Nerve Pain (Neuropathic Pain)

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Nerve pain is caused by damage to the nervous system including your spinal cord. Damaged nerves send faulty messages to the brain. The brain interprets these messages as pain or discomfort. Nerve pain can happen in areas where you have no other feeling. It can start happening weeks or months after a spinal cord injury.

How Nerve Pain Happens

Your spinal cord sends signals from your body to your brain. These signals are sent in bunches of nerves called tracts. You can think of each one of these tracts as wires sending specific information from different parts of your body to your brain. Examples include: pressure, touch, body position, temperature, and pain. After a spinal cord injury, a damaged pain tract can send faulty messages to your brain. This can be because of a damaged circuit in your spinal cord. You experience this faulty connection in your spinal cord as pain in specific parts of your body. Even though you might feel pain in your legs or arms, nerve pain really comes from your nerves or spinal cord.

How Nerve Pain Feels
Nerve pain can be described in a number of ways, such as:
  • Burning
  • Tingling
  • Pricking
  • Pins and needles
  • Itchy
  • Shooting
  • Squeezing
  • Cold
  • Electric shock

Nerve damage can cause you to be sensitive to things that are not painful. Just your clothing rubbing on your skin can feel painful. Sometimes things that hurt only a little, like a pinprick, can also become much more painful.

Talking about your pain: When talking to your doctor, you can describe how much pain you feel using a 0 to 10 scale:

Where Nerve Pain Happens

When you feel nerve pain in a specific part of your body, it’s often not where it’s really coming from. Unlike pain from cuts or bruises, nerve pain happens in the damaged nerve. It does not happen in your skin, muscles, or joints where you feel it.

A common example of nerve pain is the feeling you get when your foot ‘falls asleep’ when sitting with your legs crossed for a long time. This happens because of pressure on a nerve in your knee. When your foot ‘wakes up’, you can get the feeling of numbness and pins and needles.

Another example is the feeling you get from hitting your ‘funny bone’ in your elbow. What you’re really hitting is your ulnar nerve. Hitting this nerve can make you feel pins and needles, numbness, and burning in your hand near your wrist and pinky finger. This is because parts of your hand speak with your brain though the ulnar nerve. Even though you hit your elbow, you experience the pain in a different place.

When nerve pain happens in your spinal cord because of injury, it happens in a very similar way. The difference is that damaged tracts in your spinal cord constantly send pain information to your brain.

Nerve pain can happen in areas that otherwise have no feeling because of your spinal cord injury. Where you feel the pain is related to the parts of your body the damaged tracts used to connect.

Talking about your pain: Describe the location of your pain. Where on your body does it start and where on your body does it stop?
When Nerve Pain Happens

Nerve pain might not start right away after a spinal cord injury. It could start a few weeks later, and can last for months or years. It is important to treat nerve pain when you are first aware of it. This can help keep it from getting worse.

Try to observe patterns when your nerve pain happens. It can be constant, or come and go during the day or night. Some things can cause your pain to feel worse. These include getting sick, infections, poor sleep, and even being in a bad mood.

Talking about your pain: Let your doctor know about your pain patterns. Ask yourself these questions:
  • What times of day is it worse?
  • How long does it last?
  • Is it constant, or does it come and go?
Treatments for Nerve Pain

Nerve pain is best treated by mixing different strategies. You and your health care team need to find the mix of medications and other therapies that work for you.

Nerve Pain Medications
Nerve pain medications are different than those for other types of pain. Pain medications used to treat inflammation, headaches, and general injuries are not very good at treating nerve pain. There are a few nerve pain medication options that your doctor can try. Different people respond in different ways to these medications. It can take time to find the right medication and dose for your pain. Be patient. It sometimes takes several days before you feel the effect of the medications.
  • Pregabalin (Lyrica) and Gabapentin (Neurontin) are often the first medications tried. They are anti-convulsants (prevent seizures) that also help treat nerve pain.
  • Some specific anti-depressants (e.g. Amitryptiline) can also help treat nerve pain for some people.

You may also be prescribed short-acting pain medication that you can take as needed. These medications are called breakthrough medications. This is for when you have flare-ups or your pain is more intense (breakthrough pain).

Other Strategies

Acupuncture and TENS (Transcutaneous electrical nerve stimulation) are therapies that can help reduce nerve pain. Exercise can also help reduce long-term pain. Ask your therapist about what might work for you.

Coping with Long-Term Nerve Pain

It’s possible that your pain won’t go away completely with medication and other therapies. Learning how to cope with your pain can help reduce how much it interferes with your life. Relaxation, meditation, and stress management can help. Being involved in social and recreational activities can also help. Many other strategies are available to deal with pain. To learn more, check out the Spinal Cord Essentials Coping with Long Term Pain handout.

Using a pain journal: If you are having pain every day, try keeping a pain journal. It can help you remember what happened in the last days and weeks. It is also helpful for your doctor who can use it to see how well treatments are working.
Disclaimer: Information is provided for educational purposes only. Consult a qualified health professional regarding specific medical concerns or treatment. University Health Network does not assume and disclaims any liability to any party for any loss or damage caused by errors or omissions in this publication.