Nerve Pain: A Complete Guide to Understanding and Managing It

Pain that burns, feels like electric shocks, or tingles may be indicative of neuropathic pain. Population-based studies estimate the prevalence of pain with neuropathic characteristics to be between 6.9% and 10% among adults.^{1, 2} These estimates are based primarily on questionnaires, without confirmation of the diagnosis for each individual. Several mechanisms may coexist: finding nerve damage does not prove that it accounts for all of your pain.³ The evaluation is used to clarify the problem and select appropriate care.

Neural pain, also known as neuropathic pain, is caused by damage to or a disease of the system that transmits and processes sensations from the body. This system is called the somatosensory system.⁴ Symptoms, physical examination, and medical history help identify this type of pain. Your pain is still real even when an examination alone does not pinpoint its cause.

This guide helps you understand what nerve pain is, how to recognize it, what causes it, and what treatments can help. If you’re living with persistent pain, be sure to check out our comprehensive guide to chronic pain to understand the mechanisms behind long-lasting pain.

What is nerve pain and how does it differ from other types of pain?

Neural pain results from an injury or disease of the sensory system, whereas nociceptive pain results from the activation of sensors that detect threats to other tissues.³ The first definition is that of the International Association for the Study of Pain (IASP).⁵ The sensory system includes the nerves, the spinal cord, and regions of the brain. The spinal cord is a cord of nervous tissue within the vertebral column; it transmits messages between the brain and the body.⁶

Nociceptors are nerve receptors that respond to stimuli that can damage tissue. Their activity, known as nociception, transmits nerve signals; it is distinct from the pain experienced by the individual.⁴ A skin burn or an inflamed joint can thus cause nociceptive pain.

A single person may experience both nociceptive pain and neuropathic pain. The diagnosis, the intensity of the pain, and the resulting activity limitations collectively guide care, as the causes and mechanisms vary.⁷

Neuropathic pain is called peripheral pain when it originates in nerves located outside the brain and spinal cord.⁵Carpal tunnel syndrome, which compresses a nerve in the wrist, and diabetic neuropathy are possible causes. Pain caused by damage to the brain or spinal cord is called central pain. It can occur after a stroke, which disrupts blood flow to the brain, or in multiple sclerosis, a disease that attacks the protective sheath surrounding certain nerve fibers.⁷ Some people with multiple sclerosis develop neuropathic pain.⁸

To understand the difference from pain following a recent injury, consult our guide on acute pain.

What are the characteristic symptoms of nerve pain?

Nerve pain can cause a burning sensation, electric shocks, tingling, shooting pains, or pain accompanied by numbness.⁹ These sensations guide the evaluation but do not, on their own, confirm the diagnosis. A review of people with back pain, with or without leg pain, found that numbness was more useful than certain other terms for identifying a neurological component.¹⁰ The precise mechanisms behind each sensation remain partly debated.¹¹

Typical sensations of nerve pain:

• Burning: An intense hot sensation, as if the area is on fire
• Electric shocks: Sudden discharges that can be very intense
• Tingling: Sensations of pins and needles or a crawling sensation
• Shooting pain: Sharp, shooting pains that travel through the area
• Numbness with pain: The area may feel both numb and painful at the same time

A loss of sensation and pain can occur simultaneously when nerve fibers are affected in different ways.¹² Some fibers transmit sensations less effectively, while others produce abnormal activity. Research suggests, in particular, a link between the burning sensation and the spontaneous activity of fibers that detect stimuli threatening the tissues. It also associates certain electric shocks with discharges in tactile fibers whose protective sheath is damaged.¹¹ These explanations do not allow us to identify a person’s specific mechanism based on their symptoms alone.

Two characteristic phenomena of neuropathic pain deserve special attention.

Allodynia refers to pain experienced in response to a stimulus that does not normally cause pain, such as light touch.^{13, 14} Clothing, a breeze, or a gentle touch may cause discomfort. This observation contributes to the evaluation, though it does not, on its own, identify the cause.

Hyperalgesia refers to a pain response that is more intense than expected to a stimulus that is typically painful.^{13, 14} It may be observed during the examination and should be interpreted in conjunction with other symptoms and signs.

