Chronic Pain Types An Overview of Neuropathic Pain By Erica Jacques Erica Jacques LinkedIn Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. Learn about our editorial process Updated on December 02, 2022 Medically reviewed by Erika Prouty, PharmD Medically reviewed by Erika Prouty, PharmD LinkedIn Erika Prouty, PharmD, is a professional community pharmacist who aids patients in medication management and pharmacy services in North Adams, Massachusetts. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Neuropathic pain, or nerve pain, is one of the most intense types of chronic pain, often described as sharp, stinging, or burning. It is pain caused by damaged nerves or a problem with the nervous system. While neuropathic pain can be debilitating, there are medications to treat it, and they work by changing the way the brain interprets pain. BSIP / Getty Images Symptoms Many terms are used to describe neuropathic pain, such as: SharpShooting or "electrical shock"Burning or "hot"Tingling, "pins and needles," or "prickling"Stabbing Neuropathic pain can occur all the time or come in spurts. Likewise, neuropathic pain can range in intensity from mild and nagging to severe and disabling. Neuropathic pain tends to be worse at night, which may disrupt your sleep. It also tends to flare at rest, which may affect relaxation or mealtime. Overall, the impact neuropathic pain has on one's quality of life can lead to psychological problems, such as depression and anxiety. Causes You can develop neuropathic pain for many reasons. For instance, some types of neuropathic pain are caused by medications, like certain chemotherapy drugs. Others may result from a disease that affects the nervous system, such as: Neuropathy Guillain-Barré syndrome HIV Alcoholism Multiple sclerosis Multiple myeloma Cancer Neuropathic pain is also common in diseases that attack sensory nerves, such as diabetes, and in conditions where certain nerves are inflamed or compressed, such as carpal tunnel syndrome or sciatica. Nerve pain may also result from trauma, like with spinal cord injury, where nerves are damaged or severed. Phantom limb pain is another neuropathic pain disorder in which pain feels as if it is coming from a limb that was amputated. Unfortunately, some types of neuropathic pain have an unknown origin or a cause that is not completely understood. Reflex sympathetic dystrophy (CRPS) is an example. Though the cause may not be fully known, the pain is very real. Diagnosis The diagnosis of neuropathic pain requires a detailed medical history and physical examination, which are often enough to determine the "why" behind a person's neuropathy. However, sometimes the diagnosis requires an evaluation by a specialist, like a neurologist. In this instance, the diagnosis may require more testing, including blood tests, nerve tests like electromyography (EMG), or imaging tests, like magnetic resonance imaging (MRI) of the brain or spinal cord. Treatment Treatment of neuropathic pain usually involves addressing the underlying problem. For example, if a person has neuropathic pain from diabetes, optimizing blood glucose (sugar) control is an essential next step. Bear in mind, though, enhanced glucose control cannot generally reverse the neuropathy, although it can prevent it from getting worse and ease current symptoms. As another example, if a medication is causing debilitating nerve pain, removal or a decrease in the dose of the offending drug may be all that is needed. First-Line Medications Besides treating the underlying problem, medication is often needed to manage neuropathic pain. For the vast majority of patients, treatment of neuropathic pain involves taking one of the following: An antidepressant like Cymbalta (duloxetine) or Elavil (amitriptyline) An anti-seizure medication like Neurontin (gabapentin) or Lyrica (pregabalin) The antidepressants and anti-seizure medications prescribed for neuropathic pain all come with a black-box warning (the U.S. Food and Drug Administration's most serious warning) about their ability to cause suicidal thoughts and behaviors. If you or someone you know is given one of these drugs, make sure you know the signs and get help right away if you see them. All of the drugs may cause unpleasant side effects. The most common side effects of Cymbalta include: NauseaDry mouthTirednessConstipationDecreased appetiteExcess sweating Elavil carries a risk for potentially fatal heart toxicity, as well as other bothersome side effects, including: Dry mouthConstipationUrinary retentionLightheadedness or dizziness when standing up Neurontin may cause: Coordination problemsTirednessDifficulty speakingNausea and vomitingSwelling in the lower legs Lyrica side effects include: DizzinessTirednessDry mouthSwellingBlurry visionWeight gainDifficulty concentrating In addition, you have to wean gradually off of these medications if you want to stop taking them. Withdrawal can be unpleasant and potentially dangerous in some cases. Second-Line Medications Opioids like Vicodin (hydrocodone/acetaminophen) and Percocet (oxycodone/acetaminophen) are not as effective for treating neuropathic pain and, thus, are considered second-line treatments. In addition to their questionable