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September 14, 2020

What is neuropathic pain?

Reviewed by the Transitional Pain Service team at the Toronto General Hospital
The contents of this website are for informational purposes only and do not constitute medical advice. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Neuropathic pain is a type of pain that results from damage to the complex system of sensory neurons and pathways that responds to changes at the surface or inside the body. It is often described as a shooting, stabbing, prickling or burning sensation. The pain that a patient will experience may be constant or it may be episodic. Neuropathic pain, like other pains, may wax and wane throughout the day and may also vary in intensity.
The patient suffering from neuropathic pain may also describe a feeling of numbness, itchiness, and tingling. Some may describe their legs and feet as "falling asleep," while others may develop heightened sensitivity to touch or experience pain at the slightest hint of pressure. For example, light touch from clothing or a bed sheet may be experienced as painful.

What causes neuropathic pain?
Your nervous system is responsible for transmitting signals (nerve impulses) from the skin, muscles and joints to the brain and from the brain back down to the periphery allowing you to do normal everyday movements such as walking and running. After surgery, the nervous system may change the way pain signals are processed in the skin, muscles, and joints as well as in the spinal cord and brain. In some cases, because of the surgery, the nerves within the nervous system may not function correctly and can send false signals to the brain, resulting in chronic pain or the lack of feeling (numbness).

To properly treat neuropathic pain, doctors need to determine its underlying cause first. Neuropathic pain can be caused by many things, which can be divided into four major categories:
1
Illness
Neuropathic pain can be a symptom of a disease. In fact, a major portion of neuropathic pain is caused by diabetes. People who suffer from diabetes frequently experience a lack of feeling on their feet and hands due to nerve damage. This is why it is advisable for them to regularly examine their extremities for overlooked injuries. Chemotherapy and radiation can also prevent the nervous system from functioning, causing a person undergoing cancer treatments to feel a lot of neuropathic pain. People with multiple sclerosis, thyroid problems, and vitamin deficiencies are also known to experience neuropathic pain.
2
Infection
Infections can also cause neuropathic pain. People with HIV or AIDS are known to experience this pain, as well as those with shingles. Shingles is a reactivation of the chicken pox virus, wherein the infection travels down the nervous system, causing a blistering skin rash accompanied by pain. Some people will experience pain long after the rash has subsided. This condition is called postherpetic neuralgia.
3
Injury
Tissue, muscle, and joint injuries can all lead to neuropathic pain if a nerve was injured during the traumatic event. Injuries to the back, leg, and hip are also common causes of neuropathic pain. Spinal injuries such as herniated disks and spinal cord compression can also lead to neuropathic pain since the spinal structure and nerves are in close proximity to each other. A person suffering from repetitive stress injury such as carpal tunnel syndrome will also experience this kind of pain.
4
Surgery
Neuropathic pain as a result of surgery typically come from surgical incision; however, a unique form of neuropathic pain is called the phantom limb syndrome. With this condition, the brain still thinks that it is receiving signals from nerves that were previously connected to the missing limb.
Unlike other kinds of pain which are caused by some stimuli and are often short-lived, neuropathic pain may be caused by normal pain mechanisms that have gone awry and can be difficult to treat. Neuropathic pain should be treated as soon as possible. Delaying treatment can make the pain more difficult to manage. Once the underlying cause has been identified neuropathic pain can be treated with several different approaches.
What are treatment options for neuropathic pain?
To achieve the best results, a multidisciplinary approach involving a combination of the following treatments can be considered. Your doctor will make sure that each treatment will not interfere with the other treatments you may be receiving.
1
Medication
Over-the-counter pain medications are often the first line of defense prescribed to patients with neuropathic pain. If they don't work, doctors may prescribe stronger pain medications, antidepressants, and/or anticonvulsants. Antidepressants are used to treat depression and anxiety alongside the recurring pain. Anticonvulsants can interfere with the wrong signals being sent by the damaged nerves. Topical pain medication such as capsaicin creams can also be prescribed to treat localized pain. More details will be provided in Module 3.
2
Physiotherapy and Gentle Exercise
A licensed physiotherapist can advise you on how to do gentle exercises and passive stretching, which help relieve the pain that comes with nerve injury.
3
Massage Therapy and Acupuncture
Neuropathic pain can be treated with massage in order to ease the tension in the nerves and improve blood flow circulation. The massage therapist will work on a patient's arms, hands, legs, and feet in order to reinvigorate these body parts. Acupuncture can also help a patient deal with nerve pain by reducing the inflammation caused by the damaged nerve. The needle points inserted in the affected body parts will serve to stimulate the nervous system and release endorphins.
How can you live with neuropathic pain?
Neuropathic pain can be a long-term medical condition where recovery may take months or years. For some, it may not even be reversed. Every person is different, and perception of pain varies with each individual. Having neuropathic pain can affect your ability to work, cause sleeping problems, and lead to depression and anxiety.

If your neuropathic pain has become severe, consult with your family doctor who will determine if a referral is needed to a pain specialist. The specialist will help you identify the best treatment option for your condition. Having the right kind of treatment can reduce the pain you are feeling and improve your overall wellbeing.