Tips to Live By

Neuropathic Pain: What to Do About Pain From Neuropathy

Jan. 8, 2024 - Katie McCallum

Whether neuropathy is caused by physical injury, a metabolic condition like type 2 diabetes or harsh medications like chemotherapy drugs, it leads to symptoms that can greatly affect quality of life, including muscle weakness and, perhaps most bothersome, pain.

To understand the steps you can take to help manage pain from neuropathy, it helps to first define neuropathic pain — a type of chronic pain that's also referred to as nerve pain or neurogenic pain.

"Neuropathic pain is when nerve damage causes the nervous system to malfunction," explains Dr. Prachi Patel, a pain medicine physician at Houston Methodist. "This leads to pain commonly described as burning, shooting, tingling or 'pins and needles' sensations."

Triggers can be very subtle — occurring in response to things that aren't usually painful, like wearing socks on your feet or laying a bedsheet over your legs. Or pain can flare up absent any seeming trigger, the sensations coming and going without any noticeable cause.

Dealing with pain as debilitating as this can be challenging, but it's not impossible.

Help relieve pain by managing the underlying cause of neuropathy, when possible

"The first goal is always to treat the underlying cause of neuropathic pain, if possible," says Dr. Patel. "For example, if it is caused by diabetes, improving blood glucose control can help prevent additional nerve damage."

While more rare, other causes of neuropathy that can be addressed include:

  • Alcoholism
  • Infections
  • Shingles
  • Multiple sclerosis
  • Multiple myeloma

It's important to work with your doctor to get to the bottom of what's contributing to neuropathic pain, so you ensure the condition or problem is well-managed.

That said, some neuropathy causes can't be corrected, such as nerve damage sustained from traumatic injury, surgery, limb amputation or chemotherapy. In these cases, practicing the lifestyle measures that help relieve neuropathic pain becomes even more critical.

Ways to relieve pain from neuropathy at home

If you're suffering from neuropathic pain, your doctor will recommend a combination of methods for managing it, including:

  • Taking over-the-counter pain relievers called NSAIDs, such as ibuprofen and naproxen
  • Using topical pain medications, like lidocaine ointment or patches
  • Incorporating relaxation and mindfulness techniques into your day to help manage the stress response that worsens chronic pain
  • Massage therapy
  • Eating a balanced diet
  • Exercising frequently
  • Getting restful sleep

"All of these measures are important for managing chronic pain conditions, including neuropathic pain," says Dr. Patel. "Your doctor may also recommend physical therapy or occupational therapy, where you will learn exercises that help provide relief. These can and should be continued at home."

When other neuropathic pain medications and treatments are needed

If neuropathic pain doesn't respond to over-the-counter medications and persists despite incorporating the lifestyle measures above, consult your doctor.

"Other reasons to seek help include if it's affecting your ability to function, work or sleep," adds Dr. Patel. "We have additional options for managing pain that isn't relieved by the recommendations above."

The first-line prescription medications for neuropathic pain include:

  • Anti-seizure medications, including gabapentin and pregabalin
  • Anti-depressants, such as tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs)

"These medications help relieve pain by modulating neurotransmitters and nerve conduction, affecting how the nervous system communicates within itself," explains Dr. Patel. "In some cases, your doctor may also recommend topical therapies, physical therapy, transcutaneous electrical nerve stimulation (TENS) or an injection that helps blocks pain from specific nerves, called a nerve block."

When is surgery needed to treat pain from neuropathy?

If lifestyle measures, physical therapy and medications aren't enough to provide adequate relief, your doctor may recommend a surgical implant to help ease neuropathic pain.

"Neuromodulation devices such as spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG) and peripheral nerve stimulation (PNS) use electrical stimulation of the nervous system to interrupt pain signals," explains Dr. Patel. "This changes how you perceive the pain."

These devices are implanted under the skin via surgery. As such, they're not first-line treatment options and are only used when neuropathic pain is severe and not responding to conservative therapies.

"Most of these devices have a trial period before proceeding to surgery," adds Dr. Patel. "During this time, you go home with the electrical leads inserted through the skin. The goal is to see whether the device helps relieve pain before implanting it under the skin permanently."

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Categories: Tips to Live By