When your peripheral or central nervous system is damaged, the resulting neuropathic pain can be one of the toughest types to treat. Whether you are in constant pain or experience intense symptoms that come and go, most neuropathic pain is not likely to resolve itself. It’s critical that you get the support you need to find the best neuropathic pain treatments to help you get your life back.
Common Neuropathic Pain Causes
Neuropathic pain is also known as neuropathy or nerve pain. Regardless of what you call it, its definition remains the same.
Damage occurs to a nerve or nerve cluster that causes that nerve to misfire. The damage that causes the nerve malfunction may be at the site of the nerve itself or in the central nervous system. This causes pain and other symptoms that can be debilitating.
An estimated 30% of all neuropathic pain is caused by uncontrolled diabetes. Wildly fluctuating levels of blood sugar causes nerves to literally fray and misfire. But other neuropathic pain causes exist, including:
- Trigeminal neuralgia
- Multiple sclerosis
- Parkinson’s disease
- Complex regional pain syndrome
- Postherpetic neuralgia (pain after shingles)
- Medications during chemotherapy
- Radiation treatment
- Phantom pain after amputation
- Compression of the spinal nerves
- Injury or trauma to nerves
- Tumors that press on nerves
Neuropathic pain does not occur in a vacuum. People often experience varied symptoms, including:
- Spontaneous pain: This occurs for no apparent reason. It can feel brief and shooting or like an electric shock. It may also be constant and unrelieved.
- Allodynia: This type of pain occurs when a non-painful stimulus is applied. This includes things such as the wind or water on your face.
- Hyperalgesia: When something pinches you, most people experience a certain level of pain. Hyperalgesia, however, is an overly intense response to pain.
- Hypoalgesia: The opposite of hyperalgesia, this is the reduction of pain when a normally painful stimulus is added (e.g., a pinprick reduces the sensation of pain).
Many people with neuropathic pain also understandably suffer from difficulty sleeping. Additionally, they may experience a variety of mood disorders common among people with chronic pain (e.g., depression and anxiety).
Getting a diagnosis
Getting a proper diagnosis is your first step. This includes determining the cause of neuropathic pain. Your doctor will take a complete medical history that includes:
- Injury or trauma
- Comorbid conditions
- Other factors that could be causing pain
They will then complete a physical exam and ask about your symptoms. There are no specific tests for neuropathic pain. However, using the factors above, your doctor can make a diagnosis.
How To Treat Neuropathic Pain
The nature of neuropathic pain means that treating it requires more than taking two aspirin and calling your doctor in the morning. It is a complex collection of symptoms that requires an equally complex treatment plan.
Starting with the least invasive treatment sometimes means addressing lifestyle changes to improve overall health and wellness. This might look like:
- Refining a nutrition and exercise plan for optimal health
- Incorporating physical therapy to rehabilitate an injury that might be causing pain
- Visiting a chiropractor to align the spine and reduce the chances of compression on the spinal nerves
- Scheduling acupuncture for its pain-relieving and mood-boosting benefits
While it is unlikely that neuropathic pain will be resolved by drinking eight glasses of water daily and making sure you get your 10,000 steps in, these simple changes in conjunction with other treatments can help improve your quality of life while you and your doctor work to resolve your pain.
Types of Neuropathic Pain Treatments
After your diagnosis, it is time to design a treatment plan. Neuropathic pain treatment guidelines have your doctor starting with the least invasive treatment possible — in addition to the complementary therapies and lifestyle approaches above — before moving to another option. As with most chronic pain conditions, this approach helps you find relief without taking drastic steps or performing unnecessary procedures.
Below are common nerve pain treatments. As always, talk to your doctor to see if any of these procedures might work to treat your neuropathic pain.
When symptoms of neuropathic pain do not respond to conservative treatments such as physical therapy and rest, it’s time to investigate further. This does not mean leaping directly into surgery, though. Nerve blocks are a simple outpatient procedure that is often the first step on the road to pain relief.
Nerve blocks are used as a diagnostic tool to determine exactly which nerves are affected. It can be especially effective as a diagnostic for neuropathy in the feet and legs.
The procedure is simple.
- Your doctor positions you for the nerve block on a table for easy access to the injection site.
- If you are concerned about the procedure, they may offer you a mild sedative.
- Once the area of the block is cleaned and sterilized, your doctor administers an injection to numb the block site. This may sting at first but quickly becomes numb as the anesthetic gets to work.
- Using X-ray guidance, your doctor carefully positions the needle above the nerves to be blocked.
