What Is Nerve Pain (and How Does It Differ From Other Kinds of Pain?)
“Can you describe your pain?” This will likely be one of the first questions your doctor asks if you complain of chronic pain. Unless there’s an obvious reason for pain, your doctor needs a lot of information to identify the underlying cause. This includes the location, type, intensity and frequency of pain. The doctor is partly trying to determine whether the pain is nociceptive or neuropathic (also called nerve pain), or possibly both.
“This can be tricky because all pain is experienced through the nerves,” says sports medicine specialist Dominic King, DO. Damage to bodily tissues, such as muscles, tendons, ligaments or the capsules around joints, causes nociceptive pain. Nerve receptors adjacent to the damaged tissue, called nociceptors, transmit a pain signal to the brain. This type of pain tends to feel sharp, achy, dull or throbbing.
Understanding ‘electric pain’
If you’re experiencing something that feels more like burning, stabbing, or shooting pain ― especially if there also is numbness or tingling ― it’s likely to be neuropathic pain. This means there is direct damage or irritation to a nerve. “It can cause a lightning strike type of electric pain,” says Dr. King.
Nerve pain can arise from a variety of causes, including diabetes, infections (such as shingles), multiple sclerosis, the effects of chemotherapy or trauma. When it comes to orthopeadic issues, nerve pain often stems from a nerve being pinched by nearby bones, ligaments and other structures.
For example, a herniated disk in the spine or a narrowing of the spinal canal (stenosis) can press on a nerve as it leaves the spinal canal. This can cause pain along the path of the nerve. When nerves that originate in the lower spine are affected, symptoms might be felt in the buttocks or down a leg. If the compressed nerve is in the upper spine, the pain and other symptoms can shoot down the arm. Numbness or tingling may also occur because the brain is not receiving a consistent signal due to the compression.
Another common cause of nerve pain is carpal tunnel syndrome. A nerve and several tendons travel through a passageway in the wrist (the carpal tunnel) to the hand. Inflammation in the tunnel can press on the nerve, causing numbness and tingling in the thumb and fingers.
How is the cause of nerve pain found?
“There are so many orthopaedic conditions that overlap between pain stemming from problems with tendons, muscles, joints and nerves that you need a very discerning physician to do a good physical exam to figure out the cause,” says Dr. King. “I make my determination based on when the patient experiences pain, where the pain is located and what the pain feels like.”
Pain related to joints, such as from arthritis, will feel more like stiffness when going from sitting to standing. With tendon pain, it will feel sore when you push on the affected area. “Nerve pain is more of a burning, fiery pain,” says Dr. King. And it tends to come and go.
“Nerve pain typically gets worse with more and more use and can be associated with numbness,” says Dr. King.
Ultimately, getting the right treatment depends on getting the right diagnosis. For many bone and joint conditions, nondrug treatment will be tried first. Sometimes pain medication is needed. However, neuropathic pain does not respond to drugs commonly used for nociceptive pain, such as nonsteroidal anti-inflammatory drugs.
This article originally appeared in Cleveland Clinic Arthritis Advisor.
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Sciatica is a form of radiculopathy—a mild to severe pain caused by the compression or pinching of a spinal nerve root. Sciatica radiates pain down the legs and feet, away from the source, and is a sign of nerve irritation or inflammation. It causes an electric shock sensation and numbness in the legs and feet.
While “sciatica” is often used to describe a sharp pain in the lower back and legs, not all sciatic nerve pain is sciatica. While the symptoms are similar from case-to-case, minor details signal different causes, such as whether your pain begins in your back versus your legs. Knowing the root of the issue is vital to treating sciatic nerve pain, as certain diagnoses require different treatments.
We discuss the most common types of sciatic nerve pain and an overview of what sciatic nerve pain is, its potential causes and risk factors, and various treatment options to give you a stronger understanding of the issue.
Neurogenic
Neurogenic sciatica is when the sciatic nerve is compressed or pinched, leading to pressure along the spine. The symptoms generally include sharp, shooting pain down the legs and weakened legs and feet. While the issue is rooted in the spine, the pain is usually worse in your legs than in your back.
Along with physical pain, neurogenic sciatica causes abnormal neurological changes. Individuals may suffer from a loss of reflexes, sensory issues, muscle weakness, and paresthesia (“pins-and-needles”) due to improper nerve conduction.
Referred
Referred sciatica is not a true form of sciatica, but mirrors the pain and symptoms. Rather than being a spinal issue, referred sciatica is pain related to a muscle or joint problem. Referred pain is one of the main reasons why a diagnosis for sciatica is vital, as it may need further evaluation treatment beyond home remedies.
As opposed to shooting pains, people with referred sciatica may feel dull and achy and their pain may be worse in their back than in their legs. Referred pain also does not cause abnormal neurological changes, either, such as worsened reflexes, sensory issues, or tingling.
Alternating Sciatica
Sciatica typically only affects one leg as the sciatic nerve is only pinched on one side of the body. However, alternating sciatica affects both legs successively. It may be a result of degenerative issues in the sacroiliac joint, the joint connecting the spine to the hips, or sacroiliac arthritis.
Bilateral Sciatica
Bilateral sciatica is when both ends of the sciatic nerve are pinched. This results in pain and symptoms occurring in both legs and buttocks at once. It’s a rarer form of sciatica, and the pain in one leg can be worse than in the other. Bilateral sciatica may be the result of multiple herniated discs or disc degeneration.
Sources of Sciatic Pain
There are 33 individual bones in your spine known as vertebrae. Each vertebra is divided into regions and classified according to the number of vertebra per region. The vertebrae are then labeled by a number and letter based on their placement, such as C1 for the first vertebra in the cervical spine. There are five regions of the spine: cervical, thoracic, lumbar spine, sacrum, and coccyx.
The most common regions associated with sciatica are the lumbar spine and sacrum, and the source of your sciatic pain slightly alters your symptoms.
L4 Nerve Root
Irritation to the L4 nerve root causes pain to the hips, thighs, inner knees, calf, and foot. Thigh and hips muscles may feel weak, and calves numb. When sciatica is in the L4 level, a person may be unable to flex their foot or walk on their heels, and they may have a reduced knee-jerk reflex.
