Nerve Pain

Nerve pain (also called neuropathic pain) can be one of the most debilitating and challenging types of pain to treat. Unlike acute pain that warns us of injury or danger, nerve pain occurs when the nervous system itself is damaged or malfunctioning. This comprehensive guide will help you understand what nerve pain is, how it feels, what causes it, and the various treatment options available.

What is nerve pain?

Nerve pain results from damage or dysfunction in the peripheral or central nervous system. Unlike normal pain that results from stimulation of pain receptors, nerve pain occurs when the nerves themselves become damaged, irritated, or compressed.

The nervous system consists of:

• The brain and spinal cord (central nervous system)
• The network of nerves throughout your body (peripheral nervous system)

When nerves are damaged, they may send incorrect pain signals to your brain or fail to transmit sensations properly, resulting in uncomfortable and sometimes severe symptoms.

What does it feel like?

Nerve pain often feels different from other types of pain, which can make it easy to identify but difficult to describe. Understanding what nerve pain feels like can help you better communicate with your healthcare provider.

Common descriptions of how nerve pain feels include:

• Burning sensation: Many people describe nerve pain as a constant burning feeling
• Electric shocks: Sharp, shooting, electric-like sensations that may come and go
• Pins and needles: Tingling or prickling sensations, similar to when a limb “falls asleep”
• Freezing pain: Some nerve pain feels intensely cold or freezing
• Heightened sensitivity: Normal touch or pressure may cause significant pain
• Itching: Persistent itching that doesn’t improve with scratching
• Numbness: Areas of reduced sensation often surrounding areas of pain
• Throbbing: Pulsating pain that may worsen at night

Unlike muscle pain that typically improves with rest, nerve pain often persists regardless of position or activity level. Many patients report that nerve pain all over body can be especially distressing, as it’s difficult to find relief when multiple areas are affected simultaneously.

Common types of nerve pain

Sciatic

Sciatic nerve pain (sciatica) is one of the most common types of nerve pain, affecting up to 40% of people at some point in their lives. The body’s largest nerve, the sciatic nerve, extends from the lower spine, passing through the buttocks and traveling down both legs.

Causes of sciatic nerve pain include:

• Herniated disk pressing on the nerve
• Spinal stenosis (narrowing of the spine)
• Piriformis syndrome (when the piriformis muscle irritates the sciatic nerve)
• Trauma or injury to the lower back

Symptoms of sciatic nerve pain:

• Discomfort that spreads from your lower spine through the buttock and down the back of your leg
• Pain that worsens when sitting
• Burning or tingling sensation down the leg
• Weakness or numbness in the affected leg or foot
• Intense pain that hinders standing or walking

Ulnar

Ulnar nerve pain occurs when the ulnar nerve—which runs from your neck, down your arm, and into your hand—becomes compressed or irritated. This nerve provides sensation to your little finger and half of your ring finger.

Causes of ulnar nerve pain include:

• Cubital tunnel syndrome (compression at the elbow)
• Guyon’s canal syndrome (compression at the wrist)
• Injuries or fractures near the nerve
• Repetitive motions that irritate the nerve

Symptoms of ulnar nerve pain:

• Numbness and tingling in the ring and little fingers
• Pain that worsens with elbow bending
• Weakness in grip strength
• Pain that may extend from elbow to fingers
• Sensitivity to pressure at the elbow

Femoral

Femoral nerve pain affects the nerve that provides sensation to the front of your thigh and controls the muscles that help straighten your leg. This type of nerve pain is less common than sciatic or ulnar nerve pain but can be equally debilitating.

Causes of femoral nerve pain include:

• Pelvic or abdominal tumors that compress the nerve
• Diabetes-related nerve damage
• Internal bleeding in the pelvis or abdomen
• Trauma or injury to the pelvic region

Symptoms of femoral nerve pain:

• Pain in the thigh, hip, or groin
• Weakness when attempting to straighten the knee
• Reduced sensation in the thigh or inner leg
• Difficulty walking or standing from a seated position
• Abnormal reflexes in the knee

Nerve pain after procedures

After surgery

Nerve pain after surgery is relatively common, affecting approximately 10-50% of patients following various surgical procedures. This type of pain can result from direct damage to nerves during the procedure, inflammation, or scarring around nerves during the healing process.

Risk factors for developing nerve pain after surgery:

• Major surgeries with extensive tissue damage
• Surgeries in nerve-dense areas
• Pre-existing conditions like diabetes
• Advanced age
• Multiple surgeries in the same area

Most post-surgical nerve pain improves within weeks to months, but in some cases, it can become chronic, requiring specialized treatment.

Knee replacement

Nerve pain after knee replacement surgery affects approximately 1-10% of patients. The procedure involves significant manipulation of tissues around the knee, which contains numerous sensory nerves.

Common characteristics of nerve pain after knee replacement:

• Pain that differs from the original arthritis pain
• Burning, electrical, or shooting sensations
• Pain that extends beyond the knee joint itself
• Hypersensitivity to touch around the knee
• Pain that persists even after the surgical site has healed

Management typically involves a combination of medication, physical therapy, and sometimes nerve blocks or other interventional procedures.