The location of the pain must correspond to the nerve or nerve pathways that may be affected; this correspondence aids in the diagnosis.³ A dermatome is an area of skin associated with a nerve root—that is, the portion of the nerve near the spinal cord. Dermatome maps vary, and their territories overlap.¹⁵ The distribution of a peripheral nerve is different: this nerve may consist of fibers from several nerve roots. Sciatica can radiate down the leg; compression at the wrist can affect certain fingers. These pain patterns provide clues, though they do not constitute an exact map for every individual.

What causes neuropathic pain?

Neuropathic pain can be caused by nerve compression, diabetes, an infection, certain cancer treatments, or a disease of the brain or spinal cord.^{16, 7} Not all of these conditions cause pain in every person.

Common causes of neuropathic pain:

Nerve compression

Compression reduces the space available for a nerve or nerve root. A herniated disc—a portion of the cushion between two bones in the spine that protrudes—can press on a nerve root and contribute to sciatica. In the wrist, carpal tunnel syndrome compresses the median nerve, which transmits sensations from the hand, among other things.⁷ For more information, see our comprehensive guide to sciatica.

Diabetes

Diabetes can damage the peripheral nerves, especially those in the feet. This complication, known as diabetic neuropathy, can cause pain, tingling, or a loss of sensation.^{17, 18} The exam also checks for other possible causes of these symptoms.

Infections

After a case of chickenpox, the virus can remain dormant in clusters of nerve cells, then reactivate years later and cause shingles.¹⁹ Pain may persist along the nerve pathway after shingles. This pain is called postherpetic neuralgia.²⁰

Chemotherapy

Several chemotherapy drugs can cause peripheral neuropathy.²¹ This is a common side effect following treatments that are toxic to the nerves²², and it mainly affects the hands and feet—that is, the parts of the body farthest from the heart²³.

Nerve Injury

Direct injury to a nerve—whether from an accident, surgery, or amputation—can cause persistent neuropathic pain. After surgery, the frequency of this nerve-related component varies depending on the risk of nerve damage specific to the procedure²⁴, and after an amputation, phantom limb pain is a common and sometimes long-lasting complication²⁵.

Diseases that affect the nervous system

Multiple sclerosis affects the brain and spinal cord, while Guillain-Barré syndrome occurs when the immune system attacks the peripheral nerves. A review synthesizing the results of 24 studies estimates that approximately 26.8% of people with multiple sclerosis experience neuropathic pain.⁸ Pain is also common in Guillain-Barré syndrome and may persist beyond the initial phase.²⁶ Progressive weakness requires prompt medical evaluation.²⁷

Why do some people develop neuropathic pain while others don't?

Two people with comparable nerve damage may experience different types of pain. Changes in the nerves, spinal cord, and brain can interact, and their respective contributions vary from person to person.^{28, 29} Therefore, the extent of the injury alone is not sufficient to predict the full range of the pain experience.

What are the common types of neuropathic pain?

Common forms of neuropathic pain include nerve root pain, certain diabetes-related neuropathies, neuralgia following shingles or facial neuralgia, and phantom limb pain.⁷ Complex regional pain syndrome (CRPS) warrants special consideration: Type II CRPS involves an identified major nerve lesion, whereas no major nerve lesion is identified in Type I. Therefore, not all cases of CRPS are automatically classified as neuropathic pain.³⁰

Radiculopathy and Radicular Pain

Radicular pain originates from a nerve root near where it exits the spine. Radiculopathy refers to a loss of function in this nerve root: sensation, strength, or reflexes—automatic responses—may be altered. Irritation of the nerve root may involve compression, stretching, and an inflammatory response.^{31, 32} The examination looks for these signs to distinguish nerve root involvement from pain originating in other tissues.

Sciatica is pain that radiates from the buttock down the leg, sometimes all the way to the foot. It may be accompanied by tingling, numbness, or weakness.³³ The progression of the condition and the observed symptoms guide treatment. For more information, see our comprehensive guide to sciatica and our guide to lumbar disc herniation.

Cervical radiculopathy is damage to a nerve root in the neck. It can affect strength, reflexes, or sensation in the arm or hand. Pain in the arm alone is not enough to confirm the condition. For more information, see our guide on neck pain.

