Nerve pain

What is nerve pain?

Nerve pain, also called neuralgia or neuropathic pain, occurs when a health condition affects the nerves that carry sensations to your brain. Nerve pain can feel different from other kinds of pain.

Nerve pain can affect any nerve in your body, but it commonly affects some nerves more than others. Some examples include:

• post-herpetic pain — this can happen after you’ve had shingles(herpes zoster) and affects the same area as the shingles rash
• trigeminal pain — causing pain in your jaw or cheek
• occipitalpain — causing pain at the base of your skull that can spread to the back of your head
• pudendalpain — causing pain in the ‘saddle area’ between your legs

What are the symptoms of nerve pain?

Nerve pain often feels like a shooting, stabbing or burning sensation. Sometimes it can feel as sharp and sudden as an electric shock. You may be very sensitive to touch or cold. You may also experience pain as a result of touch that would not normally be painful, such as something lightly brushing your skin.

Nerve pain is often worse at night. It can be mild or severe.

Nerve pain may interfere with important parts of your life such as sleep, sex, work and exercise. Many people with nerve pain become angry and frustrated, and may have anxiety and depression.

What causes nerve pain?

Nerve pain is usually caused by an injury or disease that affects your central nervous system (brain and spinal cord) or the nerves that run to your muscles and organs.

Common causes include:

• an injury to your brain, spine or nerves
• poor blood supply to your nerves
• heavy alcohol use
• phantom pain after an amputation
• vitamin B12 or thiamine (vitamin B1) deficiency
• medicines

Diseases that can cause nerve pain include:

• infections such as shingles and HIV/AIDS
• multiple sclerosis
• diabetes
• stroke
• cancer and its treatment with radiation, surgery, or chemotherapy
• trapped nerves, such as in carpal tunnel syndrome

Other conditions associated with nerve pain include the following:

• Sciatica: pressure on the nerves of the lower back that causes pain down your leg accompanied by pins and needles, numbness or weakness in your leg.
• Fibromyalgia: a chronic pain syndrome associated with burning or aching pain in different parts of your body. The cause is not well understood, but it can be triggered by emotional distress and poor sleep. There may be genetic factors too.
• Peripheral neuropathy: this occurs when the peripheral nerves (nerves that that connect the brain and spinal cord to the rest of the body) are damaged. It’s caused by diabetes, autoimmune diseases and other conditions.

How will I be diagnosed with nerve pain?

Your doctor will ask about your symptoms and examine you. In the examination, they will test your nerves by checking your muscle strength, reflexes and sensitivity to touch.

Your doctor may also refer you for tests including:

• blood tests to check your general health and look for underlying conditions
• nerve conduction studies, which measure how quickly your nerves carry electrical signals
• a CT scan or an MRI scan to look for a cause of your pain

How will my nerve pain be treated?

Nerve pain can be difficult to treat, but there are many strategies you can try. Treating the underlying cause, if there is one, is the first step. Pain relief and other medicines can help, as can non-drug treatments such as exercise, acupuncture and relaxation techniques.

Your doctor will also treat or manage any underlying conditions such as diabetes and vitamin B12 deficiency.

What medicines will help my nerve pain?

Nerve pain is different from other types of pain, so simple over-the-counter pain medicines (such as paracetamol) and medicines used for inflammatory pain (such as ibuprofen) have limited effect.

There are medicines that your doctor can prescribe for nerve pain. They include medicines such as gabapentin or pregabalin. It’s best to start these as a low dose, and slowly increase the dose only if you need it. Your doctor will help guide your dosing. Other medicines that are also available if these are not effective for your pain. Different people respond to medicine in different ways, and it may take a while for your doctor to find pain medicines that help you.

Stronger pain medicines such as opioids are sometimes used, as these can have challenging side effects. They can be harmful, especially in the long term, and can be addictive.

What strategies can help with nerve pain?

Non-medicine treatments and strategies can help you live better with nerve pain.

You may need to make some lifestyle adjustments:

• A healthy lifestyle can improve your quality of life and general feeling of wellbeing.
• Try to eat a balanced diet and exercise regularly.
• Stay as fit and active as possible, to retain flexibility
• Plan daily tasks in small steps rather than trying to do them all at once.
• If pain is disturbing your sleep, ask your doctor about strategies that might help.

Non-medicine treatments that can be helpful include:

• educating yourself about nerve pain and how to manage it
• exercise — try to spread out small amounts of gentle exercise over the day as part of your regular routine (pacing)
• acupuncture
• relaxation techniques to help with your pain and with sleeping
• psychological treatments to help you feel in control of your pain, reduce distress and anxiety and improve your mood
• transcutaneous electrical nerve stimulation (TENS) to block the transmission of pain sensations to your brain

It may take time to find the strategies that work for you. If you have chronic pain, you may find it helpful to attend a multidisciplinary pain clinic, where health professionals can prepare you a personalised pain management plan. Your doctor can refer you to a pain clinic.