Treating Pain Blog

Pain Management

The Best Way to Treat and Control Neuropathic Pain

Do you ever feel a stabbing pain, numbness, burning, or “pins and needles” sensations? If you have any of these unpleasant symptoms, you may have Neuropathic Pain (NP). Neuropathic pain is unlike the “usual” pain you have immediately after an injury. With NP, nerve fibers are damaged and become overactive. They send inappropriate signals to other pain centers in the spinal cord and brain. The pain quickly reaches unbearable levels, despite a lack of tissue damage, and can persist for years if left untreated.

The best way to treat and control NP is to seek help from a pain specialist immediately when you start having symptoms. Effective management lowers pain levels and treats related problems such as insomnia, depression, and anxiety.

A pain specialist will provide you with a multitude of treatments, tailored to your individual situation. They range from oral medications to pain-relief injections, device implants, and regenerative therapies. A pain specialist can guide you and help you manage your NP.

Costs of living with NP

Every year, in the United States, patients with NP spend over 100 billion dollars on doctor visits. Another 100 billion dollars are lost due to low productivity and missed work days. In the year 2000, US scientists looked at the cost of medical visits for a total of 55,686 adult patients with NP.

They found that:

  • The most common cause of NP was back and neck pain (62.3% of patients), followed by causalgia (12.1%) and diabetic neuropathy (10.8%).
  • Patients with NP were more likely to have other pain-related conditions such as fibromyalgia, osteoarthritis, coronary heart disease.
  • Neuropathic pain led to a 3-fold increase in the use of healthcare resources.
  • Quality of life was significantly reduced in NP patients due to fatigue, sleep deprivation, anxiety, and depression.

Who needs treatment?

People with the following conditions need treatment for NP :

  • Amputation
  • Cancer that requires chemotherapy or radiation treatment
  • Complex regional pain syndrome (CRPS) 
  • Diabetes
  • Trigeminal neuralgia (face pain)
  • HIV/AIDS
  • Long-lasting shingles pain
  • Spinal nerve pressure from surrounding tissues
  • Chronic pain after a surgery
  • Nerve compression by tumors
  • Fibromyalgia

When to see a pain specialist

Neuropathic pain is difficult to treat, with only 40-60% of people reaching partial relief. However, early diagnosis and treatment from a pain specialist can decrease your pain and prevent further nerve damage.

Seek medical care right away if you notice the following symptoms:

  • Numbness, burning and a sensation of “pins and needles”.
  • Abnormal painful, itchy, burning sensations.
  • Extreme sensitivity to touch.
  • Increased sensitivity to pain.

Treatment goals

  1. Control the underlying disease (e.g. radiation to shrink a tumor that compresses a nerve in a cancer patient).
  2. Relieve the pain.
  3. Maintain functionality (your ability to move, work, drive).
  4. Improve the quality of life (sleep, mood, concentration).

Multimodal Therapy

Multimodal Therapy is an effective approach for treating NP. This therapy combines several treatments in order to reach a superior pain relief, as compared to just using one.

Treatment for NP includes a combination of:

  1. Treatments from a pain specialist
  2. Treatments from a therapist
  3. Surgeries to treat pain

Treatments from a pain specialist

Medications

Antidepressants.  Some can effectively treat NP. The doses used to treat pain are lower than the doses for depression. However, if you receive treatment with antidepressants for pain, it doesn’t mean that you’re depressed or that you’re receiving adequate treatment for depression. You may need additional treatment.

There are several classes of antidepressants. All of them increase certain neurotransmitters, chemicals that allow your nerves, spinal cord, and brain to communicate. A side effect of antidepressants is drowsiness. However, this may help you sleep if you take your medications in the evening.

Anticonvulsants.  They were found to relieve NP. There is no definite test to determine if a certain anti-convulsant will decrease your particular type of pain. Therefore, you’ll need a short trial period.

Topical agents.  These medications go directly on the skin, over a painful area. When compared to taking pills, they have a lower risk of widespread side effects (drowsiness, dizziness).  Lidocaine patches release medicine slowly, over a period of 12 hours. Capsaicin cream is made from hot peppers. It may improve NP in the periphery (leg, arm or chest area). It is often used in diabetics and people with shingles pain.

