Neuropathic pain, on the other hand, tends to be chronic and less sharp. “The character and quality of neuropathic pain tends to be pain that’s burning or electric in character,” says Vernon Williams, MD, a sports neurologist and the director of the Center for Sports Neurology and Pain Medicine at Cedars-Sini Kerlan-Jobe Institute in Los Angeles. Additionally, he says, the pain will often be associated with other symptoms, such as: (3)
Paresthesia There may be numbness or tingling, or lack of normal sensation associated with the pain.Allodynia This is a painful response to a stimulus that wouldn’t normally be considered painful at all, such as a light touch or a cold wind.Hyperalgesia This involves a dramatic increase in the severity of the response to a signal one might not ordinarily consider to be very painful. For example, if you touch someone very lightly with the tip of a pen, the individual has dramatic or severe pain in response, Dr. Williams says.
Diabetic Neuropathic Pain
Diabetic peripheral neuropathy affects between 12 percent and 50 percent of people with diabetes. Within that group, distal symmetric polyneuropathy (DSP) is most prevalent. With this form of neuropathy, the first nerve fibers to malfunction are those that are most distant from the central nervous system, with symptoms such as pain, burning, and tingling felt symmetrically in the feet and then traveling up the legs as the condition progresses. Eventually, the upper extremities may also become involved. The main symptoms are painful tingling and burning. Over time, numbness and then profound loss of sensation can set in. Patients may think they are getting better when the pain subsides, but actually, this is the worst-case scenario. (3,5) “All of us hate pain, but pain is a protective mechanism,” explains Peter Highlander, DPM, of the Bellevue Hospital in Bellevue, Ohio. “It tells us to take our hand from the hot stove. If you don’t have that protective mechanism — if you put your hand on the hot stove and don’t pull it off — you’ll go all the way from first-degree burns right down to wounds with bone exposed,” without feeling the pain and acting to avoid situations that require amputation, he says.
Chemotherapy-Related Neuropathic Pain
People with cancer can suffer from neuropathy induced by chemotherapy and other drugs used to treat the disease they’re battling, and the pain can be severe. After chemotherapy is done, the symptoms often abate quickly. But sometimes they last longer or don’t go away at all. (6)
Inflammation-Related Neuropathic Pain
Inflammation caused by infections such as herpes zoster (also known as shingles), Lyme disease, or hepatitis B and hepatitis C can lead to neuropathy. In the case of shingles, the risk of developing postherpetic neuralgia, or lasting nerve pain, increases with age. Inflammation resulting from autoimmune disorders such as vasculitis, sarcoidosis, or celiac disease can also result in nerve pain, especially burning and tingling. (7,9,10)
Other Potential Causes of Neuropathic Pain
Neuropathic pain can also result from the following conditions: metabolic disorders such as hypoglycemia or kidney failure; autoimmune disorders such as rheumatoid arthritis, lupus, Sjögren’s syndrome, and Guillain-Barré syndrome; toxicity; hereditary disorders such as Charcot-Marie-Tooth disease; hormonal disorders; alcoholism; vitamin deficiencies; trigeminal neuralgia (pain from a nerve carrying signals from the face to the brain); physical trauma; compression; and repetitive stress. Additionally, many people have idiopathic neuropathy, meaning doctors don’t know the cause. (9,10,11,12)
Anticonvulsants
Williams cites anticonvulsant and antidepressant medications as “the types of categories we’re likely to turn to and that can be most helpful,” because they have a specific effect on the pain pathways and act on pain from abnormal nerve firing or nerve signals. There is robust evidence to suggest that anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica) are effective as treatments for neuropathic pain, and as such, they are suggested as a first-line treatment. “We believe the mechanism of effect is on calcium channels, and that can reduce transmission of those abnormal nerve signals, often within the peripheral nerve or the spinal cord,” says Williams.
Antidepressants
“Antidepressants have an effect on some of the neurotransmitters, like norepinephrine and serotonin, which can have an effect on pain,” explains Williams. Among the options in this category of treatment are selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), which restore the chemical balance in the nerve cells of the brain; serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine; norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine; and serotonin receptor modulators, such as nefazodone (Dutonin) and trazodone (Oleptro), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves. (16)
Over-the-Counter (OTC) Medications
Common over-the-counter medications that people reach for to address mild to moderate neuropathic pain include acetaminophen (Tylenol); nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve); and topical treatments like capsaicin and lidocaine creams.
Prescription Medication
Popular prescription medications for neuropathic pain include tramadol (Ultram), a nonopioid medication that interferes with pain signals to the brain and affects neurotransmitters. When other medicines don’t work to relieve severe nerve pain, sometimes opioid medication such as hydrocodone, oxycodone (OxyContin), and morphine (Roxanol) are prescribed. Of course, there is a risk of addiction with these medications. (16)
Surgery
Surgery can be useful to release pressure on a nerve, says Highlander. Neurolysis is a procedure by which the outer sheath of an affected nerve is opened and scar tissue may be removed. It is a technique more commonly used to treat the pain of carpal tunnel syndrome, but it’s also in use to treat diabetic neuropathy. (18,19,20) Additional reporting by Joseph Bennington-Castro.