C-section

Nerve pain after C-section typically affects the area around the incision and sometimes radiates to the thighs. It results from injury to small sensory nerves in the abdominal wall during surgery.

Symptoms include:

• Burning or shooting pain near the incision site
• Hypersensitivity when clothing touches the area
• Numbness alternating with pain
• Pain that worsens with movement or pressure

This type of nerve pain usually improves within 6-12 months but may require treatment with medications, topical agents, or injections in persistent cases.

Hip replacement

Nerve pain after hip replacement can result from traction or compression of nerves during surgery, particularly the sciatic, femoral, or lateral femoral cutaneous nerves.

Common symptoms include:

• New onset of burning or electrical pain in the thigh, leg, or foot
• Weakness in parts of the leg
• Sensations that differ significantly from pre-surgical pain
• Pain that persists despite successful implant positioning

Treatment focuses on identifying which nerve is affected and may include medication, physical therapy, and sometimes revision surgery if the implant is compressing a nerve.

If you get nerve pain after dental procedures

Filling

Nerve pain after filling can occur when the dental procedure irritates the nerve inside the tooth or adjacent structures. This is typically temporary but can be quite uncomfortable.

Symptoms include:

• Sharp, shooting pain when biting down
• Sensitivity to hot or cold
• Persistent aching or throbbing
• Pain that occurs spontaneously

If the pain persists beyond a few weeks, it may indicate that the filling is too high, there’s an infection, or the nerve has been permanently damaged, potentially requiring root canal therapy.

Wisdom tooth extraction

Nerve pain after wisdom tooth extraction can result from damage to the inferior alveolar nerve or the lingual nerve during the procedure. These nerves provide sensation to the lower lip, chin, tongue, and gums.

Symptoms include:

• Persistent numbness or tingling in the lip, chin, or tongue
• Burning or shocking sensations
• Pain that doesn’t follow the normal healing timeline
• Altered taste sensation

This type of nerve pain may resolve on its own over several months, but in some cases, it can be permanent or require surgical intervention.

Other common causes of nerve pain

If it is all over body

When patients experience nerve pain all over body, it often indicates a systemic condition affecting multiple nerves simultaneously. This widespread neuropathic pain requires thorough evaluation to identify the underlying cause.

Common causes of widespread nerve pain include:

• Fibromyalgia
• Multiple sclerosis
• Guillain-Barré syndrome
• Vitamin B12 deficiency
• Chemotherapy-induced peripheral neuropathy
• Diabetes affecting multiple nerves
• Autoimmune conditions like lupus

Treatment for nerve pain all over body typically focuses on addressing the underlying condition while providing symptomatic relief through medication and lifestyle modifications.

After shingles (postherpetic neuralgia)

Nerve pain after shingles, known as postherpetic neuralgia (PHN), affects approximately 10-18% of people who develop shingles. This condition occurs when the varicella-zoster virus (which causes chickenpox and shingles) damages nerves during the infection.

Characteristics of postherpetic neuralgia:

• Burning, stabbing, or shooting pain in the area where shingles occurred
• Ongoing pain lasting over three months after the shingles rash has cleared
• Extreme sensitivity to touch and temperature changes
• Itching and numbness
• Pain triggered by activities that wouldn’t normally cause pain

The risk of developing nerve pain after shingles increases with age, with individuals over 60 having a much higher risk than younger populations.

Medications for nerve pain

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant medication commonly prescribed for various types of nerve pain. It alters how nerves transmit signals to the brain.

Normal dosage

The normal dosage of gabapentin for nerve pain typically starts low and increases gradually:

1. Initial dose: Usually 300 mg once daily on the first day
2. Titration: Increased to 300 mg twice daily on the second day, then 300 mg three times daily on the third day
3. Effective dose: Most patients find relief between 1,800-3,600 mg daily, divided into three doses
4. Elderly patients or those with kidney problems may require lower doses

Maximum dosage

The maximum dosage of gabapentin for nerve pain is typically 3,600 mg per day, divided into three equal doses. However, some patients with severe nerve pain may occasionally be prescribed higher doses under close medical supervision. Exceeding the recommended maximum dose increases the risk of side effects without necessarily improving pain control.

Common side effects of gabapentin include:

• Dizziness and drowsiness
• Fatigue
• Peripheral edema (swelling in extremities)
• Mild cognitive effects
• Weight gain

Gabapentin should never be stopped abruptly as this can trigger withdrawal symptoms or seizures. Always taper the medication under medical supervision.

Pregabalin

Pregabalin (Lyrica) is another anticonvulsant medication used to treat nerve pain. It’s similar to gabapentin but may be more potent, allowing for lower doses and twice-daily dosing.