L5 Nerve Root
Individuals with sciatica from the L5 nerve root typically experience pain in the buttocks, outer, thigh, and leg, as well as difficulty flexing their ankle or lifting their big toe. Sciatica from the L5 level might also cause numbness, mainly on the top of the foot and between the big toe and second toe.
S1 Nerve Root
Sciatica from the S1 nerve root is also known as classic sciatica as it’s most commonly rooted in the sacrum. Sciatica from the S1 level specifically causes pain and weakness in the buttocks, back of the calf, and outside of the foot. Individuals with sciatica from the S1 level may have numbness or tingling in their third, fourth, and fifth toes, and have difficulty walking on their tiptoes or raising their heels off of the ground. Individuals may also find they have a weakened ankle-jerk reflex.
Duration of Sciatic Pain
Sciatica and sciatic pain are categorized based on how long the symptoms and pain have occurred. The duration of your pain may be a signifier for the necessary treatment options you need.
Acute Sciatica
Acute sciatica lasts between a few days to a few weeks. Typically, it does not require medical attention from a doctor, and home remedies are usually enough to treat the pain. However, acute sciatica can be severe during the brief period of time it is present.
Chronic Sciatica
Chronic sciatica is characterized by symptoms lasting longer than 12 weeks. It’s often less severe than acute pain, but it may not respond well to self-management nor does it pass on its own. Chronic sciatica may require surgical or non-surgical treatment to improve.
Common Causes of Sciatic Pain
Sciatic pain is a result of different conditions or diseases aggravating the sciatic nerve. Not all the conditions listed are guaranteed to cause sciatic pain, but sciatic pain is a frequent symptom.
Herniated or Bulging Discs
Herniated or bulging discs occur when the spongy discs between your spinal vertebrae are compressed and bulge out of place. They can occur at any age, but become more common as you grow older or if you have degenerative disc disease, a condition where the discs lose fluid and wear down. Herniated discs are most common in the lumbar spine and near the sciatic nerve, so they can cause sciatic pain.
Bone Spurs
Bone spurs are small bone growths appearing near joints and are increasingly common with age. Bone spurs are the result of joint damage and linked to osteoarthritis, rheumatoid arthritis, and degenerative joint disease. After an injury or damage has occurred, your body attempts to heal the area by growing extra bone.
Typically, bone spurs cause no symptoms at all, though depending on where they’ve developed, a growth can compress your sciatic nerve and lead to pain.
Spinal Stenosis
The spinal canal is the spinal cord’s pathway down the back. With spinal stenosis, the spinal canal becomes narrower, placing pressure on the spinal cord. There are two types of spinal stenosis: lumbar and cervical stenosis. Cervical spinal stenosis affects the neck, while lumbar spinal stenosis affects the lower back and may cause sciatica.
Lumbar spinal stenosis can be the result of arthritis, spinal degeneration with age, tumors, or cysts.
Spondylolisthesis
Spondylolisthesis is a condition where one vertebra in the spine slips over the one below it, particularly in the lumbar spine region. The condition is typically a result of disc degeneration, arthritis, certain cancers, and certain surgeries.
Stress fractures are another common cause of spondylolisthesis, especially in young people and athletes, though they can happen to anybody. Repeated stress to the vertebra, injuries from motor vehicle accidents, or heavy lifting, can cause the vertebrae to fracture, leading to spondylolisthesis and sciatica.
Piriformis Syndrome
Piriformis syndrome is a neuromuscular disorder where the piriformis muscle (located where the femur and pelvis meet) compresses the sciatic nerve, resulting in spasms and pain in the buttocks and legs.
While the pain mimics sciatic pain, with tingling and numbness from the leg to the foot, it’s not sciatica since it’s not caused by spinal issues. Instead, it’s a referred pain beginning from the buttocks as opposed to the lower back.
Risk Factors
Roughly 40 percent of people experience sciatica at some point in time, and while it’s most common for people 40 to 50 years old, it can happen at any age.
Pre-existing spinal condition(s): Conditions such as degenerative disc disease or spinal stenosis, while they may not initially trigger sciatic pain, can eventually progress and cause sciatica.
Diabetes: As a diabetic, your body becomes more vulnerable to nerve damage, increasing the possibility of sciatic nerve damage and sciatica.
A sedentary lifestyle: Sitting for long periods of time, such as at work or school, can weaken your muscles and cause them to become stiff over time. A weak back and core puts pressure on your lumbar spine and leaves you at risk for sciatica.
Heavy lifting: Heavy lifting such as at work, at the gym, or when gardening, can strain your back and lead to lower back issues, especially if you have improper form. When lifting heavy objects, carry the brunt of the weight with your legs as opposed to your back.
Age: As you age, your spinal discs and tissues wear down, leaving you at risk for herniated discs. You also are more prone to physical health conditions, such as spinal stenosis or arthritis, resulting in sciatic pain.
Weight: If you are overweight or obese, the extra weight in your midsection puts pressure and stress on your spine, leading to back strains and sciatica.
How to Treat Sciatic Pain
In some instances, simple home remedies are enough to ease and treat mild-to-moderate sciatic pain. However, if your sciatic pain is chronic or severe, receiving medical attention is the best step to take for proper treatment. Nearly all treatments—with a doctor or otherwise—are nonsurgical.
Massage Therapy
Massages improve blood circulation, relax muscles, reduce muscle tightness, and release endorphins, all of which are natural pain-relievers and can ease irritation. You can self-massage at home or visit a massage therapist for treatment.
Topical Treatments
A simple way to reduce this pain is to use topical treatments such as analgesic (pain-relief) ointments or hot and cold therapies. They provide temporary relief for localized pain and can be used throughout the day as needed.
For hot and cold therapies, use ice packs (wrapped in a towel to prevent ice burns), heat pads, or hot towels for twenty-minute intervals. Hot and cold ointments are another simple treatment and can be used on the go if needed.
Exercise
Physical activity can strengthen your back and core muscles and relieve pressure on your lower spine. Stretching and light aerobic exercises increase your body’s flexibility and potentially alleviate symptoms. However, avoid strenuous or heavy exercises and be sure your form is correct at all times so as not to worsen your pain.
Medications
While medications don’t directly treat sciatica, they can relieve pain temporarily and make daily activities easier. You can use over-the-counter (OTC) anti-inflammatory medications such as ibuprofen or aspirin, or your doctor might prescribe muscle relaxants, antidepressants, or higher doses of anti-inflammatory drugs. For more severe pain, your doctor may inject corticosteroids or epidural steroid injections in your lumbar spine to relieve inflammation for one to two months.