- A small amount of contrast dye is injected to verify the location.
- Numbing medication is administered.
After a brief 15-to-30-minute recovery period, your doctor tests to see if your nerve pain is present. If your nerve pain is not resolved, a few things may be happening.
- Your pain may not be neuropathic
- Different nerves are involved
- More anesthetic is needed
If your pain is resolved, this may be all the treatment you need. For those with pain that returns, nerve blocks make it easier to target appropriate, longer-term treatments.
Peripheral nerve stimulation
When the peripheral nerves are damaged, it’s crucial to target the exact damaged nerve or nerve cluster in treatment. Damaged nerves send pain signals until something tells them to stop or gives them a different message.
Peripheral nerve stimulation is a more permanent neuropathic pain treatment that provides a different message. Electrodes placed in the vicinity of the damaged nerve interrupt pain signals with a stimulating low voltage current of electricity. Instead of pain, those nerves report a tingling sensation or sometimes no sensation at all.
Patients are also in control of the level and frequency of stimulation. Stimulation can be increased or decreased as needed, offering a more personalized approach to pain treatment.
Peripheral nerve stimulation is a good next step for people who respond well to nerve blocks. It’s also a great option for those who would prefer not to undergo radiofrequency ablation that more permanently destroys the nerve (more on that below).
The challenge of neuropathic pain treatments is that people respond so differently. What works well for one patient may do nothing for another with nearly identical pain. Fortunately, there are more options if nerve blocks and peripheral nerve stimulation are ineffective.
On the continuum of least to most invasive, radiofrequency ablation (RFA) is another option that helps avoid a surgical intervention for neuropathic pain. First used in 1931 to treat trigeminal neuralgia, a notoriously debilitating and hard-to-treat chronic pain condition, RFA uses information provided by a nerve block to target and effectively destroy the nerves causing pain.
Your doctor may use one of two types of RFA.
- Radiofrequency thermo-coagulation: Sometimes called continuous radiofrequency ablation, this procedure uses an electrode that is heated to 50-80°C and applied to the nerve for several minutes.
- Pulsed radiofrequency: Pulsed radiofrequency ablation uses lower heat and focuses on stunning the nerve instead of completely destroying it.
Your doctor can explain the pros and cons of each procedure and how they might work for you.
It’s important to note that the nerves in the body are incredibly resilient. This procedure may completely treat your neuropathic pain, but it may need to be repeated from time to time as your nerves heal and regenerate.
As with other neuropathic pain treatments above, RFA is performed as an outpatient procedure with just a local anesthetic or a mild sedative if you prefer.
To begin, your doctor cleans and sterilizes the area of the spine where the ablation occurs. Next:
- Your doctor places a hollow needle using fluoroscopic guidance in the targeted area.
- They send a microelectrode through the needle to the targeted nerve.
- The microelectrode receives a mild electrical current to double-check the placement. If it is correct, more anesthetic is added to the nerve before the radiofrequency ablation can begin.
- If the area is inflamed, your doctor may also administer a corticosteroid.
From the moment you sign in to when a friend or family member drives you home, the entire procedure takes just a couple of hours. Most patients feel immediate and complete relief that can last six months or more.
If you are still experiencing pain after three weeks, talk to your doctor. It is possible that the correct nerve was not targeted or may not have been completely destroyed.
Spinal cord stimulator
Spinal cord stimulation (SCS) is the next phase of neuropathic pain treatments. The concept is remarkably similar to peripheral nerve stimulation. A specific set of nerves is targeted and the pain signals are replaced by another sensation.
The main difference in the two procedures is location. With peripheral nerve stimulation, implants can be placed at the exact location of the 43 pairs of peripheral nerves around the body. On the other hand, spinal cord stimulators are placed near the spinal cord — the original site of pain signals.
Both are used as nerve pain treatment, but SCS may resolve neuropathy in feet and legs that peripheral nerve stimulation cannot address. You’ll use a small handheld remote to control the level of stimulation. This allows you to increase stimulation if you experience greater levels of pain.
Learn More About Nerve Pain Treatments At Arizona Pain
Neuropathic pain is among the most debilitating forms of chronic pain for people across the globe. It can be frustrating and difficult to treat, with many people searching for years for any level of relief.
At Arizona Pain, our Phoenix pain management specialists want to help you get your life back. We offer a wide variety of holistic pain treatments individualized to each patient. Starting with the proper diagnosis, we work with you to address every aspect of pain relief. We’re with you every step of the way.
When you’re ready to live your life with less pain, get in touch.