Peripheral neuropathy

Peripheral neuropathy affects the nerves outside the brain and spinal cord.³⁴ It can affect a single nerve or multiple nerves, and its most common form affects both sides of the body, starting with the most distant parts.³⁴

Diabetes is a common cause of peripheral neuropathy. The most common form is symmetric distal polyneuropathy: multiple nerves are affected on both sides, starting in the feet and sometimes spreading to the hands.¹⁸ The risk increases with the duration of diabetes. Symptoms may include burning, numbness, and tingling.^{17, 35} Better control of blood glucose levels helps prevent neuropathy, particularly in type 1 diabetes. For type 2 diabetes, the Cochrane Review did not confirm a reduction in its incidence with intensive control. Such control also increased the risk of severe hypoglycemia, a dangerous drop in blood sugar. Treatment goals are set in consultation with the prescribing physician.³⁶

Chemotherapy-induced neuropathy can develop after certain cancer treatments that affect the nerves.²¹ A review of 31 studies, involving a total of 4,179 people who underwent these treatments, reported neuropathy in approximately 68% of patients during the first month after chemotherapy, 60% at three months, and 30% at six months or later.²² These figures do not apply to all types of chemotherapy. Symptoms mainly affect the hands and feet and may persist.

Specific Neuralgias

Postherpetic neuralgia occurs after an episode of shingles. It affects some people who have had shingles, and the risk increases significantly with age, which is the most well-established risk factor.^{20, 37} The pain can be very severe and persist for months or years after the rash has healed: about 10% of people still experience pain one month after shingles, and a small proportion continue to do so for five years or more.³⁸ It occurs in the area where the rash appeared.

Trigeminal neuralgia causes sudden, intense facial pain.³⁹ It affects the trigeminal nerve, which transmits sensations from the face, among other things. Episodes of pain are very brief and sudden, and their intensity is often described as extreme. They can be triggered by simple activities such as chewing, talking, or brushing your teeth, or even by light touch that would not normally cause pain.³⁹

Complex Syndromes

Complex Regional Pain Syndrome (CRPS), formerly known as algodystrophy, causes pain that is disproportionate to the initial injury.⁴⁰ It can affect the limb’s color, temperature, or sweating, as well as its sensitivity, movement, skin, or nails. It often occurs after an injury or surgery, sometimes with no apparent cause.⁴¹ Type I differs from Type II in that no major nerve damage has been identified. Both types require appropriate management.³⁰

Following a wrist fracture, a review of three trials found fewer cases of CRPS in people receiving vitamin C than in those receiving a placebo, a product with no active ingredient.⁴² The 2022 guidelines, however, highlight conflicting results across the trials and conclude that the use of vitamin C for prevention remains uncertain.³⁰ Discuss this option with the team treating the fracture.

Phantom limb pain can be felt in the missing limb after an amputation.⁴³ Changes in the central nervous system may contribute to this, in conjunction with changes in the nerves and spinal cord²⁵; peripheral and psychological factors may also be considered during evaluation, although the role of emotional factors and stress remains less well documented⁴⁴.

Why does nerve pain sometimes persist after healing?

Nerve pain may persist because nerve damage or changes in the processing of sensory signals remain even after a wound has healed or other tissues have been repaired.^{45, 29} Visible healing does not prove that all nerve functions have returned to their previous state. These mechanisms may interact and must be reassessed as the condition evolves.

Peripheral hypersensitivity refers to nerve receptors that have become more sensitive: they react more readily or more strongly to stimuli in the affected area. It can occur, in particular, alongside an inflammatory response.¹³ This mechanism cannot be confirmed based on a single symptom.

Central sensitization refers to an increase in the response of certain nerve cells in the spinal cord or brain to sensory stimuli.⁴⁶ It is being studied as a mechanism that may contribute to hypersensitivity. However, human studies do not allow for a clear distinction between its contribution and that of the peripheral nerves in an individual.⁴⁷

The image of an alarm that has become overly sensitive can help illustrate this hypersensitivity. It depicts a strong reaction to touch or movement, even in the absence of a new injury. This image does not demonstrate the mechanism of your pain. A critical review found no studies meeting its criteria to establish that central sensitization causes persistent pain. In particular, it highlights the difficulty of measuring pain and sensitization separately.⁴⁸

Neuroplasticity refers to the nervous system’s ability to change over time and through experience—in terms of its structure, connections, and functioning—both during development and in adulthood.^{49, 50} Treatment options are selected and then reevaluated based on symptoms, function, and goals.