Chiropractic or Physical Therapy
Your doctor might refer you to a chiropractor or physical therapist for physical rehabilitation.
With a physical therapist, you learn techniques and exercises to strengthen your back and core, improve your posture, and how to avoid aggravating your sciatic nerve. Your physical therapist makes a home exercise routine for you to follow to reduce symptoms.
Chiropractors have an excellent understanding of the body’s musculoskeletal system and how to manipulate it to ease any pain. They complete different treatments to take the pressure off your sciatic nerve, including massage, hot and cold therapy, and spinal adjustments.
Surgery
It’s rare for sciatica patients to need surgery and is typically the final step if other nonsurgical treatment options have not shown improvement. If you have severe pain lasting beyond 6 to 12 weeks or you are debilitated by your pain, your doctor may suggest surgery.
The most common surgeries to treat sciatic pain are microdiscectomy, laminectomy, a spinal fusion, or disc replacement, and the surgery you are referred to is based on your diagnosis.
FAQs
When is sciatic pain a medical emergency?
Sciatic pain is rarely an emergency, but if your sciatic pain is paired with incontinence, fever, loss of appetite, worsening numbness and tingling, swollen legs or lower back, or it began after an accident, seek immediate medical care.
What causes sciatica to flare up?
Some potential triggers for sciatica flare-ups include:
Stress and anxiety: Sciatica can be exacerbated by anxious thoughts as, when stressed, the brain deprives the nerves of needed oxygen and can result in weakness and tingling in the legs.
Wallet sciatica: Wallet sciatica is a term used to describe sciatica aggravated by sitting on your wallet, keys, or cellphone. When an item is in your back pocket, it directly presses up against the sciatica nerve and causes a flare-up.
High heels: When wearing high heels, your center of gravity shifts and stretches your hamstring and sciatic nerve. Walking on your toes, as you do in heels, might also irritate your sciatica.
Poor posture: Having poor posture when sitting or standing puts stress on your lower back and spine, resulting in a flare-up.
Tight clothing: Some clothing may be just tight enough to press against your sciatic nerve and trigger your sciatica pain.
Why is sciatica so painful at night?
Sciatica pain can be aggravated when lying down, making it difficult to sleep and find a comfortable position. In some instances, sciatic pain can be severe to the point of waking you up at night. Adjusting your sleep position, as well as using a supportive mattress, can ease your pain.
Side sleeping may place pressure directly onto the nerve roots and tilt your hips out of alignment with your spine. It’s best to lay on your unaffected side and use a pillow between your knees to keep your spine aligned and prevent pain.
Lying on your back emphasizes the lumbar spine’s curve, potentially pinching the sciatic nerve’s roots and causing pain. Elevate your legs using a pillow under your knees or an adjustable base to reduce the pressure and relieve your symptoms.
Stomach sleeping can overextend your lower back and irritate your sciatica, so it’s best to try a different sleeping position. However, if it’s too difficult to switch positions, temporarily use a pillow under your hips to protect your back.
Can sciatica be caused by a bad mattress?
While it’s unlikely a bad mattress is the cause of your sciatica, your mattress can definitely worsen pain if it’s unsupportive. Older mattresses tend to be rather unsupportive and lumpy, but even new mattresses can aggravate your sciatica if they’re not suited for your sleeping position.
It’s best to use a high-quality mattress built for your sleeping position and body weight to keep your spine aligned and minimize your pain as much as possible.
Should I push through sciatic pain?
If you’re experiencing any sciatic pain while exercising or completing any daily activities, don’t ignore it. Instead, take a few minutes to rest and allow your pain to pass. However, if your sciatic pain makes it difficult to complete daily activities as normal, speak with your doctor for treatment options.
Conclusion
If you’re experiencing sciatic nerve pain, it’s best to get diagnosed and figure out what type of sciatic pain it truly is, as it can be a sign of a larger underlying condition. Although what you’re experiencing may feel like sciatica, it can be caused by an unrelated issue such as piriformis syndrome. In order to protect your body and prevent worsening the issue, always get a doctor’s opinion if you are unsure.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.
Photo by Joseph Chan on Unsplash If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Femoral neuropathy, or femoral nerve dysfunction, occurs when you can’t move or feel part of your leg because of damaged nerves, specifically the femoral nerve. This can result from an injury, prolonged pressure on the nerve, or damage from disease. In most cases, this condition will go away without treatment. However, medications and physical therapy may be necessary if symptoms don’t improve.
What causes femoral neuropathy?
The femoral nerve is one of the largest nerves in your leg. It’s located near the groin and controls the muscles that help straighten your leg and move your hips. It also provides feeling in the lower part of your leg and the front of your thigh. Because of where it’s located, damage to the femoral nerve is uncommon relative to neuropathies caused by damage to other nerves. When the femoral nerve is damaged, it affects your ability to walk and may cause problems with sensation in your leg and foot. View the femoral nerve on this BodyMap of the femur.
Damage to the femoral nerve can be the result of:
a direct injury
a tumor or other growth blocking or trapping part of your nerve
prolonged pressure on the nerve, such as from prolonged immobilization
a pelvic fracture
radiation to the pelvis
hemorrhage or bleeding into the space behind the abdomen, which is called the retroperitoneal space
a catheter placed into the femoral artery, which is necessary for certain surgical procedures
Diabetes may cause femoral neuropathy. Diabetes can cause widespread nerve damage due to fluctuations in blood sugar and blood pressure. Nerve damage that affects your legs, feet, toes, hands, and arms is known as peripheral neuropathy. There is currently some debate about whether femoral neuropathy is truly a peripheral neuropathy or a form of diabetic amyotrophy.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetes is the most common reason for peripheral neuropathy in people who’ve had diabetes for at least 25 years.
Signs of femoral neuropathy
This nerve condition can lead to difficulties moving around. Your leg or knee might feel weak, and you may be unable to put pressure on the affected leg.
You might also feel unusual sensations in your legs. They include:
numbness in any part of the leg (typically the front and inside of the thigh, but potentially all the way down to the feet)
difficulty extending the knee due to quadriceps weakness
feeling like your leg or knee is going to give out (buckle) on you
How serious is it?
Prolonged pressure placed on the femoral nerve can prevent blood from flowing in the affected area. The decreased blood flow can result in tissue damage.
