Whether it feels like burning, pinpricks, or sudden shocks of electricity, nerve pain can disrupt your life at home and at work. It can limit your ability to get around. Over time, it can grind you down. Studies show that people with nerve pain have higher rates of sleep problems, anxiety, and depression.
When you have a serious medical condition such as cancer or HIV, dealing with the additional misery of nerve pain can be especially hard. But there is good news. While nerve pain can't always be cured, it can be treated -- and there are a lot of good options available.
What Causes Nerve Pain?
Countless nerves in the body convey sensations to the brain, including pain. While we might not like pain much, it does have an important function: it prevents injury. When your foot begins to step on a nail, it's the pain sensation that alerts your brain to the danger.
That's how it's supposed to work, at least. But in people with nerve pain, that messaging system isn't working correctly. Your brain receives a pain signal, and you feel the pain, but there's no obvious cause. Now, it's just pain without a purpose -- and because of this, there's no immediate way to relieve it. Since you can't take away the external threat (there isn't one), you have to treat the internal source of the pain or the experience.
What makes the nerves behave this way? Usually, it's damage from a physical injury or disease.
- Degenerative joint or disc disease in the spine with spinal cord or nerve compression are very common causes that nerve pain. Also a herniated disc can cause nerve pain.
- Cancer and other tumors can cause nerve pain. As they grow, tumors can press on the surrounding nerves. Cancers can also grow out of the nerves themselves. Sometimes, treatments for cancer -- such as chemotherapy drugs -- can damage the nerves, leading to pain.
- HIV can cause painful nerve damage. Nerve pain affects up to one-third of people with HIV, and nerve pain in the hands and feet is often the first symptom that appears. Treatment with antiretroviral drugs can also lead to nerve damage that causes pain.
- Diabetes is a common cause of nerve damage in the U.S. Over time, high levels of glucose in the blood (blood sugar) can injure the nerves.
- Shingles can be followed by a painful condition called postherpetic neuralgia. This type of nerve pain can be particularly severe and sudden.
- Physical injuries can result in nerves that are compressed, crushed, or severed.
These are only a few examples of diseases and conditions that can cause nerve damage and nerve pain. Others include repetitive stress, vitamin deficiencies, hormone imbalances, heart disease, stroke, multiple sclerosis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, Lyme disease, alcoholism, and more. In some cases, nerve pain develops for no apparent reason.
Nerve Pain Symptoms
Symptoms of nerve damage can vary from person to person. Sometimes, the nerves become hypersensitive. Something that normally feels painless -- a breeze on your arm, the sensation of a bed sheet on your body -- becomes painful.
Damage to the sensory nerves doesn't only cause pain. It can also result in:
- Loss of reflexes
In extreme cases, nerve damage can cause paralysis and affect things like digestion and breathing.
The severity of nerve pain is usually linked to the severity of the underlying disease. So in general, nerve pain tends to be worse as people get older.
Diagnosing Nerve Pain
If you think you might have nerve pain, you need to see your doctor now. Sometimes, the cause might be fairly clear, especially if you have already been diagnosed with a condition known to cause nerve pain, like HIV, cancer, or diabetes.
But in other cases, the cause of nerve pain can be hard to sort out. Because so many conditions can trigger nerve pain, your doctor might need to run a number of lab tests. You'll also need a thorough neurological exam, and possibly other tests -- like CT scans, MRIs, nerve conduction studies and electromyographies. Sometimes, a doctor will recommend a biopsy of the skin or a nerve to examine the nerve endings.
Treating Nerve Pain
When nerve pain is caused by a condition like diabetes, HIV or cancer, getting treatment for the underlying disease is obviously the priority.
But treatments for the underlying disease might not necessarily help with your pain. Nerve pain may need its own treatment, separate from treatment for the disease that's causing it.
The most effective and suitable treatment for nerve pain varies, because it depends on the specifics -- like the patient's health, the underlying cause, the risks of potential side effects, and the costs. However, doctors generally use the same set of treatments for nerve pain, whether it is caused by cancer, HIV, diabetes, or another condition. Here’s a rundown of the basic options.
- Topical treatments. Some over-the-counter and prescription topical treatments -- like creams, lotions, gels, and patches -- can ease nerve pain. They tend to work best for pain that's isolated in specific areas on your skin.
- Anticonvulsants. These drugs were originally developed to treat epilepsy, but some also help control nerve pain. To boost their effects, they are often used in combination with antidepressants. They might not work as well with all types of nerve pain.
- Antidepressants . Certain types of antidepressants can help with nerve pain. Studies have shown that using them along with anticonvulsants may have bigger benefits than using them alone. However, some studies have indicated that while tricyclic antidepressants may help with diabetic nerve pain, they might not help with nerve pain caused by HIV or cancer chemotherapy.
- Painkillers. Powerful opioid painkillers might be a first choice for people with especially severe pain or nerve pain caused by cancer. However, for other kinds of nerve pain, doctors generally try anti-inflammatories, over the counter pain relievers, antidepressants and/or anticonvulsants first. Opioids can have serious side effects with a real potential for addiction. Over-the-counter painkillers may not work very well for moderate to severe nerve pain.
- Electrical stimulation. A number of treatments use electrical impulses to block the pain messages sent by damaged nerves. These include TENS (transcutaneous electrical nerve stimulation) and repetitive transcranial magnetic stimulation (rTMS.) Both are noninvasive and painless. Some other electrical stimulation approaches are more complex and require surgery.
- Other techniques. For nerve pain caused by bones or discs in your back, epidural injections with steroid can be very helpful. (There is a little lidocaine=anestheic in them, but mostly it's the steroids that help.)
- Complementary treatments. Many people find that alternative approaches -- like acupuncture, meditation, and massage -- can help relieve nerve pain. If you're interested in dietary supplements for nerve pain, talk to your doctor first.
- Lifestyle changes. While they won't cure nerve pain, making some changes to your habits could help you feel better and ease some of your discomfort. Exercising more, eating a healthy diet, quitting smoking, and making time to practice relaxation techniques could all help.
The Costs of Untreated Nerve Pain
Nerve pain can make you feel terribly alone. After all, it's not an injury that your family or friends can see. You might feel frustrated if they can't understand what you're feeling.
But while you might feel alone, you're not. Experts believe that 40 million Americans are living with nerve pain. The impact of nerve pain is tremendous. Both the costs to the healthcare system as well as loss of wages and productivity are staggering.
Despite the significant price of nerve pain and the millions of people living with it, experts think that it is still underdiagnosed and undertreated. Studies show that even people who do seek out treatment often aren't getting the right treatment. Too many rely on drugs that are unlikely to help.
So if you have nerve pain -- whether it's caused by diabetes, cancer, HIV, shingles, or another condition -- you need to treat it seriously. Don't assume that it will go away on its own. Don't assume that following the treatment for the underlying disease will resolve it. Instead, talk to your doctor about treating your nerve pain directly.