Pain relievers. Over-the-counter pain medications, such as anti-inflammatory drugs and Tylenol (Acetaminophen), can relieve mild NP. Opioids are not always effective for NP.

Pain-relief Injections

Nerve blocks.  These injections treat pain that starts in a particular nerve or in a group of nerves that serve the same purpose.

There are different types:

  • Peripheral nerve block    It uses local anesthetics and steroids to interrupt pain signals along a nerve, usually in an arm, leg, or breast area.
  • Sympathetic nerve block    This block targets nerves that control basic functions like blood flow or digestion. It controls painful blood vessel spasm, CRPS pain, chronic stomach pain.
  • Neurolytic block    Nerve fibers are intentionally damaged with chemicals, heat, or freezing temperatures. Effects last for weeks, months, or longer. It helps in the setting of cancer pain. However, it carries a risk for increased pain and is used on a case-by-case basis.

Epidurals.  An epidural steroid injection is a common treatment for pain in a certain body area. Your pain specialist injects steroids and a local anesthetic around the spinal cord. Epidurals improve NP due to spinal stenosis, disc herniation, postherpetic neuralgia. The effects last from weeks to months.

Implantable Devices 

This is a growing field of pain medicine. It uses devices implanted in your spinal area, to treat long-lasting pain. The devices are often used to treat NP that failed to improve with oral medications, pain-relief injections, or physical therapy.

Spinal cord stimulators.  Your pain specialist places these small devices under the skin of your back, buttons or abdomen. They have thin wires (electrodes) that send mild electrical bursts to your spinal cord in order to stop pain signals. They are used for:

  • Nerve root pain
  • Failed back surgery syndrome (FBSS)
  • CRPS
  • Neuropathy 

To read more about SCS, click here.

Intrathecal (pain) pumps.  These small devices deliver medication through a thin tube, to the space around your spinal cord. They release opioids alone or opioids combined with other medications, in a time-controlled manner. Intrathecal pumps treat pain caused by:

  • Cancer
  • FBSS
  • CRPS
  • Body-wide muscle spasms

To read more about intrathecal pumps, click here.

Treatment with electric pulses

Treatments that use mild electric current pulses relieve some types of NP. They are useful in people concerned with medication side effects.

Transcutaneous Electrical Nerve Stimulation (TENS).  You attach several electrodes to the skin, over a painful area such as the neck or back. When the TENS device is on, you’ll feel tingling. You can carry this battery-operated device with you and use it throughout the day.

Regenerative therapy

Platelet-rich plasma (PRP).  A lab processes your blood to obtain highly concentrated platelets. These are injected into painful joints, tendons, and ligaments. This treatment relieves pain in the facet joints and SI joints.

Platelet growth factor epidurals.  A lab processes your blood to obtain a high concentration of platelets, growth factors, and other helpful agents. These are placed into the epidural space where they help with back pain (sciatica, radiculopathy).

Stem cells.  Cells from your own bone marrow are used to heal injured bone, ligaments, tendons, cartilage, and muscles. They are often used in the spine to treat facet joint pain due to arthritis or disc pain due to aging and injury.

Treatments offered by a therapist

  • Physical therapy.  It lowers peripheral neuropathy pain. If you have muscle weakness as a result of NP, physical therapy helps improve your movements.
  • Counseling.  Treatments for stress, depression, or anxiety decrease the negative impact of NP. 
  • Acupuncture.  This traditional Chinese treatment triggers the release of pain-numbing chemicals. There are few downsides to acupuncture. See if it helps with your NP.
  • Massage.  While it’s unclear whether massage helps with NP directly, it can relieve painful muscle spasms that start over your area of pain.

Surgery that treats pain

Often surgery creates NP after a mastectomy, an amputation, or a failed back surgery. However, in certain situations, surgery decreases NP.

Examples:

  • Surgery to remove a tumor.  Used when pressure from a tumor causes nerve pain.
  • Microvascular decompression.  This surgery removes vessels that press on nerves and cause pain. It often improves trigeminal nerve pain.
  • Motor cortex stimulation.  Electrical bursts travel to the part of the brain that controls movement. This procedure is used to treat phantom limb pain, trigeminal nerve pain, post-stroke pain, and more. 

At NSPC, we fully understand the challenges of having to live with neuropathic pain. Our pain specialists are here to help you. Click here for an appointment.