If your nerve damage is the result of an injury, it may be possible that your femoral vein or artery is also damaged. This could cause dangerous internal bleeding. The femoral artery is a very large artery that lies close to the femoral nerve. Trauma often damages both at the same time. Injury to the artery or bleeding from the artery can cause compression on the nerve.
Additionally, the femoral nerve provides sensation to a major portion of the leg. This loss of sensation can lead to injuries. Having weak leg muscles can make you more prone to falling. Falls are of particular concern in older adults because they can cause hip fractures, which are very serious injuries.
Diagnosing femoral neuropathy
Initial tests
To diagnose femoral neuropathy and its cause, your doctor will perform a comprehensive physical exam and ask questions about recent injuries or surgeries, as well as questions about your medical history.
To look for weakness, they will test specific muscles that receive sensation from the femoral nerve. Your doctor will probably check your knee reflexes and ask about changes in feeling in the front part of the thigh and the middle part of the leg. The goal of the evaluation is to determine whether the weakness involves only the femoral nerve or if other nerves also contribute.
Additional testing might include:
Nerve conduction
Nerve conduction checks the speed of electrical impulses in your nerves. An abnormal response, such as a slow time for electrical signals to travel through your nerves, usually indicates damage to the nerve in question.
Electromyography (EMG)
Electromyography (EMG) should be performed after the nerve conduction test to see how well your muscles and nerves are working. This test records the electrical activity present in your muscles when the nerves that lead to them are active. The EMG will determine whether the muscle responds appropriately to stimulation. Certain medical conditions cause muscles to fire on their own, which is an abnormality that an EMG can reveal. Because nerves stimulate and control your muscles, the test can identify problems with both muscles and nerves.
MRI and CT scans
An MRI scan can look for tumors, growths, or any other masses in the area of the femoral nerve that could cause compression on the nerve. MRI scans use radio waves and magnets to produce a detailed image of the part of your body that is being scanned.
A CT scan can also look for vascular or bone growths.
The first step in treating femoral neuropathy is dealing with the underlying condition or cause. If compression on the nerve is the cause, the goal will be to relieve the compression. Occasionally in mild injuries, such as mild compression or a stretch injury, the problem may resolve spontaneously. For people with diabetes, bringing blood sugar levels back to normal may alleviate nerve dysfunction. If your nerve doesn’t improve on its own, you’ll need treatment. This usually involves medications and physical therapy.
Medications
You might have corticosteroid injections in your leg to reduce inflammation and get rid of any swelling that occurs. Pain medications can help relieve any pain and discomfort. For neuropathic pain, your doctor may prescribe medications, such as gabapentin, pregabalin, or amitriptyline.
Therapy
Physical therapy can help build up the strength in your leg muscles again. A physical therapist will teach you exercises to strengthen and stretch your muscles. Undergoing physical therapy helps to reduce pain and promote mobility.
You might need to use an orthopedic device, such as a brace, to assist you with walking. Usually, a knee brace is helpful in preventing knee buckling.
Depending on how severe the nerve damage is and how much trouble you’re having moving around, you might also need occupational therapy. This type of therapy helps you learn to do regular tasks like bathing and other self-care activities. These are called “activities of daily living.” Your doctor might also recommend vocational counseling if your condition forces you to find another line of work.
Surgery
Your doctor might recommend surgery if you have a growth blocking your femoral nerve. Removing the growth will relieve the pressure on your nerve.
Long-term outlook after treatment
You might be able to heal fully after you treat the underlying condition. If the treatment isn’t successful or if the femoral nerve damage is severe, you might permanently lose feeling in that part of your leg or the ability to move it.
Tips to prevent nerve damage
You can lower your risk of femoral neuropathy caused by diabetes by keeping your blood sugar levels under control. This helps protect your nerves from damage caused by this disease. Preventive measures would be directed at each cause. Talk to your doctor for advice about what preventive measures would be the best for you.
Maintaining an active lifestyle helps to keep your leg muscles strong and improve stability.
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
What predicts depression and anxiety among people with PN? Not necessarily the severity of the PN symptoms! The predictors are the psychological variables (i.e.: How do you feel? Hopeless, optimistic, anxious, etc.); social variables (i.e.: Are you active? Do you have support?) All of these variables can be changed!
Dwelling on what might have been if you were not diagnosed, self-pitying, ruminating about better times, and think of yourself primarily as a “PN patient” does not provide the escape from stress of the illness. These coping strategies are ineffective and can make your neuropathy symptoms worse.
Below are effective Self-Care and Coping Skills:
Managing Peripheral Neuropathy
The following suggestions can help you manage peripheral neuropathy:
Take care of your feet, especially if you have diabetes. Check your feet daily for signs of blisters, cuts or calluses. Tight shoes and socks can worsen pain and tingling and may lead to sores that won’t heal. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bed covers off hot or sensitive feet.
Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and possibly amputation.
Eat healthy meals. If you’re at high risk of neuropathy or have a chronic medical condition, healthy eating is especially important. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Drink alcohol in moderation.
Massage. Massage your hands and feet, or have someone massage them for you. Massage helps improve circulation, stimulates nerves and may temporarily relieve pain.
Avoid prolonged pressure. Don’t keep your knees crossed or lean on your elbows for long periods of time. Doing so may cause new nerve damage.
Skills for Coping With Peripheral Neuropathy
Living with chronic pain or disability presents daily challenges. Some of these suggestions may make it easier for you to cope:
Set priorities. Decide which tasks you need to do on a given day, such as paying bills or shopping for groceries, and which can wait until another time. Stay active, but don’t overdo.
Acceptance & Acknowledgement. Accept and acknowledge the negative aspects of the illness, but then move forward to become more positive to find what works best for you.
Find the positive aspects of the disorder. Of course you are thinking there is nothing positive about PN. Perhaps your outlook can help increase empathy, encourage you to maintain a balanced schedule or maintaining a healthier lifestyle.
Get out of the house. When you have severe pain, it’s natural to want to be alone. But this only makes it easier to focus on your pain. Instead, visit a friend, go to a movie or take a walk.
Get moving. Develop an exercise program that works for you to maintain your optimum fitness. It gives you something you can control, and provides so many benefits to your physical and emotional well-being.
