When the sensory system is impacted by injury or disease, the nerves within that system cannot work to transmit sensation to the brain – this often leads to a sense of numbness or lack of sensation. However, in some cases when this system is injured, individuals experience pain in the affected region. Neuropathic pain does not begin abruptly nor resolve quickly; it is a chronic condition that leads to persistent pain symptoms. For many patients, the intensity of their symptoms can wax and wane throughout the day. Although neuropathic pain is thought to be associated with peripheral nerve problems, such as neuropathy caused by diabetes or spinal stenosis, injuries to the brain or spinal cord can also lead to chronic neuropathic pain. Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain which occurs when someone experiences an acute injury, such as smashing a finger with a hammer or stubbing a toe when walking barefoot. This type of pain is typically short-lived and usually responsive to common pain medications in contrast to neuropathic pain.
Causes & Symptoms
Neuropathy, or peripheral neuropathy, describes a problem with the functionality of the peripheral nerves. These nerves are ‘in charge’ of communication between the central nervous system and the rest of the human body. Depending on the peripheral nerve affected, neuropathic pain can produce a broad range of symptoms of varying severity. In many instances, other health conditions may cause neuropathy, which means it can be a symptom as well as a disease. Some of the symptoms of neuropathic pain include:
- Sharp pain – One of the main symptoms of neuropathy is a sharp, shooting pain, sporadically within the legs. Some people experience a painful ache that occurs from a stimulus that should not hurt, such as a light touch. This symptom is typical of sensory neuropathy, where dysfunctional nerves create atypical feelings in the body.
- Numbness and tingling – If neuropathic pain affects the sensory nerves, the individual may experience tingling and numbness in localized areas of the body. This symptom happens because the nerves that carry sensory information, such as pain, temperature, or touch, are not performing optimally. Numbness normally occurs in the lower part of the body with a mounting loss of awareness or stimuli in the region. Some people also experience abnormal sensations, such as burning, tightness, shock-like sensations, or itching.
- Cramps – Usually, neuropathic pain affects the motor nerves that power most movement across the body. In some cases, neuropathy can cause frequent muscle cramps that develop from even the smallest amount of exertion. This can sometimes impede daily activities. These cramps can be so painful that they require more relief than over-the-counter pain medication can offer.
- Imbalance – Neuropathic pain can also cause people to lose balance. This happens because receptors that sense where the body lies in space do not function as well in people with peripheral neuropathy; the brain depends on input from the feet and limbs to make adaptations that help maintain balance – numbness in the feet and decreased sensation can mix up or weaken these signals.
- Weakening Muscles – When muscles become weak because the motor nerves have developed neuropathic pain, people often experience difficulty with small motions that require precision, such as buttoning a shirt and taking a lid off a jar. Lifting heavy objects may become more difficult or even impossible. In older adults, these symptoms often seem unrelated and can go unnoticed, because people assume they are simply experiencing the natural aging process.
- Low blood pressure – The automatic nerves also control blood pressure. If peripheral neuropathy disrupts automatic nerves, a person can experience hypotension or low blood pressure. This can bring on many symptoms, including fatigue, dizziness, and palpations, as well as nausea, blurred vision, and, in severe cases, fainting. As with gastric problems, these symptoms of autonomic neuropathy tend to go undetected or be misdiagnosed.
Chronic pain can also affect day-to-day life and affect a person’s quality of life. Some side effects of neuropathic pain may include:
- Difficulty sleeping, due to pain
Who Gets Neuropathic Pain?
A look into a patient’s medical history is vital when diagnosing neuropathic pain. Neuropathy can be caused by an underlying condition or disease, nerve compression, laceration, and inflammation (both men and women). These are a few risk factors regarding neuropathic pain:
Neuropathy is a disabling, lower-extremity condition, that many diabetic patients encounter within their disease. According to studies, about 50% of patients with diabetes will most likely develop a specific neuropathic pain, known as diabetic neuropathy. People with diabetes who do not manage their blood glucose levels properly are at an even higher risk of developing diabetic nerve pain.
Alcoholic neuropathy is a result of poor nutrition and poisoning of the nerves through excessive alcohol intake. Doctors state that as many as half of alcohol abusers will develop nerve pain.
People with vitamin deficiencies
Vitamin B-12 is an essential nutrient that the body produces naturally. Serious anemia, nerve damage, and degeneration of the spinal cord may ensue if there is a sufficient deficiency of this type of vitamin.
People with infections
Neuropathic pain often develops as a result of weakened limbs. Other infections that may promote nerve pain include shingles, and HIV.
People performing repetitive physical stress
Entrapment neuropathies are frequently developed from repetitive and forceful actions that require excessive motions of joints in the body. These activities may cause inflammation to the ligaments, tendons, and muscles; eventually leading to constricted nerve pathways.
How Does It Affect You? How Serious Is It?
