What is Neuropathic Pain?

Raj N. Sureja, MD
Have you ever had your foot or hand fall asleep?  Do you remember the “pins and needles” sensation you felt as it “woke up”?  Have your ever received an oral injection of numbing medication by a dentist and had it hit a nerve?  The sensation felt like you had received an electrical shock.  These are examples of nerve pain.  Imagine, if you will, that these sensations never go away and you have to live with burning, searing or shooting pain.  This pain can happen anywhere in the body, wherever nerves are traumatized. That is how some of my patients feel every day, living with neuropathic pain, which is caused by inflamed or damaged nerves.
Pain is a complex and often hard to describe sensory experience or group of sensations that can be caused by trauma, disease, over-use or for no apparent reason.  Pain is used by our body to let us know something is not as it should be and that we should take action to resolve the unpleasant feeling.  It is communicated by our nerves to our brain by intricate chemical pathways, in a process that takes a mere fraction of a second.  Pain is the ultimate protection system that sends an immediate alarm when we are in danger.  But if this alarm malfunctions and gets stuck in the “on” position, it can cause major problems for the patient.
How do nerves get inflamed or damaged?  Sometimes this happens when the nerve is pinched or compressed, as with a spinal disc herniation.  It can be caused by a disease, such as diabetes, when uncontrolled, attacks the peripheral nerves.  Nerve damage can be caused by strong chemotherapy drugs used to treat cancer.  Alcoholics can suffer nerve damage by drinking too much over a long period of time. Sometimes, we may not know the cause of nerve pain.
Nerve pain is also known as “Neuropathic pain,” and can be treated in a variety of ways.  We can try oral anti-inflammatory medications that reduce pain by suppression of the inflammatory response.  We can inject steroids near the nerve roots to do the same thing.  We can prescribe physical therapy to stretch the body and relieve mechanical pressure on nerves.  There are prescription drugs, specifically developed to treat nerve pain, like gabapentin, which we can try.  Cognitive behavioral therapy can address the ruminating, symptom magnification and depression that often accompany chronic pain.
For more recalcitrant cases, we may need to perform an Interventional procedure that interrupts the nerve signals, like radio frequency ablation or a nerve block.  For more severe cases, we can implant a Spinal Cord Stimulator, which works by interrupting abnormal chronic pain signals and replacing them with a more pleasant sensation.
For some patients, nerve pain will never completely resolve.  However, we have many treatment options available to help those who suffer from Neuropathic pain.  Using an Interdisciplinary approach often is successful by bringing together everyone who treats the patient in a comprehensive, coordinated plan of action. Working in concert, your physicians can help you find a more balanced approach to treating your pain that will offer you a much better quality of life.