Seek and accept support. It isn’t a sign of weakness to ask for or accept help when you need it. In addition to support from family and friends, consider joining a chronic pain support group. Although support groups aren’t for everyone, they can be good places to hear about coping techniques or treatments that have worked for others. You’ll also meet people who understand what you’re going through. To find a support group in your community, check with your doctor, a nurse or the county health department.
Prepare for challenging situations. If something especially stressful is coming up in your life, such as a move or a new job, knowing what you have to do ahead of time can help you cope.
Talk to a counselor or therapist. Insomnia, depression and impotence are possible complications of peripheral neuropathy. If you experience any of these, you may find it helpful to talk to a counselor or therapist in addition to your primary care doctor. There are treatments that can help.
How to Sleep With Neuropathy
Sleep is an essential part of living—sleep helps us avoid major health problems and it is essential to our mental and physical performance. It affects our mood and stress and anxiety levels. Unfortunately, sleep disturbance or insomnia is often a side effect of neuropathy pain. It is a common complaint among people with living with chronic pain.
It’s no surprise that about 70 percent of pain patients, including those suffering from PN, back pain, headaches, arthritis and fibromyalgia, report they have trouble sleeping according to the Journal of Pain Medicine.
Pain can interfere with sleep due to a combination of issues. The list includes discomfort, reduced activity levels, anxiety, worry, depression and use of medications such as codeine that relieve pain but disturb sleep.
Most experts recommend a range of seven to nine hours of sleep per night for adults, regardless of age or gender. This may seem impossible to people with chronic pain, but there are steps you can take to improve your sleep, which may lead to less pain and lower levels of depression and anxiety. First, talk with your doctor to see if there are medications that may lessen your sleep disturbance. You should also check with your doctor to make sure your current medications aren’t causing some of your sleep disturbance.
Beyond medication, there are several things you can do yourself to improve your sleep. Here are some methods to try and help you fall asleep more quickly, help you sleep more deeply, help you stay asleep, and ultimately help keep you healthy.
Following are tips for improving your sleep:
Reduce your caffeine intake, especially in the afternoons
Quit smoking
Limit and/or omit alcohol consumption
Limit naps to less than one hour, preferably less
Don’t stay in bed too long—spending time in bed without sleeping leads to more shallow sleep
Adhere to a regular daily schedule including going to bed and getting up at the same time
Maintain a regular exercise program. Be sure to complete exercise several hours before bedtime
Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support
Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.
Turn off your TV and Computer, many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it.
Don’t watch the clock – turn your alarm clock around so that it is not facing you
Keep a note pad and pencil by your bed to write down any thoughts that may wake you up at night so you can put them to rest
Refrain from taking a hot bath or shower right before bed; the body needs to cool a degree before getting into deep sleep
Try listening to relaxing soft music or audio books instead, or practicing relaxation exercises.
Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.
Some patients find comfort from a pillow between their legs that keeps their knees from touching. And there’s an added benefit: A pillow between your legs at night will prevent your upper leg from pulling your spine out of alignment and reduces stress on your hips and lower back.
It may take three to four weeks of trying these techniques before you begin to see an improvement in your sleep. During the first two weeks, your sleep may actually worsen before it improves, but improved sleep may lead to less pain intensity and improved mood.
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Medically Reviewed by Melinda Ratini, DO, MS on September 16, 2020
Reflex sympathetic dystrophy syndrome (RSD) is a disorder that causes lasting pain, usually in an arm or leg, and it shows up after an injury, stroke, or even heart attack. But the severity of pain is typically worse than the original injury itself. Doctors don’t know exactly what causes it, but they are able to treat many cases.The term reflex sympathetic dystrophy syndrome is actually not a name that doctors use anymore. It’s an older term used to describe one form of Complex Regional Pain Syndrome (CRPS). RSD is sometimes called Type I CRPS, and it’s caused by injury to tissue with no related nerve damage.
What Causes RSD?
Doctors think the pain caused by RSD comes from problems in your sympathetic nervous system. Your sympathetic nervous system controls blood flow movements that help regulate your heart rate and blood pressure.
When you get hurt, your sympathetic nervous system tells your blood vessels to get smaller so you don’t lose too much blood at your injury site. Later, it tells them to open back up so blood can get to damaged tissue and repair it.
When you have RSD, your sympathetic nervous system gets mixed signals. It turns on after an injury, but doesn’t turn back off. This causes a lot of pain and swelling at your injury site.Sometimes, you can get RSD even if you haven’t had an injury, although it’s not as common.
RSD is a little more typical in women than in men. Children can get it, too, but usually it shows up between ages 30 and 60.
Symptoms
When you get RSD, your symptoms may show up slowly. You may have pain first, and then it may get worse over time. You may not realize your pain is abnormal at first.
The types of injuries that can cause RSD include:
Amputation
Bruises
Burns
Cuts
Fractures
Minor surgery
Needle sticks
Radiation therapy
Sprains
It’s most common to get RSD in your arm, shoulder, leg, or hip. Usually the pain spreads beyond your injury site. In some cases, symptoms can spread to other parts of your body, too.
RSD can also affect your immune system. This can cause:
Redness
Skin that’s warm to the touch around the injury
Swelling
The pain you get with RSD is usually constant and severe. Many people describe RSD pain as:
Your skin may also feel sensitive when you do things that don’t normally hurt it, like taking a shower. Or it might hurt just to wear your clothes.
Other symptoms of RSD include:
Changes in your hair or nail growth, or skin’s texture
Excess sweat in certain areas of your body
Muscle weakness or spasms
Stiff joints
Trouble moving the injured area
White, mottled, red, or blue skin
Diagnosis
Often, doctors don’t know your pain is being caused by RSD until you’ve had it for some time. When pain doesn’t go away, or is more severe than it should be for your type of injury, it can be the first clue that it could be RSD.
There’s no single test that can tell your doctor whether you have RSD. Instead, they’ll rely on a physical exam and your medical history information. There are also a few tests that can provide clues to see if you have certain signs of the condition. These include:
Bone scan. This test can detect if any of your bones are wearing away at the ends or whether there are issues with regular blood flow.
MRI. Your doctor might order an MRI to look inside your body, specifically at your tissues, for noticeable changes.
Sweat test. This test can tell your doctor if you sweat more on one side of your body than the other.
Thermography test. This sympathetic nervous system test checks to see if the temperature or blood flow is different at your injury site than in other parts of your body.
