Neuropathic pain is caused by a lesion or damage to the somatosensory nervous system. This system of nerves carries information between the brain and spinal cord to the skin, muscles and other areas of the body.
People who have neuropathic pain often describe a cluster of symptoms and signs. Common symptoms include feelings of burning pain, extreme pins and needles sensations or sensitivity to touch.
Any disease or injury that has the potential to damage nerves or cause nerve pressure can develop into neuropathic pain. Common causes include surgery, traumatic injury, viral infections or cancer. Neurological conditions such as ischemic stroke, hemorrhages or multiple sclerosis can damage nerves.
Other health conditions can cause chronic neuropathic pain. Treatments like chemotherapy could damage the nervous system. Additionally, it may result because of complications from uncontrolled diabetes or alcoholism.
“Pain is a very complex condition and each person is affected differently,” said Dr. Muhammad Ubaidulhaq, pain management specialist at Marshfield Clinic Health System.
Neuropathic pain first warning signs
An early symptom is spontaneous pain without a known or physical injury. You might feel a weird burning or shooting pain. You could also feel uncomfortable sensations like squeezing or pressure.
See your doctor if these painful sensations do not go away, are ongoing and disrupt your life. “Neuropathic pain is a symptom of a larger issue or disease. We need to dig deeper to find what is causing your pain to help find effective treatments for it,” Dr. Ubaidulhaq said.
This means that your doctor will work with you through a process of testing and diagnostics to understand your pain and why it’s happening. Your doctor wants to identify the cause, or underlying pathology.
Ways to treat neuropathic pain
Every person is different and pain is complex. Your doctor will evaluate your needs and work with you to test and find treatments that help reduce your pain. People with chronic neuropathic pain may be referred to a pain clinic for assessment and long-term pain management. Pain management specialists are working to manage your symptoms and reduce the pain as much as possible.
Non-steroid, anti-inflammatory drugs, or NSAIDs, (for example ibuprofen and aspirin) are usually not effective for long-term management of neuropathic pain.
Your doctor may consider medications like serotonin noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), gabapentin and pregabalin. Pain management specialists can also offer topical options with capsaicin and lidocaine patches or creams and tramadol painkillers.
There’s options to help disrupt the pain signals. Your doctor may recommend Scrambler therapy, which provides mild electric currents similar to a TENS unit. For complex pain that’s not responding to other treatments, a surgical option is the DRG stimulator (Dorsal Root Ganglion therapy). This surgically implanted device provides stimulation therapy to help with extremity and other isolated nerve pain.
If your pain isn’t managed through a combination of first and second line medications, lifestyle modifications and therapeutic treatments, your doctor may prescribe stronger medications like opioids or cannabinoids.
Lifestyle modifications can help manage pain
When you’re making lifestyle modifications, your goal is to target the underlying issue causing your pain. Various treatment options, including physical therapy, exercise and diet changes can address the chronic diseases that cause neuropathic pain.
You can move to an anti-inflammatory diet and to control diabetes and glucose levels. There are supplemental changes you can discussion with your provider to support vitamin and folate needs. This aligns with other balanced, healthy diet recommendations of lower fat and plant-based eating.
“Research has shown Vitamin D supplementation, magnesium and vitamin B12 supplementation showed promising results people with diabetic peripheral neuropathy,” Dr. Ubaidulhaq said.
Increased physical activity with aerobic exercise, walking and yoga will improve underlying conditions causing pain. Since chronic pain causes stress, practices like meditation can also provide relief.
“Chronic pain is debilitating and impacts every aspect of your life. There’s not one magic treatment or pill that will fix pain,” Dr. Ubaidulhaq said. “But our goal is to work with patients to find the right mix of treatments to help reduce their pain as much as possible.”