There are many different types of neuropathic pain that affect different nerves and parts of the human body. Damage to one nerve is called mononeuropathy, while damage to two or more nerves in different areas is called multiple mononeuropathies. In most cases, there is damage to many nerves, which is called polyneuropathy. Here are a few neuropathic pain conditions in further detail:
Diabetes causes high blood sugar in the body. Over time, this can damage the blood vessels that supply vital oxygen and nutrients to the nerves. The decrease in oxygen and nutrients make it difficult for the nerves to function as usual. Diabetic neuropathy can include any of the above types of neuropathy, but up to 50% of patients with diabetes will have neuropathic pain.
A rare type of nerve damage is proximal neuropathy. This type of nerve damage is usually only on one side of the body and can affect the hip, buttock, or thigh. Proximal neuropathy can cause severe pain and difficulty with movement, as well as weight and muscle loss.
Focal neuropathy is usually damage to a single nerve within the head, hand, torso, or leg of the body. Focal neuropathy may also cause double vision and sudden weakness or pain in the front of the thigh and other areas of the body.
Autonomic neuropathy affects the nerves that control the internal organs and regulate essential functions such as breathing and digestion. Autonomic neuropathy can cause a range of problems that can affect the heart, blood pressure, and digestive system.
Peripheral neuropathy is a type of nerve damage that affects the peripheral nervous system. The peripheral nervous system sends signals between the central nervous system and the rest of the body. Peripheral neuropathy can affect the extremities of the body, including the feet, legs, arms, and hands.
Recommended Treatment & Rehabilitation
The diagnosis of neuropathic pain requires a detailed medical history and physical examination, which are often enough to determine the “why” behind a person’s neuropathy. However, sometimes the diagnosis requires an evaluation by a specialist, such as a neurologist. The primary goals of treatment for neuropathic pain are to manage the pain as much as possible and to minimize the negative side effects of the treatment. Individuals with chronic neuropathic pain may be referred to a pain clinic for assessment, management, and advice on living with chronic pain. Every person is different, and your doctor will take into consideration your needs so to suggest a good treatment recommendation. There are various treatments available for neuropathic pain and often it is a ‘trial and error’ process to find the best option for an individual. Regular painkillers such as non-steroidal anti-inflammatory drugs (ibuprofen, aspirin, and paracetamol) are usually not effective for neuropathic pain.
Most other treatments may include the following:
- Anti-epileptics – Primarily used for the treatment of epilepsy, these drugs can also reduce nerve pain and ease neuropathic symptoms. Being prescribed an anti-epileptic medication does not mean you have, or you are at risk of developing epilepsy.
- Antidepressants – Primarily used for depression, this group of drugs has also been discovered to have an effect on managing nerve pain. Being prescribed an antidepressant does not mean that you have, or you are at risk of developing depression.
- Opioids – The evidence of benefits in using opioids to treat neuropathic pain is not clear, however, some individuals find them beneficial. It is suggested to discuss with your doctor the potential benefits and risks before you start taking an opioid.
- TENS device – a TENS device produces a mild electrical impulse. Electrodes from the device are placed on the skin over the area of pain. It is believed that selective stimulation of certain nerve fibers could block signals carrying pain impulses to the brain and spinal cord which may help to relax the muscles and ease the pain.
Another common treatment of neuropathic pain includes anti-seizure medications (such as gabapentin, lamotrigine, and phenytoin). In most severe cases of painful neuropathic pain, medications typically used to treat the heart may be of some benefit; however, these can lead to significant side effects and must be monitored closely.
Studies have shown that strengthening exercises for neuropathic pain moderately improve muscle strength in people with peripheral neuropathy. In addition, exercises to help with neuropathic pain, when done regularly, may reduce neuropathic pain and can help control blood sugar levels. Here are a few great exercises to improve balance and strength:
Side leg raises
Firstly, using a chair or counter, steady your balance with one hand. Then stand straight with your feet slightly apart. Secondly, slowly lift one leg to the side and hold for 5-10 seconds. Finally, you lower your leg at the same pace. Repeat with the other leg. As you improve your balance, try this exercise without holding onto the counter.
Using a chair or a counter, steady your balance. Afterwards, lift the heels of both feet off the ground so you are standing on your toes. Finally, slowly lower yourself down. Repeat the same procedure for 10-15 repetitions.
Place one leg behind you with your toe pointing forwards. Then, take a step forwards with the opposite foot and slightly bend the knee. Lean forwards with the front leg whilst keeping the heel on your back leg planted on the floor. Finally, hold this stretch for 15 seconds. After finishing this method, repeat the entire exercise three more times per leg.
Alternative & Homeopathic Treatment
A variety of at-home treatments can help relieve neuropathic pain. These treatments include the following:
- Hot bath – Taking a warm bath can be soothing and can also alleviate pain symptoms from neuropathic pain. Warm water increases blood circulation throughout the body, decreasing pain symptoms from numbness.
- Essential oils – Some essential oils can help increase circulation in the body. They also have pain-relieving and anti-inflammatory properties that could boost healing.
- Meditation – Meditation techniques can help people struggling with neuropathic pain symptoms live through their pain. It can help lower stress and decrease your pain intensity.
- Acupuncture – Acupuncture promotes natural healing by stimulating the body’s pressure points. This technique triggers the nervous system to release chemicals that can change the pain experience or threshold. Acupuncture helps to provide an energy balance to the body that can affect your emotional well-being.