Dose

The typical dosing schedule for pregabalin:

1. Starting dose: Usually 75 mg twice daily
2. Titration: May be increased to 150 mg twice daily within one week if needed
3. Maximum dose: Up to 300 mg twice daily for neuropathic pain

Pregabalin for nerve pain dose adjustments may be necessary for:

• Elderly patients
• Those with kidney impairment
• Patients experiencing significant side effects

Like gabapentin, pregabalin should be tapered gradually when discontinuing to avoid withdrawal symptoms.

Amitriptyline

Amitriptyline is a tricyclic antidepressant that has proven effective for various neuropathic pain conditions, even at doses lower than those used for depression.

Typical dosing of amitriptyline for nerve pain:

1. Starting dose: Usually 10-25 mg taken in the evening or before bedtime
2. Titration: Gradually increased by 10-25 mg every 3-7 days as tolerated
3. Effective dose: Most patients find relief between 25-100 mg daily
4. Maximum dose: Generally not exceeding 150 mg daily for pain management

Common side effects include:

Drowsiness (hence the evening dosing)

• Dry mouth
• Constipation
• Blurred vision
• Urinary retention
• Weight gain

Amitriptyline may not be suitable for elderly patients or those with certain cardiac conditions due to its potential effects on heart rhythm.

What is a good painkiller?

Finding a good painkiller for nerve pain often requires trial and error, as individual responses vary significantly. Traditional pain relievers that work well for other types of pain often provide limited relief for neuropathic pain.

First-line treatments typically include:

1. Anticonvulsants:

• Gabapentin (Neurontin)
• Pregabalin (Lyrica)
• Carbamazepine (Tegretol) – particularly effective for trigeminal neuralgia

2. Antidepressants:

• Amitriptyline, nortriptyline (tricyclic antidepressants)
• Duloxetine (Cymbalta), venlafaxine (Effexor) – serotonin and norepinephrine reuptake inhibitors (SNRIs)

3. Topical treatments (for localized nerve pain):

• Lidocaine patches (5%)
• Capsaicin cream or patches
• Compounded creams containing multiple agents

When first-line treatments are insufficient, options may include:

4. Tramadol – a weak opioid with additional mechanisms that may help nerve pain

5. Tapentadol (Nucynta) – works on both opioid receptors and norepinephrine reuptake

6. Strong opioids (used cautiously due to limited efficacy for nerve pain and risk of dependence):

• Oxycodone
• Morphine
• Methadone (may have specific benefits for neuropathic pain)

7. Other medications:

• Lamotrigine (for certain types of nerve pain)
• Memantine (primarily for central neuropathic pain)
• Ketamine (in specialized settings)

The best approach to finding a good painkiller for nerve pain typically involves:

• Starting with lower-risk medications
• Allowing adequate trial periods (often 4-8 weeks) to assess effectiveness
• Combining medications with different mechanisms when appropriate
• Incorporating non-medication approaches simultaneously

Non-medication treatments

While medications are often necessary, comprehensive management of nerve pain typically includes various non-pharmacological approaches:

Physical and occupational therapy

• Specific exercises to improve strength and flexibility
• Desensitization techniques for hypersensitive areas
• Activity modification to reduce pain triggers
• Assistive devices when appropriate

Interventional procedures

• Nerve blocks
• Spinal cord stimulation
• Peripheral nerve stimulation
• Radiofrequency ablation
• Intrathecal drug delivery systems

Complementary approaches

• Acupuncture
• Transcutaneous electrical nerve stimulation (TENS)
• Mindfulness meditation
• Cognitive behavioral therapy
• Biofeedback

Lifestyle modifications

• Anti-inflammatory diet
• Regular gentle exercise
• Stress management
• Adequate sleep hygiene
• Avoiding alcohol and smoking

When to see a doctor

Consult a healthcare provider if you experience:

• Sudden onset of severe nerve pain
• Nerve pain accompanied by weakness or loss of function
• Pain that doesn’t improve with over-the-counter treatments
• Pain that interferes with daily activities or sleep
• Nerve symptoms that develop after an injury or surgery
• Progressive worsening of symptoms

Living with chronic nerve pain

For many people, nerve pain becomes a chronic condition requiring long-term management. Developing effective coping strategies is essential for maintaining quality of life:

• Pacing activities to avoid pain flares
• Keeping a pain journal to identify triggers
• Building a support network of understanding family, friends, and healthcare providers
• Setting realistic goals that accommodate good and bad days
• Focusing on abilities rather than limitations
• Exploring adaptive equipment that reduces pain during necessary activities

Conclusion

Nerve pain presents severe challenges compared to other pain types, but with proper diagnosis and a comprehensive treatment approach, significant improvement is possible for most patients. The key is working closely with healthcare providers to find the right combination of treatments for your specific condition, while actively participating in non-medication approaches to pain management.

Understanding the nature of nerve pain—whether it’s sciatic nerve pain, nerve pain after surgery, or nerve pain all over body—is the first step toward finding effective relief. With continued advances in both pharmacological and non-pharmacological treatments, the outlook for people with neuropathic pain continues to improve.

Remember that successful management often requires patience, persistence, and a multidisciplinary approach combining medical treatment with self-management strategies.