X-rays. These are typically ordered if your syndrome is in later stages to look for mineral loss in your bones.
Treatment
Early detection is key in RSD treatment. The earlier you’re able to catch it, the better your treatment will work. Some cases of RSD don’t respond to treatment. RSD doesn’t have a cure, but it’s possible to recover from many of the symptoms.
Some of the medications your doctor may suggest include:
Anesthetic creams like lidocaine
Antidepressants
Anti-inflammatory drugs, called NSAIDs
Anti-seizure medications that may help treat pain
Nasal spray that treats bone loss
Nerve blocking injections
Over-the-counter options like aspirin, ibuprofen, or naproxen for pain
Electrodes on your spinal cord that send small electric shocks to relieve pain
Physical therapy to help you move around more easily and take away pain
Psychotherapy that can teach you relaxation methods
Splints to help with hand pain
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Hyperalgesia is a condition where a person develops an increased sensitivity to pain. What may not hurt most people can cause significant pain in an individual with hyperalgesia.
Although there are many potential causes associated with hyperalgesia, the condition is thought to be the result of changes to nerve pathways, which cause a person’s nerves to have an overactive response to pain.
Medications are available to prevent a person’s symptoms from worsening.
Fast facts on hyperalgesia:
Hyperalgesia can be very difficult for a doctor to diagnose.
Different types of hyperalgesia exist, and doctors have a variety of theories regarding why people experience hyperalgesia.
Researchers are also studying a potential genetic link to hyperalgesia
The condition closely resembles both drug tolerance and drug withdrawals.
Causes
Hyperalgesia is an extreme reaction to painful stimuli.
There are several nerve or “pain” pathways in the body where signals can start to miscommunicate with each other, resulting in hyperalgesia.
Some scientists think that hyperalgesia occurs when chemicals known to reduce pain are disrupted.
Others propose that hyperalgesia happens when “crossed wires” in the nervous system prevent pain signals from transmitting accurately.
Nociceptive and neuropathic pain
Nociceptive and neuropathic are two different types of pain. Nociceptive pain is acute and it usually has a specific cause, such as an injury.
Neuropathic pain results from damage to the nervous system. It can happen even when there is no injury or outside stimulus.
Hyperalgesia is considered a form of neuropathic pain.
Types
Doctors usually divide hyperalgesia into primary and secondary categories. Both of these conditions are due to initial tissue trauma and inflammation.
Primary hyperalgesia
This type of hyperalgesia is when the increased pain occurs in the tissue where the injury took place. An example would be when a person has surgery on their elbow, and the pain starts to worsen over time instead of improving.
Secondary hyperalgesia
This type occurs when the pain seems to spread to non-injured tissue or tissues.
Other types of hyperalgesia
Another kind of hyperalgesia is opioid-induced hyperalgesia (OIH). OIH occurs when a person experiences worsening or new pain as a result of taking opioids, such as morphine, hydrocodone, or fentanyl for pain relief.
Symptoms
The chief symptom of hyperalgesia is an increasingly extreme reaction to painful stimuli without any new injuries or worsening of a medical condition. An example would be a surgical incision that becomes more painful over time, yet the wound is not infected, and a person has not experienced any further injury.
Hyperalgesia is different from tolerance to medications although the two processes are similar.
If a person develops a tolerance to a particular drug, it usually means that their body has become accustomed to the presence of the drug at the current dosage, and the drug is no longer working properly. When a person has developed a tolerance to a drug, increasing the dosage will usually decrease a person’s pain.
Drug tolerance is different from hyperalgesia, where increasing pain medication will not reduce the amount of pain a person feels. Sometimes, increasing the pain medication makes the person’s pain worse.
Another similar medical condition is allodynia. This condition is where a person develops a significant pain response to non-painful stimuli. Even brushing against a person’s skin can cause pain.
In hyperalgesia, a person has experienced a painful stimulus, such as cancer pain or pain following surgery, but their response to the pain is greater than the expected level of pain.
How do doctors diagnose hyperalgesia?
Diagnosing hyperalgesia may be difficult for a doctor.
Hyperalgesia can present difficulties for a doctor to treat because a person may have developed OIH.
To make a diagnosis, a doctor will take a medical history and review a person’s medication.
They may also ask them questions about the nature of their pain.
Some of the signs that could indicate hyperalgesia include:
Pain extends beyond the area where a person experienced an initial injury or previously felt pain. Examples could include headaches, neck pain, leg pain, or back pain.
Some people describe the pain as “diffuse” or spreading. Some may report all-over body pain and aches.
The quality or experience of the pain is different than it used to be. The pain may become sharp, aching, or stabbing where previously the person felt the pain differently.
Currently, there are no definitive diagnostic tests for hyperalgesia.
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Peripheral neuropathy is a blanket term for pain and discomfort and other symptoms that result from damage to peripheral nerves, which are the nerves that extend away from the brain and spinal cord.
The peripheral nervous system carries signals from the brain and spinal cord to the rest of your body, and then returns nerve signals from the periphery to be received by the spinal cord and brain. Any problems along the way can affect the skin, muscles, and joints of your hands, feet, and other parts of the body.
Many things can cause neuropathy, including certain chemotherapy drugs. Damage to peripheral nerves by these drugs is called chemotherapy-induced peripheral neuropathy, abbreviated as CIPN.
CIPN isn’t uncommon. Of people with cancer who are treated with chemotherapy, about 30 to 40 percent develop CIPN. It’s one of the reasons that some stop cancer treatment early.
What are the symptoms of CIPN?
CIPN generally affects both sides of your body the same way. Symptoms are likely to begin in your toes but can move to your feet, legs, hands, and arms. Symptoms range from mild to severe. Some of the more common symptoms are:
tingling or pins-and-needles sensation
sharp, stabbing pain
burning or shock-like sensations
loss of sensation or complete numbness
trouble with small motor skills such as writing, texting, and buttoning
balance and coordination problems, which can lead to stumbling or falling when walking
differences in your sensitivity to temperature, making it harder to gauge heat and cold
reduced reflexes
swallowing difficulties
jaw pain
hearing loss
constipation
trouble urinating
Severe peripheral neuropathy can lead to serious health problems such as:
changes to blood pressure
changes to heart rate
breathing difficulties
injury due to falling
paralysis
organ failure
What causes CIPN?
