Nerve Pain

Nerve pain is also known as neuralgia or neuropathic pain. It differs from tissue pain (nociceptive pain) because of the type of sensations that are felt. Frequently described as intense pain associated with variable symptoms of sharp, shooting lancinating pains, some patients liken it to the sensation of an electric shock. It may also be accompanied by skin sensitivity, skin colour changes, swelling, tingling and numbness are amongst commonly recounted phenomena.

What Causes Nerve Pain?

Nerve pain occurs when the function of the nerve is affected – damage or irritation to the nerves causes them to fire uncontrollable pain signals to the brain.

Nerve Compression

When a nerve becomes compressed or irritated by alteration in surrounding tissue. Nerve compression is the cause of many well known neuralgias such as sciatica, trigeminal neuralgia, lateral recess stenosis

Injury

Any type of injury or trauma to nerves.

Infection

Shingles and other type of infections such as HIV/AIDS can cause nerve pain.

Diabetes

Diabetes is the primary cause of peripheral neuropathy in the UK– high blood sugar levels can, over time, cause nerve damage.

Stroke

Central Post-Stroke Pain (CPSP) is a form of neuropathic pain thought to be caused by damage to the central nervous system.

Multiple Sclerosis (MS)

This condition affects the central nervous system – in sufferers of MS the body’s immune system attacks the myelin sheath (a protective substance enveloping the nerve fibres) mistaking it for a foreign body. This damage to the nerve fibres causes a range of different symptoms which may include nerve pain.

Different Types of Neuralgias

Trigeminal Neuralgia

Irritation or compression of the trigeminal nerve can cause damage to the myelin sheath resulting in the nerve firing uncontrollable pain signals. The Trigeminal nerve is responsible for innervating large areas of the head and face, it controls important motor functions such as biting and chewing. Trigeminal neuralgia may occur at multiple times throughout the day and is characterised by bouts of sharp stabbing pain on one side of the face that last for a few seconds at a time – some patients report a dull ache between episodes.

Shingles or Postherpetic Neuralgias

Shingles is the reactivation of the varicella-zoster virus which lies dormant in the nervous system following an initial attack of chickenpox. The virus travels down the sensory nerves causing dermatomal pain and skin lesions (a rash of small red blisters). The dermatome refers to areas of skin mainly served by a single nerve exiting the spinal column. The rash most commonly occurs on the thoracic trunk in one or two adjacent dermatomes.

Sciatica and Other Referred Spinal Pain

The sciatic nerve is the largest single nerve in the body, responsible for innervating a large proportion of muscles in the legs and feet, nearly all the skin on the legs as well as innervating other nerves in the lower leg including the tibial and peroneal nerve. Compression of the sciatic nerve as it exists the spinal column in the lower back can cause painful referred symptoms, patient’s frequently report shooting pains down the legs and all the way into the feet. Compression of the sciatic nerve as well as other nerves in the spinal column, are common forms of referred spinal pain.

Phantom Pain and Sensations

Following amputation, the majority of patients report an awareness of the missing body part – this is known as a phantom sensation. Some patients also feel pain in the missing limb itself. The exact cause of phantom limb pain is unknown – research is ongoing. However, one of the main theories suggest that the amputation causes changes in the periphery nerves (nervous system outside of the central nervous system CNS). Nerve impulses carried by afferent neurons (sensory neurons) from the sensory receptors and organs to the CNS are altered by the amputation. This leads to reorganisation in the CNS, contributing to changes and the development of phantom pain.

Pain at the end of the stump of a missing limb is more common, this is due to the severed nerve endings growing painful swellings called neuromas.

Lateral Recess Stenosis

A common form of spinal stenosis, lateral recess stenosis refers to the narrowing of the lateral recess – a bony tubular passageway through which nerves exist the spinal column. The narrowing can result in pressure on the exiting nerve causing variable symptoms.

Headache – The Trigeminal Cephalalgias (Cluster Headaches)

A group of primary headache disorders, the trigeminal autonomic cephalalgias include short lasting unilateral neuralgia with conjunctival tearing (SUN CT), cluster headache and chronic paroxysmal hemicrania.

Treating Nerve Pain

The physical mechanisms by which neuralgias originate, are propagated and perceived by the human nervous system mean that different drugs are required to treat the pain produced. Where tissue pain such as a sore finger are a cut responds to paracetamol and aspirin-like drugs, so neuralgias do not. Instead, antiepileptic drugs and antidepressant drugs are often used along with strong and weak morphine-like drugs or opiates.

Medication For Nerve Pain

  • over the counter analgesics
  • over the counter non-steroidal anti-inflammatory drugs (NSAIDs)
  • stronger prescription painkillers such as opioids
  • muscle relaxants
  • anticonvulsants
  • tricyclic antidepressants
  • spinal injections of corticosteroid and anaesthetic

Pain Management Clinics

The pain management clinic consists of a multi-disciplinary team of pain management consultants, physiotherapists, psychologists, surgeons and other health professionals working together to provide an effective combination treatments, tailored individually to suit the patient’s needs.

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