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What is nerve pain?
Pain that continues long after the original injury has healed is known as chronic pain. Nerve pain (or neuropathic pain) is a type of chronic pain that results after injury to the peripheral or central nervous system. It can be caused by trauma or disease that affects various nerves in the body. People often describe nerve pain as a burning, stabbing, shooting pain or uncomfortable numbness and tingling sensations.1-4
What does nerve pain feel like?
The symptoms of nerve pain can be mild or disabling but they usually tend to get worse over time. Although nerve pain is usually difficult to describe, people frequently describe it as a sharp pain, almost like an electric shock or burning sensation. Nerve pain is usually worst during the night. Other common symptoms of neuropathic pain include:3-5
- Allodynia – pain caused by an action that is not normally painful, such as the gentle touch of someone else's hand on your skin6
- Hyperesthesia – an unreasonably painful reaction to being in contact with everyday objects such as clothes or bed sheets6
- Hyperalgesia – an unreasonably painful response to something that normally would cause only mild pain6
- Hyperpathia – pain that continues even when the cause of the pain has been removed6
- Paresthesia and dysesthesia – abnormal and unpleasant sensations in the skin that feel like intense tingling or “pins and needles.” 1,6
What are the different kinds of nerve pain?
Types of Nerve Pain
Painful peripheral neuropathy, such as peripheral diabetic neuropathy or diabetic painful neuropathy, describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body. Painful diabetic peripheral neuropathy can be caused by high blood glucose in poorly-controlled diabetes. This can cause nerve damage, especially in the hands and feet, which can lead to chronic pain.5,7
Low back pain with nerve pain can result from something that compresses a nerve. Examples include chronic pain that radiates down the leg (radiculopathy or sciatica) or down the arm (radiculopathy), or pain after back surgery that starts gradually and persists. Some cases of neck pain also involve nerve pain.8,9
Post-herpetic neuralgia is persistent or recurrent pain in areas of the skin affected by shingles caused by herpes zoster.8
Compression neuropathy occurs when nerves are physically compressed. A common example is carpal tunnel syndrome, which causes acute pain in the hand and wrist.10
Phantom limb pain is a sensation of pain felt to come from a limb that has been amputated.8
Pain associated with multiple sclerosis is felt in several places but especially in the arms and legs.11,12
Pain after a stroke may be due to nerve pain.8
HIV-associated peripheral neuropathies can occur in people who are HIV positive. Between
15% and 50% of people living with HIV suffer some degree of peripheral neuropathy.13
Nerve pain related to cancer can be caused by the cancer (tumour) itself or by the treatment
Medication-induced nerve pain can be caused by certain drugs.15
Sympathetic dystrophy, also known as complex regional pain syndrome, can cause nerve pain.8
What can cause nerve pain?
Neuropathic pain can result from nerve damage to the peripheral or central nervous system.
Diabetes mellitus is a common health problem that can cause nerve damage that leads to nerve pain. Diabetic nerve pain is a common complication of uncontrolled diabetes. It is caused by high levels of glucose in the blood over a long period of time, which leads to extensive damage of peripheral nerves.5,16
Causes of Nerve Pain5,8,17-20
Consequences of nerve pain
Nerve pain can have a significant negative effect on a person’s daily routine and on his or her general quality of life. Many people with nerve pain find it difficult to sleep, hard to concentrate, and often feel tired and lethargic. Chronic pain can make it impossible for some people to work. Some people cannot even get dressed because the sensation of their clothes next to their skin produces unbearable pain. Nerve pain can also lead to financial difficulties because patients often spend a lot of money and time trying to find relief from their pain. Patients with chronic, constant pain can also develop symptoms of severe anxiety and depression.21-25
How is nerve pain diagnosed?
Nerve pain can have many different causes and doctors need to carefully investigate to determine the specific cause in each case. A detailed and careful physical examination is a good starting point. Your doctor will also ask you questions and take full medical history. In addition, your doctor may also order other tests:16
- A blood test26
- An MRI or CT scan27
- Nerve conduction tests, in which small electric discharges indicate how well nerves are working in different parts of the body26
- A test for diabetes. Some people may not know they have diabetes but may have high levels of glucose in their blood. High blood glucose levels can cause nerve damage that can lead to nerve pain. Therefore, it is important to check if patients with neuropathic pain have diabetes.5
How does nerve pain affect patients, their families and their caretakers?
