Nerve Pain

Nerve pain, also called neuropathic pain or neuralgia, results from damage to or dysfunction of the nervous system itself rather than activation of pain receptors by tissue injury. Unlike nociceptive pain (from tissue damage), nerve pain originates from abnormal nerve signaling and often persists after the initial injury heals. Common causes include nerve compression (sciatica, carpal tunnel), radiculopathy (pinched spinal nerve), diabetic neuropathy, post-surgical or post-traumatic nerve injury, and complex regional pain syndrome (CRPS). At Mountain Spine & Orthopedics, we use advanced diagnostic techniques and targeted treatments including medications, nerve blocks, epidural injections, and nerve decompression surgery to restore function. Learn more about peripheral neuropathy from the National Institute of Neurological Disorders and Stroke.

Symptoms include burning, shooting, stabbing, or electric shock-like pain, often described as pins-and-needles or tingling (paresthesias). Pain may be constant or intermittent, spontaneous or triggered by light touch (allodynia). Associated symptoms include numbness, hypersensitivity to temperature or touch, muscle weakness in the affected nerve distribution, and impaired coordination. Nerve pain often worsens at night and may not respond well to traditional pain relievers.

Risk factors include diabetes (diabetic neuropathy is most common cause), nerve compression from herniated discs, spinal stenosis, or bone spurs, prior surgery or trauma causing nerve injury, chemotherapy (chemotherapy-induced peripheral neuropathy), alcohol abuse, vitamin deficiencies (especially B12), autoimmune diseases, infections (shingles, HIV), and family history of neuropathy. Repetitive motions or prolonged pressure on nerves (carpal tunnel, ulnar nerve at elbow) also increase risk.

Diagnosis includes detailed neurological examination assessing sensation, reflexes, and muscle strength in affected areas. Electrodiagnostic studies (EMG/nerve conduction studies) measure nerve electrical activity and identify specific nerve damage. Diagnostic imaging (MRI, complimentary review available) identifies structural nerve compression from discs, stenosis, or tumors. Diagnostic nerve blocks help confirm specific nerves as pain sources. Blood tests screen for diabetes, vitamin deficiencies, or autoimmune causes of neuropathy.

Medications for Nerve Pain

Neuropathic pain medications stabilize abnormal nerve signaling:

• Anticonvulsants - gabapentin, pregabalin (first-line for nerve pain)
• Antidepressants - duloxetine, amitriptyline (dual benefit for pain and mood)
• Topical agents - lidocaine patches, capsaicin cream for localized nerve pain

Traditional pain relievers (NSAIDs, acetaminophen) are generally less effective for nerve pain. Opioids are minimized due to limited efficacy and addiction risk.

Nerve Block Injections

Nerve block injections deliver local anesthetic +/- corticosteroid directly to affected nerves, providing both diagnostic confirmation and therapeutic relief. Types include:

• Epidural steroid injections - spinal nerve root compression (sciatica, radiculopathy)
• Sympathetic nerve blocks - complex regional pain syndrome (CRPS), certain neuropathies
• Peripheral nerve blocks - specific nerve entrapments or neuralgias

Radiofrequency Ablation and Neuromodulation

For nerve pain confirmed by diagnostic blocks, radiofrequency ablation uses heat to lesion pain-transmitting nerves, providing 6-12+ months of relief. For severe refractory nerve pain, spinal cord stimulation (neuromodulation) implants electrodes that deliver electrical pulses to mask pain signals, highly effective for failed back surgery syndrome and CRPS.

Physical Therapy and Rehabilitation

Physical Therapy maintains mobility, prevents muscle atrophy, and desensitizes hypersensitive nerves through graded exposure. Occupational therapy addresses functional limitations. Transcutaneous electrical nerve stimulation (TENS) may provide temporary relief.

Surgical Nerve Decompression

For nerve compression causing pain (pinched nerves, carpal tunnel, disc herniation compressing nerve roots), surgical decompression removes the compressive structure, allowing nerve recovery. Options include microdiscectomy, carpal tunnel release, or foraminotomy depending on location and cause.

Nerve pain characteristics help distinguish it from other pain types: burning, shooting, or electric quality (not dull aching), pain in a specific nerve distribution (dermatomal pattern for spinal nerves), triggered by light touch or temperature changes, and often worse at night. Nerve pain may occur without obvious triggers and can persist despite tissue healing. Red flags requiring urgent evaluation include rapidly progressive weakness (drop foot, hand weakness), loss of bladder/bowel control, saddle anesthesia (numbness in groin/inner thighs), or progressive numbness spreading proximally, which may indicate spinal cord compression or cauda equina syndrome requiring emergency intervention.

Preventing nerve damage includes managing diabetes (strict blood sugar control prevents diabetic neuropathy progression), avoiding prolonged pressure on nerves (proper ergonomics, taking breaks from repetitive tasks, avoiding crossing legs), maintaining healthy weight to reduce nerve compression risk, limiting alcohol and avoiding tobacco (both toxic to nerves), ensuring adequate vitamin B12 and other vitamins through diet or supplementation, and seeking early treatment for acute nerve compression before permanent damage occurs. Prompt treatment of shingles reduces postherpetic neuralgia risk.

Experiencing burning, shooting, or electric nerve pain limiting your life? Schedule your consultation today at Mountain Spine & Orthopedics for comprehensive nerve pain evaluation. Complimentary MRI review and second opinion available. Car accident or trauma causing nerve damage? We treat accident-related nerve injuries and neuropathic pain.