Click on a topic below:
- Nerve Pain Overview
- Complex Regional Pain Syndrome
- Diabetic Neuropathy
- Phantom-Limb Pain
- Trigeminal Neuralgia
- Chemo Neuropathy
- Radiation Neuropathy
Some individuals may suffer from prolonged pain that persists for months or years after an injury, or they may experience pain without any obvious injury at all. This pain condition is usually “nerve-related” or neuropathic in nature. Neuropathic pain results from a nervous system malfunction set off by nerve damage that may be caused from diseases such as diabetes, trauma or medications- especially chemotherapy and HIV drugs. Rather than the nervous system functioning properly to signal the presence of tissue injury, with Neuropathic Pain, the nerves themselves are malfunctioning and become the cause of the pain. Neuropathic Pain can lead to serious disability. Some patients experience uncomfortable and abnormal sensations that makes wearing clothes and walking unbearable. This syndrome responds poorly to standard pain treatment and without proper timely and proper treatment may get worse instead of better over time.
Complex Regional Pain Syndrome
(CRPS, also known as Causalgia)
Complex Regional Pain Syndrome, previously known as Causalgia or Reflex Sympathetic Dystrophy (RSD), is caused by abnormal activity in the sympathetic nervous system. This syndrome most often results from an injury or surgery to an extremity, particularly the hand or foot. As the injury or surgery heals, the pain persists, intensifies, and can spread. The skin around the affected area can change color and be cold to touch. It is typically a burning, itching kind of pain, and almost any stimulus to the affected area is painful. There can also be changes to hair and nail growth patterns. It is usually treated first with medications and physical therapy. If these treatments do not bring relief, the next step may be a series of nerve blocks. A treatment option for refractory pain includes spinal cord stimulation, i.e. placing electrical stimulators in the spinal canal to send tingling sensations into the painful extremity. If you believe you are suffering from Complex Regional Pain Syndrome, see your doctor for a full evaluation and possible referral to a pain specialist. The earlier Complex Regional Pain Syndrome is identified and treated, the better the response to treatment.
People with diabetes are prone to nerve damage because high sugars can damage nerve fibers. Typically, diabetic neuropathy injures the nerves in the legs and feet, but can also affect the nerves in the gastrointestinal system, eyes, heart, and blood vessels. Typically, it causes pain and numbness in the feet and legs that may spread into the hands and arms if your blood sugars are not in control. In addition to pain and numbness, you lose the ability to differentiate temperatures, have muscle weakness, and may develop severe foot problems such as ulcers and infections. Treatment focuses on obtaining tight glycemic control with a hemoglobin A1C of less than 7%, proper foot care, diet and exercise, and medications such as tricyclic antidepressants, anti-seizure medications and possibly opioids.
Phantom-limb pain is continued pain in an extremity even after it has been amputated. Pain can continue to be felt despite the limb being gone because the nerve fibers at the stump still exist and send the message of pain to the brain so that the brain thinks the limb still exists. Symptoms include pain, temperature changes, cramping, and pins and needles that are felt in the missing limb. Treatment includes massage, relaxation, physical therapy, biofeedback, medications such as anti-depressants, anti-seizure medications, and analgesics, and surgical removal of possible neuromas in the stump.
Herpes Zoster (commonly called “Shingles”) results from reactivation of the varicella-zoster virus (VZV), the same virus that causes chicken pox in children. Herpes Zoster begins as a severely painful rash in adults when the latent virus that hibernates in the spinal or cranial sensory nerve ganglia reactivates. The shingles begin as a burning sensation that follows the path of one or more spinal nerves under the skin. The rash evolves into reddened, fluid-filled blisters, and the patient may experience flu-like symptoms and anxiety. The blisters eventually become cloudy, sometimes bleed, and then crust over within 7-10 days. Once healed, scarring and changes in skin color may remain. While can erupt on almost any part of the body, the most common areas are the torso (trunk) and the face. Shingles pain may start several days before the rash appears, often preceded by a prodrome of burning pain, itching or sensitivity of the affected area. For most patients, the pain of shingles gradually disappears over several weeks or months. Most patients will have no pain or just a small amount of pain one year after the eruption of the rash. While medications do not cure zoster infections, they have been found to help shorten the duration and discomfort of the outbreak.
Trigeminal Neuralgia (TN), also called “tic doloreaux,” is one of the most intense pain syndromes, typically diagnosed in adults after age 50. It may be caused by compressive blood vessels, tumors and vascular malformations, which result in an electric shock-like pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The episodes last only a few seconds, but the pain experienced can be excruciating. The disorder most often affects only one side of the face, but some patients experience pain on both sides at different times. (add benefit of injections)
Chemotherapy neuropathy is a type of peripheral neuropathy (injury to the nerves that give messages to and from the brain and spinal cord) that is due to the medications involved in chemotherapy. Patients undergoing chemotherapy who already suffer from peripheral neuropathy are at greatest risk of developing this. Symptoms include numbness, pins and needles sensation, burning pain, and weakness. Any area of the body can be affected but the fingers and toes are the most common. Treatment includes protection of the area affected, use of B vitamins, physical therapy, TENS units, biofeedback, and medications such as analgesics, anti-depressants, and anti-seizure medications.
Radiation neuropathy is the development of peripheral neuropathy in patients who have undergone radiation therapy, when the radiation causes damage to the peripheral nerves. Symptoms include numbness, pins and needles sensation, burning pain, and weakness. Treatment includes protection of the area affected, use of B vitamins, physical therapy, Transcutaneous Electrical Nerve Stimulator (TENS) units, biofeedback, and medications such as analgesics, anti-depressants, and ant-seizure medications.