Chronic pain can have an extensive negative impact on daily life. People who suffer from chronic neuropathic pain often have difficulties with relationships with spouses, family members, and friends. Many men find the loss of physical activity difficult to accept, while women find it hard to perform their usual roles and participate in normal family activities. Families can be a great source of support for people suffering from chronic neuropathic pain even though it may be difficult for them to understand what their loved one is going through.28
- IASP. Classification of chronic pain. 2002. Available at: http://www.iasp-pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Classification-of-Chronic-Pain.pdf. Accessed 25 January, 2016.
- Baron R. Peripheral neuropathic pain: from mechanisms to symptoms. Clin J Pain. 2000;16(2 Suppl):S12-20.
- Cruccu G, Truini A. Tools for assessing neuropathic pain. PLoS Medicine. 2009;6(4):e1000045.
- Painful diabetic neuropathy. Available at: http://sydney.edu.au/medicine/diabetes/foot/Pain1.html. Accessed 25 January, 2016.
- NIH. National Institute of Neurological Disorders and Stroke. Peripheral neuropathy fact sheet. Available at: http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Accessed 25 January, 2016.
- IASP. Available at: http://www.iasp-pain.org/Taxonomy?navItemNumber=576#Pain. Accessed 25 January, 2016.
- NIDDK. Diabetic neuropathies: the nerve damage of diabetes. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx. Accessed 25 January, 2016.
- IASP. Guide to pain management in low-resource settings. A Kopf, NB Patel (Eds). Available at: http://www.iasp-pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Guide_to_Pain_Management_in_Low-Resource_Settings.pdf. Accessed 25 January, 2016.
- Disorders of the nervous system. Available at: http://www.dartmouth.edu/~dons/part_2/chapter_19.html. Accessed 25 January, 2016.
- England JD. Entrapment neuropathies. Curr Opin Neurol. 1999;12(5):597-602.
- Roberts A. Pain and MS: options exist to manage this difficult symptom. Available at: https://mssociety.ca/en/pdf/mscaninsert-0511-msandpain-EN.pdf. Accessed 25 January, 2016.
- Murphy D, Gutrecht J. Lhermitte’s sign in cavernous angioma of the cervical spinal cord. J Neurol Neurosurg Psychiatry. 1998;65(6):954-5.
- Berger JR, Nath A. Remedies for HIV-associated peripheral neuropathy. Neurology. 2000;54(11):2037.
- American Cancer Society. Facts about cancer pain. Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/pain/facts-about-cancer-pain. Accessed 29 January, 2016.
- Peltier AC, Russell JW. Recent advances in drug-induced neuropathies. Curr Opin Neurol. 2002;15(5):633-8.
- Horowitz SH. The diagnostic workup of patients with neuropathic pain. Med Clin North Am. 2007;91(1):21-30.
- Hadden RD, Hughes RA. Management of inflammatory neuropathies. J Neurol Neurosurg Psychiatry. 2003;74 Suppl 2:ii9-ii14.
- Mayo Clinic. Peripheral neuropathy. Available at: http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/causes/con-20019948. Accessed 25 January, 2016.
- Noble J et al. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998;45(1):116-22.
- Nerve compression syndromes of the hand. Available at: http://emedicine.medscape.com/article/1285531-overview. Accessed 25 January, 2016.
- Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333.
- Costigan et al. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1-32.
- Meyer-Rosberg K et at. Peripheral neuropathic pain – a multidimensional burden for patients. Eur J Pain. 2001;5(4):379-89.
- Gore M et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage. 2005;30(4):374-85.
- Castro M et al. Comorbid anxiety and depression disorders in patients with chronic pain. Arq Neuropsiquiatr. 2009;67(4):982-5.
- Azhary H et al. Peripheral neuropathy: differential diagnosis and management. Amer Family Physician. 2010;81(7):887-892.
- Jovin Z et al. Assessment of neuropathic pain and clinical evaluation of patients with suspected neuropathic pain. Curr Top Neurol Psychiatr Relat Discip. 2010;18(2):30-7.
- Closs SJ et al. The impact of neuropathic pain on relationships. J Adv Nurs. 2009;65(2):402-11.