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Neuropathic Pain

By

James C. Watson

, MD, Mayo Clinic College of Medicine and Science

Medically Reviewed Jun 2022 | Modified Sep 2022
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Neuropathic pain is caused by damage to or dysfunction of the nerves, spinal cord, or brain.

Neuropathic pain may result from

Neuropathic pain may also develop after surgery, such as removal of a breast (mastectomy) or lung surgery (thoracotomy).

Neuropathic pain can contribute to anxiety and/or depression. Anxiety and depression can also worsen pain.

Symptoms of Neuropathic Pain

Neuropathic pain may be felt as burning or tingling or as hypersensitivity to touch or cold. Hypersensitivity to touch is called allodynia. Even a light touch may cause pain.

Sometimes neuropathic pain is deep and aching.

If movement is painful, people may be reluctant to move the painful part of their body. In such cases, muscles that control the painful part may waste away, and movement may become more limited.

People continue to feel pain long after the cause resolves because structures in the nervous system have been changed, making the structures more sensitive to pain.

Diagnosis of Neuropathic Pain

  • A doctor's evaluation

Doctors base the diagnosis of neuropathic pain mainly on the following:

  • Symptoms

  • The likelihood of a nerve injury

  • Results of the examination

Depending on the symptoms, doctors may do tests to check for disorders that could be causing the pain. Tests may include magnetic resonance imaging (MRI), nerve conduction studies and electromyography Electromyography and Nerve Conduction Studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more Electromyography and Nerve Conduction Studies (EMG), and blood tests. Nerve conduction studies and EMG help doctors determine whether pain results from a problem with muscle or nerves and help them determine where the injury or dysfunction is located.

Treatment of Neuropathic Pain

  • Drugs (such as pain relievers, antidepressants, and antiseizure drugs)

  • Physical and/or occupational therapy

  • Surgery if needed

  • Stimulation of the spinal cord or nerves

  • A nerve block

Understanding what the nature of neuropathic pain is and what to expect often helps people feel more in control and better able to manage their pain.

Treatment of neuropathic pain can vary depending on the specific disorder causing it. For example, if the cause is diabetes, better control of blood sugar levels may help slow the progression of the nerve damage that causes pain.

Often, treatment of neuropathic pain begins with drugs. Drugs can help reduce the pain, making it less debilitating and disruptive, but it is often difficult to completely relieve the pain with drugs.

Drugs

Pain relievers (analgesics) may be given to reduce neuropathic pain.

Pain relievers used to treat neuropathic pain include the following:

However, drugs often provide only partial relief and typically only in fewer than half of people with neuropathic pain.

Physical and occupational therapy

Other treatments

Surgery may be needed if the pain results from an injury that puts pressure on a nerve.

Peripheral nerve stimulation involves placing thin wires under the skin to stimulate an individual peripheral nerve. (Peripheral nerves are those outside the brain and spinal cord.) The wires are attached to a small device (stimulator) placed on the skin's surface. This treatment is particularly effective for neuropathic pain, and it targets the painful area better than TENS. Placing the wires under the skin is a minimally invasive outpatient procedure because it requires making small cuts into the skin.

Spinal cord stimulation may be used to relieve neuropathic pain in people with nerve damage after back surgery or with complex regional pain syndrome Complex Regional Pain Syndrome Complex regional pain syndrome is chronic neuropathic pain characterized by persistent burning or aching pain plus certain abnormalities that occur in the same area as the pain. Abnormalities... read more . This treatment involves implanting a spinal cord stimulator under the skin, usually in a buttock or abdomen. Like a heart pacemaker, this device generates electrical impulses. Small wires (leads) from the device are placed in the space around the spinal cord (epidural space). These leads transmit impulses to the spinal cord. The impulses change the way pain signals are sent to the brain and thus change how unpleasant symptoms are perceived.

Nerve blocks are used to disrupt a nerve pathway that transmits or enhances pain signals. Nerve blocks may be used in people with severe, persistent pain when drugs cannot relieve the pain. Various techniques may be used:

  • Injecting the area around the nerves with a local anesthetic to prevent the nerves from sending pain signals (doctors commonly use ultrasonography to help them locate the nerves to be treated)

  • Injecting the area around collections of nerve cells called ganglia to help regulate the transmission of pain signals

  • Injecting a caustic substance (such as phenol) into a nerve to destroy it

  • Freezing a nerve (cryotherapy)

  • Burning a nerve with a radiofrequency probe

Drugs Mentioned In This Article

Generic Name Select Brand Names
Elavil, Tryptanol, Vanatrip
Norpramin
Effexor, Effexor XR, Venlafaxine
Active-PAC with Gabapentin, Gabarone , Gralise, Horizant, Neurontin
Arthricare for Women, Arthritis Pain Relieving, Capzasin-HP, Capzasin-P, Castiva Warming, Circatrix, DermacinRx Circata, DermacinRx Penetral, DiabetAid, Qutenza, Zostrix, Zostrix HP, Zostrix Neuropathy
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, LidaMantle, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
Castellani Paint, Chloraseptic, Chloraseptic Kids, Phenaseptic, Sore Throat
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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