To learn more about these mechanisms and possible treatments, see our guide on chronic pain.

How is neuropathic pain diagnosed?

The diagnosis of neuropathic pain is based on your symptoms, your medical history, and an examination of sensation, muscle strength, and reflexes—the body’s automatic responses.⁵¹ Additional tests may be performed to look for a lesion or condition that could explain these signs.⁵² No blood test or imaging test directly measures your pain.

A history of symptoms helps to understand the symptoms, their progression, and their impact on daily activities. Words such as “burning,” “electric shocks,” or “tingling,” along with their location, can guide the evaluation but do not, on their own, confirm a neuropathic cause.

The physical exam includes tests of nerve function. The healthcare professional will test your sensation (light touch, prick, temperature), your reflexes, and your muscle strength, as part of a structured assessment of sensory symptoms⁵³. Abnormal results on these tests may point to a specific nerve or nerve root, but this conclusion is based on the entire examination and medical history—never on a single test alone.

Questionnaires that use the same questions for each person can help structure the interview and identify neuropathic pain.⁵⁴ The DN4 questionnaire (4-Question Neuropathic Pain) and the LANSS scale—a questionnaire that groups certain sensations and signs—can help identify this type of pain, though they cannot confirm a diagnosis on their own. The European guidelines strongly recommend their use, provided they are incorporated into a broader assessment.⁵³

Additional tests are not always necessary, but can be useful in certain situations:

• Magnetic resonance imaging (MRI) can reveal a lesion in the brain or spinal cord or compression of a nerve root. The results are interpreted in conjunction with the patient’s symptoms and a physical examination. It is not routinely performed, particularly in cases of neuropathy that typically affects both feet.
• Nerve conduction studies measure the transmission of electrical signals in specific nerves. Electromyography (EMG) records the electrical activity of muscles. These tests can help identify nerve damage; they do not directly measure pain and do not detect all types of damage to small fibers.
• Blood tests can screen for diabetes, vitamin B12 deficiency, or certain diseases in which the immune system attacks the body. The tests are selected based on the observed symptoms.

Signs requiring urgent medical evaluation:

• New-onset muscle weakness that is progressing rapidly.
• New difficulty starting to urinate, an inability to urinate, or unusual loss of bladder control.
• An unusual loss of bowel control or of the sensation of needing to have a bowel movement.
• A loss of sensation around the genitals or anus.
• Sciatica on both sides, or weakness or numbness in both legs that is severe or getting worse.

These symptoms require urgent medical evaluation. New problems with bladder function, bowel movements, or genital sensation, as well as the symptoms in both legs described above, may indicate severe nerve compression in the lower back: go to the emergency room immediately.⁵⁵ Back pain accompanied by a fever, chills, or general malaise also requires urgent medical attention.⁵⁶ Progressive weakness may also be a sign of Guillain-Barré syndrome and must be evaluated promptly.²⁷

How is neuropathic pain treated?

Treatment for neuropathic pain may include addressing the underlying cause, appropriate medications, and support for resuming daily activities.⁵⁷ Not all of the medications studied are the same as those used for pain following an injury.⁵⁸ Several may provide relief for some people, but their average benefits remain modest.⁵⁷

The diagnosis is a key factor in choosing a medication. A review of 27 studies, involving a total of 3,619 people with back or leg pain related to the spine, found small to moderate benefits from medications targeting neuropathic pain. Some analyses suggested greater benefits when neuropathic pain was likely or confirmed. However, the certainty of the results remained low to very low.⁵⁹ Another review, limited to anticonvulsants—medications also used to treat epileptic seizures, such as gabapentin and pregabalin—found no reduction in pain or functional limitations for lower back pain or pain related to the lower back’s nerve roots; adverse effects were more common.⁶⁰ These results do not allow us to predict your individual response.⁵⁷

What role do anti-inflammatory drugs play?

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are not listed as first-line treatments for neuropathic pain in the cited guidelines. The 2015 systematic review found no trials for these medications that met its criteria.⁵⁷ An anti-inflammatory medication may be appropriate if another source of pain is also present. The prescriber evaluates its appropriateness and risks.

