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Understanding Nerve Pain
It is estimated that around the world, 7-8% of adults currently live with chronic pain as a result of injury or damage to nerve tissue.1
What is nerve pain?
Pain that is experienced as a result of direct injury or damage to the nerve fibres themselves, is called neuropathic pain.1
Neuropathic pain is typically chronic and intense3, identified by shooting, stabbing or burning pain sensations.4 It may be intensified by factors that typically should not cause pain, for example, contact with clothing or light touch.
Nerve pain can be debilitating;5 it is often associated with low quality of life, sleep disturbances, depression and anxiety.6
Diagnosis
Before nerve pain can be effectively managed, a primary care physician will determine:
Where the pain may be coming from
Whether there are any underlying causes of the pain to address, for example, diabetes
The functional limitations that arise as a result of the pain
Whether depression, anxiety or sleep imbalances may be heightening pain sensations
The impact of the pain on quality of life
Managing neuropathic pain is based on considering the person as a whole and may include a combination of medication and non-drug treatments.
Medication
There are several options for drug therapy that may help to manage the symptoms associated with nerve pain.
There are three approaches to drug treatment for nerve pain:7,
Antidepressant or antiepileptic medication.
Opioids
Each approach to pain is an attempt to improve a patient’s quality of life by reducing pain and increasing activity levels.
Medicines may also have side effects though not everyone will experience side effects. It is important to understand how the medicines will work for you, have the correct expectations about their role and any side effects to look out for. Your doctor or pharmacist will be able to discuss this with you.
Medicines alone may not resolve the pain completely and non-drug approaches to managing neuropathic pain is also important due to the complex nature of the pain experience.
Non-drug treatment
Supporting yourself with psychological tools will help you to focus on aspects of functioning despite having pain rather than placing focus on pain completely resolving before you can function.
The types of psychological tools offered by a registered psychologist, is based on the individual’s needs, and is aimed at addressing the pain-related distress and disability.8
It is important to note that while available therapies that target nerve pain are quite effective, they are often aimed at allowing those living with pain to enjoy a better quality of life, having the opportunity to perform daily tasks with improved pain management, rather than elimination the pain completely. Determining the underlying source of the pain may also provide a great deal of relief when the issue is also addressed.
For example, nerve pain that is a common symptom of uncontrolled diabetes, called diabetes neuropathy, may be significantly reduced with better management of the diabetes. 9
Any persistent pain warrants investigation. With the correct assessment and diagnosis, there is a far better likelihood of obtaining the best approach to your treatment and overall care.
Management of Neuropathic Pain. 2nd Edition. 2012. Malaysian Association for the Study of Pain. Available at https://www.masp.org.my/index.cfm?menuid=21. Accessed on 22 June 2020.
It is often more difficult to determine the source of the pain when it comes to nerve involvement, which is particularly true for neuropathic-type of pain.
To estimate the probability that your pain is originating from your nerves, answer yes or no to each of the four questions below.
Question 1:
Does your pain have any of the following characteristic(s)?
Yes
No
Burning
Painful cold-like sensation
Electric shocks
Question 2:
Do you feel one or more of the following symptoms in the same area as the pain?
Yes
No
Tingling
Pins and needles
Numbness
Itching
Question 3:
Are either of the following sensations dulled in the area of the pain?
Yes
No
Touch
A toothpick/pinprick
Question 4:
When you brush the area of the pain with a soft brush or ball of cotton wool, is the sensation painful or pain increases?
Yes
No
For every ‘YES’ answer, allocate 1 point. For every ‘NO’ answer, allocate 0 points.
The score out of 10 will reveal the possibility that the pain is from a source relating to a nerve. The higher the score, the more likely the correlation is. This is not a diagnostic tool but an opportunity for you to discuss these results with your doctor.
Reference:
Bouhassira D et al. Comparison of Pain Syndromes Associated With Nervous or Somatic Lesions and Development of a New Neuropathic Pain Diagnostic Questionnaire (DN4). Pain 2005 Mar;114(1-2):29-36.
