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Nerve Pain

Pain can be generated not just by direct damage to tissues or wear and tear but also resulting from either pressure on or damage to nerves. These are called Neurogenic or Neuropathic pains. “Trapped nerve” is a commonly-given diagnosis: many such pains are actually due to other causes but, even so, nerve pains are a common component of chronic pain conditions. In addition, as a result of ongoing pain of various types, the nervous system itself can become more jumpy or sensitised which will worsen, or even independently cause, nerve pain.

Definition

The International Association for the Study of Pain defines Neuropathic (nerve) pain as:

Pain initiated or caused by a primary lesion or dysfunction in the nervous system” (IASP 1997). 

 

What is nerve pain like and how can it be diagnosed?

Neuropathic pain often arises from nerve damage or abnormal functioning of the nerves, though such "damage" may not be obvious.  Many different pains can have a neuropathic component.  The way that someone with pain describes the pain they experience can give us useful clues as to whether there is a neuropathic element.  Neuropathic pain tends to be of a burning nature, with sufferers disliking touch over the affected area (this is called allodynia).  Sometimes there can be a shooting "electric shock" element, either spontaneously or in response to touch or movement.  Often they may describe efforts to stay out of draughts, or away from the sun, out of normal proportion. Their clothing may be very uncomfortable against their skin.

The way people describe their pain often gives important  pointers to the pain being neuropathic.  Some simple tools may help to diagnose neuropathic pain.   In particular, several questionnaires may be useful. These are discussed in more detail in the assessment of nerve pain section.

As well as the primary pain symptoms, it is frequent for people with neuropathic pain to have  anumber of other symptoms.   They often experience sleep interference, lack of energy, drowsiness, concentration/memory difficulties, mood swings, depression, anxiety and difficulty in performing their normal physical activities.

 

Types of Nerve Pain

Neuropathic pain is not rare.  It is thought to affect 2-4% of the general population (1-2 million people suffer with neuropathic pain in the UK).  It can affect up to 20-25% of diabetic patients and 30-40% of patients with cancer.  The average GP may have 35-70 patients suffering with neuropathic pain - however, there is increasing evidence that neuropathic pain and central nervous system sensitisation mechanisms are involved in a very large number fof different pain types.

 A number of conditions which we see in the Clinic are types of Nerve Pain:

We have compiled pages on a number of these pages, as listed in the menu on the right.

Treatment of Nerve Pain

One of the problems of treating nerve pains is that they often do not respond well to what are often thought of as “usual” painkilling drugs. There are a number of possible reasons for this. We often make use of other drugs which are primarily sold for other reasons, but which have effects on nerve pain as a useful side-effect. Those most commonly used include some of the antidepressant and anticonvulsant drugs, as well as others such as Membrane-stabilising drugs. Occasionally injections can be used, sometimes using locally active steroids , as well as other approaches such as TENS.  Further information on these treatment approaches can be accessed from the links or through the "What can we do to help?" section of our site.

Note for Professionals: a Map of Medicine pathway for the management of Neuropathic Pain produced by the British Pain Society has very recently been released and can be accessed as a direct link here.  

 

Further Reading

There is a useful page of further information at patient.co.uk  

The Neuropathy Trust

 

 

 

 

 

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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk

Page updated 15/02/2016