Medication approaches.

The 2015 international review first recommends certain antidepressants, pregabalin, or gabapentin for several types of neuropathic pain in adults.⁵⁷ The 2020 French guidelines place certain treatment options at different stages, notably pregabalin.⁶¹ Trigeminal neuralgia and sciatica require recommendations specific to their respective diagnoses.⁶²

Tricyclic Antidepressants (e.g., amitriptyline, nortriptyline)

These medications can relieve certain types of neuropathic pain, even in the absence of depression. Their effects and side effects guide the adjustment of the treatment in consultation with the prescribing physician. Research—primarily in animals for certain mechanisms—suggests that they strengthen nerve pathways that block messages related to stimuli that threaten tissues. Norepinephrine, a substance that enables nerve cells to communicate, is thought to contribute to this process.⁶³ Doses for pain are often lower than those used for depression.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Duloxetine and venlafaxine affect the availability of two neurotransmitters: serotonin and norepinephrine. They can reduce certain types of neuropathic pain.⁵⁷ The choice between them depends on the diagnosis, other medications, and side effects. Venlafaxine is not listed among the initial treatment options in the guidelines of the British organization NICE, which evaluates healthcare, outside of specialized care.⁶²

Gabapentinoids (gabapentin, pregabalin)

Gabapentin and pregabalin are anticonvulsants—medications also used to treat epileptic seizures. They can relieve certain types of neuropathic pain.⁵⁷ Follow-up care takes into account pain relief, as well as drowsiness, dizziness, and other risks. These medications are not automatically suitable for every type of pain that radiates down a leg.

Topical Treatments

Topical treatments are applied to the skin. Patches containing lidocaine, a substance that reduces local sensitivity, or capsaicin, a substance derived from chili peppers, may be considered for certain localized peripheral neuropathic pains.⁵⁷ The products and concentrations are not interchangeable. High-concentration capsaicin patches require specialized care.⁶²

For trigeminal neuralgia, the NICE guidelines recommend carbamazepine as the initial treatment. A specialist consultation is recommended if it is not suitable or does not provide sufficient relief.⁶²

Non-Medication Approaches

Non-drug treatments can help people resume their activities, better manage their symptoms, and reduce the impact of those symptoms. They can be used alongside medications when those are helpful.⁶⁴ The choice depends on the diagnosis and your goals.

Physical therapy is one of the recommended treatments for complex regional pain syndrome. The Cochrane Review notes, however, that the evidence regarding the effects of various techniques remains highly uncertain.⁶⁵ The following section describes these techniques and other options depending on the specific nerve-related problem.

Transcutaneous electrical nerve stimulation, or TENS delivers an electric current through electrodes placed on the skin. French guidelines have evaluated it as a treatment for certain types of peripheral neuropathic pain.⁶¹ A Cochrane review of 15 studies, involving a total of 724 participants, found the evidence to be too weak and the study protocols too varied to confidently conclude that it is effective.⁶⁶

Psychological approaches, such as cognitive-behavioral therapy—which helps examine the thoughts and behaviors associated with symptoms—or acceptance and commitment therapy—which helps people act in accordance with their values despite their symptoms—can be discussed as needed. A French guideline recommends psychotherapy—particularly cognitive-behavioral therapy and mindfulness—as a second-line adjunct to other treatments.^{67, 61}

Lifestyle habits can be part of your care: staying active in an appropriate way, finding solutions to sleep problems, and recognizing stressful situations. These steps are aimed at supporting your health and daily activities; they do not mean that you are responsible for the pain.

How does physical therapy help manage nerve pain?

Physical therapy can help manage neuropathic pain through tailored exercises, explanations, and—depending on the diagnosis—guided movements or sensory training.⁶⁸ Treatment aims to relieve symptoms and facilitate daily activities. Results depend on the specific condition being treated; the evidence is less certain for some techniques.

Pain education explains symptoms and helps patients discuss their concerns and daily activities. A meta-analysis of eight reviews on chronic pain found favorable results in some analyses regarding pain or difficulties such as fear of movement and anxiety. Other analyses found no benefit, and the quality of the reviews was very low.⁶⁹ These findings do not apply exclusively to neuropathic pain. Explanations should always be tailored to your specific situation.