Chemotherapy drugs are systemic treatments — that is, they affect your entire body. These powerful medications can take a toll, and some can damage your peripheral nervous system.
It’s hard to say exactly what causes CIPN since each chemotherapy drug is different, as is each person who receives treatment.
Some of the chemotherapy drugs associated with CIPN are:
nanoparticle albumin bound-paclitaxel (Abraxane)
bortezomib (Velcade)
cabazitaxel (Jevtana)
carboplatin (Paraplatin)
carfilzomib (Kyprolis)
cisplatin (Platinol)
docetaxel (Taxotere)
eribulin (Halaven)
etoposide (VP-16)
ixabepilone (Ixempra)
lenalidomide (Revlimid)
oxaliplatin (Eloxatin)
paclitaxel (Taxol)
pomalidomide (Pomalyst)
thalidomide (Thalomid)
vinblastine (Velban)
vincristine (Oncovin, Vincasar PFS)
vinorelbine (Navelbine)
Besides chemotherapy, peripheral neuropathy can be due to the cancer itself, such as when a tumor presses on a peripheral nerve.
Other cancer treatments such as surgery and radiation therapy can also lead to peripheral neuropathy. Even if you’re receiving chemotherapy, the neuropathy can be caused or aggravated by other conditions such as:
alcohol use disorder
autoimmune disorders
diabetes mellitus
HIV
infections that lead to nerve damage
poor peripheral blood circulation
shingles
spinal cord injury
vitamin B deficiency
How long does it last?
Symptoms can appear as soon as chemotherapy begins. Symptoms tend to get worse as the chemotherapy regimen progresses.
It’s a temporary problem for some, lasting only a few days or weeks.
For others, it can last for months or years and can even become a lifelong problem. This may be more likely if you have other medical conditions that cause neuropathy or take other prescription drugs that cause it.
How is CIPN treated?
Once your oncologist (a doctor who specializes in cancer treatment) determines that your peripheral neuropathy is caused by chemotherapy, they will monitor your treatment to see if symptoms are worsening. In the meantime, symptoms can be treated with:
steroids to reduce inflammation
topical numbing medicines
antiseizure medications, which can help relieve nerve pain
prescription-strength pain relievers such as narcotics (opioids)
It’s very important to work with your doctor to prevent neuropathy from getting worse. In addition, there are a few other things you can do, such as:
relaxation therapy, guided imagery, or breathing exercises
massage therapy
acupuncture
biofeedback
Pain, numbness, or strange sensations can make it difficult to work with your hands, so you should be extra careful with sharp objects. Wear gloves for yardwork or when working with tools.
If symptoms involve your feet or legs, walk slowly and carefully. Use handrails and grab bars when available and put no-slip mats in your shower or tub. Remove loose area rugs, electrical cords, and other tripping hazards in your home.
Wear shoes indoors and out to protect your feet. And if you have severe numbness in your feet, be sure to inspect them every day for cuts, injuries, and infection that you can’t feel.
Temperature sensitivity can also be a problem.
Make sure your water heater is set to a safe level, and check the temperature of the water before getting in the shower or bath.
Check the air temperature before going outside in winter. Even though you might not feel the cold, gloves and warm socks can help protect your feet and hands from frostbite.
If you find it helps to relieve your peripheral neuropathy symptoms, you can apply an ice pack on your hands or feet, but only for less than 10 minutes at a time with at least 10 minutes of breaktime between each repeat application.
Here are a few additional tips:
Don’t wear tight clothes or shoes that interfere with circulation.
Avoid alcoholic beverages.
Take all your medications as directed.
Get plenty of rest while in treatment.
Follow your doctor’s recommendations for diet and exercise.
Keep your oncologist informed about new or worsening symptoms.
Currently, there’s no scientifically proven way to prevent neuropathy caused by chemotherapy. And there’s no way to know in advance who’ll develop it and who won’t.
Some research, such as this 2015 studyTrusted Source and this 2017 studyTrusted Source, suggests that taking glutathione, calcium, magnesium, or certain antidepressant or antiseizure drugs might help mitigate the risk for certain people. However, the research is limited, weak, or shows mixed results at best.
Before starting chemotherapy, tell your oncologist about other health conditions, such as diabetes mellitus, that could lead to peripheral neuropathy. This can help them choose the best chemotherapy drug for you.
Your oncologist may try to lessen the risk by prescribing lower doses of chemotherapy drugs over a longer period of time. If symptoms start, it may be appropriate to stop chemotherapy and restart when symptoms improve. It’s something that must be decided on a case-by-case basis.
While mild symptoms may resolve within a short time frame, more severe cases can linger for months or years. It can even become permanent. That’s why it’s so important to keep your oncologist informed about all your symptoms and side effects.
Addressing CIPN early may help ease symptoms and prevent it from getting worse.
Last medically reviewed on January 24, 2019
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Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.
Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.
Symptoms
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it’s especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.
Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.
When to see a doctor
Mild sciatica usually goes away over time. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if:
You have sudden, severe pain in your low back or leg and numbness or muscle weakness in your leg
The pain follows a violent injury, such as a traffic accident
You have trouble controlling your bowels or bladder
Causes
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.
Risk factors
Risk factors for sciatica include:
Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.
Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there’s no conclusive evidence of this link.
Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.
Complications
Although most people recover fully from sciatica, often without treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you have:
Loss of feeling in the affected leg
Weakness in the affected leg
Loss of bowel or bladder function
Prevention
It’s not always possible to prevent sciatica, and the condition may recur. The following can play a key role in protecting your back:
Exercise regularly. To keep your back strong, pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Ask your doctor to recommend specific activities.
Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
Use good body mechanics. If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
Diagnosis
During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.
Imaging tests
Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.
X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
Treatment
If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.
Medications
The types of drugs that might be prescribed for sciatica pain include:
Anti-inflammatories
Muscle relaxants
Narcotics
Tricyclic antidepressants
Anti-seizure medications
Physical therapy
Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.
Steroid injections
In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.
Surgery
This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.
Lifestyle and home remedies
For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.
Other self-care treatments that might help include:
Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.
Alternative medicine
Alternative therapies commonly used for low back pain include:
Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.
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Neuralgia is nerve pain that may be caused by many different things, including nerve damage, nerve irritation, infection, or other diseases. It is caused by irritation or damage to a nerve and is a sharp and very intense pain that follows the path of the nerve.