benefit, opioids are associated with several side effects that may severely affect your quality of life. They include: DrowsinessDizzinessConstipationDry mouthNausea and vomitingItchingIncreased sweatingShallow breathingSlow heart rateLoss of consciousnessInvoluntary muscle twitches (myoclonic jerks)Urinary retentionMemory and thinking problems In addition to these side effects, there is a nationwide concern about opioid addiction and abuse, which must be considered. Unique Therapies There are some types of neuropathic pain that may require a unique treatment plan. For instance, if your neuropathic pain is localized (confined to a small area), as is often the case in postherpetic neuralgia, a topical (on the skin) therapy, like a lidocaine patch may be used. In other instances, surgery may be necessary—for example, to release a compressed nerve, as in carpal tunnel syndrome. In the case of a herniated disc, in which an inflamed spinal nerve is a culprit behind the pain, an epidural steroid injection into the spine is sometimes performed. Lastly, sometimes certain medications are used to treat specific neuropathic pain conditions. A classic example is trigeminal neuralgia, which is characterized by severe, stabbing neck and facial pain. This disorder is treated with the anti-seizure medications Tegretol (carbamazepine) or Trileptal (oxcarbazepine). Complementary Therapies A variety of complementary therapies can help relieve neuropathic pain. These therapies are commonly used in combination with medications and include: Physical or occupational therapy Electrical stimulation Relaxation therapy Acupuncture Massage therapy A Word From Verywell Neuropathic pain is often chronic and can be challenging to treat. The good news is that there are a lot of treatment options, and often it's the combination of therapies that does the trick. With that, remain persistent in your efforts to soothe your pain—but also aware that it's often a trial and error process. 25 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cleveland Clinic Health Library. Neuropathic Pain. International Neuromodulation Society. Neuropathy, Neuropathic Pain, and Painful Peripheral Neuropathy: Many Kinds, Causes, and Treatments. Colloca L, Ludman T, Bouhassira D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2 Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M. Peripheral neuropathy and new treatments for multiple myeloma: background and practical recommendations. Haematologica. 2010;95(2):311–319. doi:10.3324/haematol.2009.012674 Fallon MT. Neuropathic pain in cancer. Br J Anaesth. 2013;111(1):105–111. doi:10.1093/bja/aet208 Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron. 2006;52(1):77–92. doi:10.1016/j.neuron.2006.09.021 Trevelyan EG, Turner WA, Robinson N. Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: a qualitative study. Br J Pain. 2016;10(2):70–77. doi:10.1177/2049463715590884 National Institutes of Health, National Institute of Neurological Disorders and Stroke. Complex Regional Pain Syndrome Fact Sheet. Merck Manual: Consumer Version. Neuropathic Pain. Eli Lilly and Company. Highlights of Prescribing Information. Hocaoğlu N, Murat N, Mıcılı SC, Aydın B, Ergür BU, Kalkan Ş. Correlation between Amitriptyline-Induced Cardiotoxic Effects and Cardiac S100b Protein in Isolated Rat Hearts. Balkan Med J. 2016;33(6):681–687. doi:10.5152/balkanmedj.2016.150435 U.S. National Library of Medicine, StatPearls. Amitriptyline. Pfizer. Neurontin (gabapentin) capsules, tablets, oral solution: Information for Patients. Pfizer Parke-Davis. Lyrica-pregabalin capsule; Lyrica-pregabalin solution. Highlights of Prescribing Information. Harvard Medical School, Harvard Health Publishing. Going Off Antidepressants. Vernachio K, Lovett AW, Williams J. A review of withdraw strategies for discontinuing antiepileptic therapy in epilepsy and pain management. Pharm Pharmacol Int J. 2015;3(1):232-235. doi:10.15406/ppij.2015.03.00045 Centers for Disease Control and Prevention. Opioid Overdose: Prescription Opioids. American Society of Anesthesiologists. What Are Opioids. The University of Iowa, GeriatricPain.org. Side Effects of Opioid Medications and General Approaches to Management. Ibrahim AM, Obaidi Z, Ruan G, Adaramola D, Onguti S. Nalbuphine for Opioid-Induced Urine Retention. Ann Intern Med. 2018;169(12):894–895. doi:10.7326/L18-0387 Dhingra L, Ahmed E, Shin J, Scharaga E, Magun M. Cognitive Effects and Sedation. Pain Med. 2015;16 Suppl 1:S37–S43. doi:10.1111/pme.12912 Merck Manual: Professional Version. Neuropathic Pain. The University of California, UCSF Health. Trigeminal Neuralgia Treatments. American Cancer Society. What Is Peripheral Neuropathy? The Foundation for Peripheral Neuropathy. Massage for Neuropathy. Additional Reading Fornasari D. Pharmacotherapy for Neuropathic Pain: A Review. Pain Ther. 2017;6(Suppl 1):25-33. doi:10.1007/s40122-017-0091-4 Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015;90(4):532-45. doi:10.1016/j.mayocp.2015.01.018 McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013 Aug 29;(8):CD006146. doi:10.1002/14651858.CD006146.pub2 By Erica Jacques Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! 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