Graded motor imagery gradually leads to the recognition and mental representation of movements, followed by observing them in a mirror.⁷⁰ A review of six studies involving 171 people with Type I CRPS found encouraging results regarding pain. Three studies focused on the complete program, and three on the mirror alone. The small number of participants and differences between studies make it impossible to recommend one technique over another.⁷¹ The comprehensive program consists of three stages:

1. Determine whether an image shows a left or right limb.
2. To imagine a movement without carrying it out.
3. Watch the movement of the unaffected limb in a mirror.

Mirror therapy allows the patient to see the reflection of the unaffected limb instead of the painful or missing limb.⁷² In Type I CRPS following a stroke, adding this therapy to standard rehabilitation care may improve pain and function for up to six months of follow-up. The certainty of these results remains low.⁷³ The physical therapist adapts the technique and monitors your response.

Sensory training can take various forms. Desensitization involves gradually exposing the skin to tolerable touches. Tactile discrimination, on the other hand, involves recognizing a characteristic of the touch, such as its location or the size of the object. In a small study of 13 people with CRPS, this training reduced pain, whereas stimulation alone did not; the improvement persisted at three months.⁷⁴ This preliminary result does not prove that all forms of touch have the same effect.

Neural mobilization uses guided movements of the limbs or trunk to move the nerves relative to the surrounding tissues and improve their tolerance to movement.⁷⁵ These movements can be performed by you or with a physical therapist. Their intensity is adjusted to avoid aggravating significant symptoms.

A review of 21 studies, involving a total of 914 people with pain radiating from the spine down to the leg, found that neural mobilization was more effective in relieving pain than the comparison treatments.⁷⁶ The benefits regarding activity limitations varied across the study groups. The studies were very different and often subject to errors that could skew their results; therefore, the conclusions remain uncertain.

The therapeutic exercise program combines endurance and strength-building activities, depending on your needs.⁷⁷ In a study without a control group, 17 people with diabetic neuropathy were evaluated after ten weeks of exercise supervised by a professional. Their most severe pain of the month and their nerve symptoms had decreased.⁷⁸ While this encouraging result is promising, it does not allow us to attribute the entire improvement to the exercises alone. The program may include:

• Endurance activities, such as stationary cycling, tailored to your tolerance and health condition.
• Strength-training exercises for your legs, arms, or core, depending on your goals.
• Balance training if a loss of sensation makes it difficult to move around.
• A progression tailored to your pain, fatigue, and the activities you want to resume.

The physical therapist tailors the exercises to your symptoms, your strength, and the activities that are important to you. In cases of diabetic neuropathy, a loss of sensation can mask an injury to the foot. A wound or area of damaged skin requires an evaluation and adjustments to your activities; foot care advice is part of your follow-up care.¹⁷

How does neuropathic pain progress?

Neuropathic pain may decrease, go away, or persist, depending on its cause and the response to treatment.^{79, 52} Follow-up focuses on pain, but also on sleep, mobility, and daily activities. An improvement in these activities can be significant even if the pain does not completely go away.

Progression of pain related to the spine or wrist:

Sciatic-type pain often improves within a few weeks to a few months, but it can last longer.⁵⁵ Drug trials include people with different pain mechanisms, making it difficult to predict individual outcomes.⁵⁹ On imaging, some herniated discs shrink with non-surgical treatment, especially extrusions and detached fragments. In an extrusion, the protruding portion of the disc is wider than its base in at least one view of the scan, or it is completely detached. These terms describe the shape of the herniation.⁸⁰ This reduction alone does not indicate how your symptoms will progress.⁸¹

For carpal tunnel syndrome, persistent symptoms or a loss of strength require reevaluation, as prolonged compression can cause lasting nerve damage.⁸² A Cochrane review of 14 studies, involving a total of 1,231 participants, found a higher rate of clinical improvement with surgery than with a splint beyond three months. However, the average benefit in terms of symptom severity and hand function remained too small to be considered clinically significant.⁸³ The decision takes into account your symptoms, expected benefits, risks, and your preferences.

Conditions that may require long-term follow-up:

Diabetic neuropathy may require long-term follow-up to manage diabetes, treat pain, and protect the feet.⁸⁴ Monitoring sensation and wounds remains important even when pain subsides.¹⁷

Postherpetic neuralgia can last for months or years after shingles. Treatment focuses on pain relief, sleep, and daily activities.⁸⁵ The benefits and side effects of medications must be reevaluated.

