of anesthetic and/or steroid medication around specific nerves to interrupt pain signals.
- Facet joint injections
- Epidural steroid injections
- Peripheral nerve blocks
- Sympathetic nerve blocks
Neuromodulation
Advanced techniques that modify nerve activity to relieve pain.
- Spinal Cord Stimulation (SCS)
- Peripheral Nerve Stimulation
- Transcutaneous Electrical Nerve Stimulation (TENS)
Other Interventions
Additional procedures for specific neuropathic pain conditions.
- Radiofrequency ablation
- Pulsed radiofrequency
- Intrathecal drug delivery systems
- Platelet-Rich Plasma (PRP) injections
Holistic and Adjunctive Therapies
Comprehensive pain management includes non-pharmacological approaches:
- Physical therapy – Exercises to improve strength, flexibility, and function
- Cognitive Behavioral Therapy (CBT) – Psychological strategies to manage pain perception
- Acupuncture – Traditional Chinese medicine technique for pain modulation
- Mindfulness and relaxation techniques – Stress reduction to decrease pain sensitivity
- Nutritional counseling – Dietary approaches to support nerve health
Specialist Nerve Pain Consultation
If you’re experiencing symptoms of neuropathic pain, a specialist assessment can provide clarity and a path forward. Dr. Mona Mubarak offers comprehensive evaluation and personalized treatment plans for complex nerve pain conditions.
When to Seek Specialist Help
- Pain persists beyond 3 months despite treatment
- Burning, shooting, or electric shock-like sensations
- Pain that prevents normal sleep or daily activities
- Numbness, tingling, or weakness accompanying pain
- Previous treatments haven’t provided adequate relief
We serve patients at Affidea Clinic Tallaght (Dublin), Galway Clinic, and DF Medical Center (Lucan).