Neuralgia is also sometimes called neuropathy, neuropathic pain, or neurogenic pain. It is most common in older adults but can affect people of all ages.
MedicalRF.com / Getty Images
Symptoms
How can you tell if the pain you are experiencing is neuralgia or some other type of pain? Neuralgia is typically more severe and has some distinct symptoms:
Increased sensitivity: The skin along the path of the damaged nerve will be very sensitive, and any touch or pressure, even gentle, is painful.
Sharp or stabbing pain: Pain will occur along the path or the damaged nerve and will be felt in the same location each time. It often comes and goes but can also be constant and burning and may feel more intense when you move that area of your body.
Weakness: Muscles supplied by the damaged nerve may feel very weak or become completely paralyzed.
Types
Certain painful conditions are classified as neuralgia because they are caused by nerve damage and lead to nerve pain. You can also experience neuralgia as a side effect of surgery. The pain can range in severity based on the extent of nerve damage and what nerves are affected.
Unfortunately, treating neuralgia is not an easy task and treatment will vary depending on the cause, location, and severity of your pain. The first step your doctor will likely take will be to identify the cause of the nerve problem and work to reverse or control it. He or she will also likely recommend pain medications to control your symptoms, including:1
Antidepressant medications
Antiseizure medications
Over-the-counter pain medications, such as aspirin, acetaminophen or ibuprofen
Narcotic analgesics for short-term pain
Lidocaine patch
Capsaicin or lidocaine medicated skin creams
Other treatment options may include anesthetic shots, nerve blocks, physical therapy, surgery, nerve ablation, or complementary and alternative therapies. Talk to your doctor to discover the source of your pain and find out what treatments may work for you.
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Neuralgia is a stabbing, burning, and often severe pain due to an irritated or damaged nerve. The nerve may be anywhere in the body, and the damage may be caused by several things, including:
aging
diseases such as diabetes or multiple sclerosis
an infection, such as shingles
Treatment for the pain of neuralgia depends on the cause.
This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can occur wherever the outbreak of shingles was. The pain can be mild or severe and persistent or intermittent. It can also last for months or years. In some cases, the pain may occur before the rash. It will always occur along the path of a nerve, so it’s usually isolated to one side of the body.
This type of neuralgia is associated with pain from the trigeminal nerve, which travels from the brain and branches to different parts of the face. The pain can be caused by a blood vessel pressing down on the nerve where it meets with the brainstem. It can also be caused by multiple sclerosis, injury to the nerve, or other causes.
Trigeminal neuralgia causes severe, recurrent pain in the face, usually on one side. It’s most common in people who are older than 50 years.
Glossopharyngeal neuralgia
Pain from the glossopharyngeal nerve, which is in the throat, is not very common. This type of neuralgia produces pain in the neck and throat.
Causes of neuralgia
The cause of some types of nerve pain is not completely understood. You may feel nerve pain from damage or injury to a nerve, pressure on a nerve, or changes in the way the nerves function. The cause may also be unknown.
Infection
An infection can affect your nerves. For example, the cause of postherpetic neuralgia is shingles, an infection caused by the chickenpox virus. The likelihood of having this infection increases with age. An infection in a specific part of the body may also affect a nearby nerve. For example, if you have an infection in a tooth, it may affect the nerve and cause pain.
Multiple sclerosis
Multiple sclerosis (MS) is a disease caused by the deterioration of myelin, the covering of nerves. Trigeminal neuralgia may occur in someone with MS.
Pressure on nerves
Pressure or compression of nerves may cause neuralgia. The pressure may come from a:
bone
ligament
blood vessel
tumor
The pressure of a swollen blood vessel is a common cause of trigeminal neuralgia.
Diabetes
Many people with diabetes have problems with their nerves, including neuralgia. The excess glucose in the bloodstream may damage nerves. This damage is most common in the hands, arms, feet, and legs.
Less common causes
If the cause of neuralgia isn’t infection, MS, diabetes, or pressure on the nerves, it may be from one of many less-common factors. These include:
chronic kidney disease
medications prescribed for cancer
fluoroquinolone antibiotics, used to treat some infections
trauma, such as from surgery
chemical irritation
When to seek medical help
The pain of neuralgia is usually severe and sometimes debilitating. If you have it, you should see your doctor as soon as possible.
You should also see your doctor if you suspect you have shingles. Besides neuralgia, shingles also causes a red, blistering rash. It’s usually on the back or the abdomen, but it may also be on the neck and face. Shingles should be treated as soon as possible to prevent complications. These can include postherpetic neuralgia, which can cause debilitating and lifelong pain.
What to expect at a doctor’s appointment
When you see your doctor for neuralgia, you can expect to be asked a series of questions about your symptoms. Your doctor will want you to describe the pain and to tell them how long the pain has been a problem. You will also need to inform them of any medications you take and any other medical issues you have. This is because neuralgia may be a symptom of another disorder, such as diabetes, MS, or shingles.
Your doctor will also perform a physical exam to pinpoint the location of the pain and the nerve that’s causing it, if possible. You may also need to have a dental exam. For example, if the pain is in your face, your doctor may want to rule out other possible dental causes, such as an abscess.
To find an underlying cause of your pain, your doctor may order certain tests. You may need to have blood drawn to check your blood sugar levels and kidney function. A magnetic resonance imaging (MRI) test can help your doctor determine if you have MS. A nerve conduction velocity test can determine nerve damage. It shows how fast signals are moving through your nerves.
Treatment of neuralgia
If your doctor can pinpoint the cause of your neuralgia, your treatment will focus on treating the underlying cause. If the cause is not found, treatment will focus on relieving your pain.
Potential treatments may include:
surgery to relieve the pressure on the nerve
better control of blood sugar levels in people with diabetes-caused neuralgia
physical therapy
nerve block, which is an injection directed at a particular nerve or nerve group and that is intended to “turn off” pain signals and reduce inflammation
medications to relieve the pain
Medications prescribed may include:
antidepressants such as amitriptyline or nortriptyline, which are effective in treating nerve pain
antiseizure medications such as carbamazepine, which is effective for trigeminal neuralgia
short-term narcotic pain medications, such as codeine
topical creams with capsaicin
There is no cure for neuralgia, but treatment can help improve your symptoms. Some types of neuralgia improve over time. More research is being done to develop better treatments for neuralgia.
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