Items to review during follow-up:

• Progression of the condition: New weakness or a loss of sensation may require changes to the necessary care.
• Cause of pain: Treatment for nerve compression, diabetes, or another condition may vary.
• Pain and Activities: Tracking your sleep, walking, or work can help you determine what changes are right for you.
• Concerns and well-being: These can be discussed if the person wishes to include them in their care plan.
• Available support: The individual can list the people or resources they wish to include in their plan.

The key takeaway: Even when pain persists, the plan can focus on the activities and quality of life that matter most to the individual. Goals are discussed and adjusted as the situation evolves.¹⁴

When to consult for pain that seems nerve-related?

If you experience a burning pain, accompanied by numbness or limiting your activities, you should see a doctor to determine the cause.⁵² If your symptoms worsen, you experience weakness, or you have any of the urgent signs described below, you should seek medical evaluation sooner rather than later.

Signs suggesting neuropathic pain:

• Pain described as burning, electric shocks, or tingling
  
• Pain that follows the path of a nerve (for example, radiating down the leg or arm)
  
• Numbness or tingling associated with the pain
  
• Pain triggered by light touch (allodynia)
  
• Pain that persists after a seemingly healed injury

When to seek urgent care:

• New-onset muscle weakness that is progressing rapidly.
• New difficulty starting to urinate, an inability to urinate, or unusual loss of bladder control.
• An unusual loss of bowel control or of the sensation of needing to have a bowel movement.
• A loss of sensation around the genitals or anus.
• Sciatica on both sides, or weakness or numbness in both legs that is severe or getting worse.

New urinary or bowel symptoms, loss of sensation in the genital area, and the symptoms in both legs described above warrant an immediate visit to the emergency room.⁵⁵ Also seek urgent medical attention if weakness progresses rapidly, or if back pain is accompanied by fever, chills, or general malaise.^{56, 27}

What to expect during your consultation:

Your healthcare professional will ask you detailed questions about your pain, including when it started and what it feels like. A physical exam will check your sensation, reflexes, and muscle strength. Depending on the findings, further tests like an MRI or nerve conduction studies might be recommended.

If you are experiencing symptoms of nerve pain, our physical therapists can evaluate you and refer you to the appropriate treatment. For more complex issues, a multidisciplinary approach involving several healthcare professionals may be recommended.

Common Questions About Nerve Pain

Frequently asked questions about nerve pain include whether it can go away, sensitivity to touch, medications, the reality of the pain, treatment timelines, and exercise.

Can nerve pain go away completely?

Yes, neuropathic pain can sometimes go away, but that depends on its cause and how it progresses. Some pain persists despite treatment. In such cases, the plan also aims to improve sleep, daily activities, and quality of life.

Why does it hurt when someone lightly touches my skin?

This pain caused by light touch is called allodynia. The nervous system reacts with pain to a stimulus that is normally painless. Several mechanisms may contribute to this; the examination looks for signs that will guide treatment.

Do anti-inflammatory medications work for nerve pain?

Anti-inflammatory medications are not typically the first-line treatment recommended for neuropathic pain. They may be helpful for another component of pain that occurs at the same time. The choice is made in consultation with the prescribing physician based on the diagnosis and associated risks.

Is nerve pain "all in my head"?

No. Neuropathic pain is a real experience. An evaluation looks for relevant symptoms, signs, and context. The fact that the brain is involved in any experience of pain does not mean that the pain is imaginary.

How long does treatment take to work?

The timeframe depends on the medication or treatment approach chosen. Drug therapy often requires a gradual increase in dosage and early monitoring of its effects and tolerability.⁶² In clinical trials, the average benefit is modest, and some people respond better than others.^{57, 86} Work with the prescribing physician to schedule a follow-up; do not adjust a medication on your own if it needs to be tapered off gradually.

Can exercise help with nerve pain?

Exercise can help some people reduce their symptoms and resume activities. A small study of people with diabetic neuropathy showed improvement after ten weeks, but did not include a comparison group.⁷⁸ The program must take into account sensitivity, strength, and the condition of the feet.

References

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