Physiotherapy for Nerve Pain: Specialized Techniques to Treat Nerve Pain

Physical therapy for nerve pain tailors exercises, advice, and movement techniques to the specific nerve condition and your daily activities. Neuropathic pain results from an injury or disease affecting the system that transmits sensations from the body. Treatment also takes into account your muscles, joints, and overall health.^{1, 2}

Burning pain, electric shocks, or tingling may accompany nerve damage. However, these sensations alone are not enough to confirm the diagnosis. This guide outlines possible treatments, their outcomes, and their limitations to help you prepare for your appointment.²

To understand what nerve pain is and its various causes, first consult our complete guide to nerve pain.

What is Physiotherapy for Neuropathic Pain?

Physical therapy for neuropathic pain combines a nerve assessment, tailored exercises, and advice to help you improve your daily activities and relieve your symptoms. Depending on your condition, it may include neural mobilization—which involves moving the nerves along with the joints—motor imagery—which uses the imagination to visualize movement—or desensitization—which works on touch tolerance.

Treatment aims to reduce symptoms and improve your functional abilities. A nerve injury may still require care. Sensitization—that is, an increased response of the nervous system to certain stimuli—can also contribute to pain. Its presence does not mean that all tissues have healed.³

A review of six international guidelines recommends combining medical care with rehabilitation—that is, care that helps you regain or maintain your abilities. It also highlights the lack of robust research on several techniques. Physical therapy is incorporated into the treatment plan based on the cause of the pain, your limitations, and any other necessary treatments.⁴

For certain conditions, such as carpal tunnel syndrome—in which a nerve is compressed at the wrist—or nerve damage originating in the spine, non-surgical treatments may be recommended first. The choice depends on the severity of the symptoms and the results of the examination. Significant or progressive weakness may influence this decision.⁵

Treatments are tailored to the nerve’s sensitivity and the movements that cause you problems. Strength, mobility, sleep, and a return to normal activities may also be part of the treatment plan. These goals apply to several types of pain, not just neuropathic pain.⁶

How Does It Differ from Traditional Physiotherapy?

Physical therapy for neuropathic pain places special emphasis on nerve damage, sensitivity, and strength, while incorporating the exercises and guidance used for other types of pain. A nerve disorder or injury may require specific adaptations.⁷

Nerve damage among other tissues

After a sprain, treatment supports the healing of ligaments—the bands of tissue that connect bones—as well as the restoration of mobility and strength. After nerve damage, the treatment plan may also combine tissue recovery, sensitivity management, and a return to normal activities.

Nerve damage and increased sensitivity can occur simultaneously. Certain movements or light touches then become painful. The central nervous system, which includes the brain and spinal cord, may contribute to this sensitivity. The spinal cord is the nerve cord that transmits messages between the brain and the body within the spinal column.³ In an experiment involving 37 people with persistent arm pain, simply imagining a movement also increased pain on average. This result does not mean that every thought triggers a flare-up, but it does show why even mental exercises must be adapted.⁸

Specific Techniques

The plan may include the following techniques, depending on your symptoms:

• Pain education explains how nerves, the brain, and your circumstances influence your symptoms.
• Graded motor imagery combines the recognition of right and left, the visualization of movement, and the use of a mirror.
• Mirror therapy uses the reflection of the opposite limb to create the visual impression that the affected limb is moving.
• Desensitization gradually exposes the skin to contact in amounts tailored to your tolerance.
• Neural mobilization uses joint movements to stimulate the nerves and build their tolerance to movement.

A Different Pace

The pace depends on how you respond to the exercises and the abilities you need to regain. A movement can be reduced, broken down into smaller steps, or replaced if it causes symptoms to worsen too much. We’ll decide on the progression together; nerve pain doesn’t automatically require a slower program than any other injury.⁶

What types of nerve pain and related problems does physical therapy treat?

Physical therapy addresses issues associated with nerve damage originating in the spine, peripheral neuropathies—which affect nerves outside the brain and spinal cord—phantom limb pain, and certain types of pain following shingles or surgery. It is also part of the care for complex regional pain syndrome (CRPS), not all cases of which are classified as neuropathic. Each condition requires a tailored assessment and treatment plan.^{9, 10}

Radiculopathy (Sciatica and Cervical Radiculopathy)

Radiculopathy refers to a loss of function in a nerve root—the portion of the nerve located near the spine. It can lead to a decrease in sensation, strength, or reflexes—the automatic responses tested during an examination. Pain may also be present. Compression, inflammation, and other changes in the nerve can contribute to the symptoms.⁵ Imaging results should be compared with the physical examination: changes in the discs—the cushions between the bones of the spine—are common in people without pain. A study of 1,211 people without symptoms found bulging cervical discs in 87.6% of them and spinal cord compression in 5.3%. These findings do not rule out significant damage in a person who is experiencing symptoms.^{11, 12}

Nerve disorders such as carpal tunnel syndrome and radiculopathy are among the most common causes of neuropathic pain.⁵

Sciatica generally refers to pain that radiates down the leg from the lower back, often associated with a nerve root. Cervical radiculopathy affects the nerve roots in the neck and may be accompanied by pain that radiates down the arm. Exercises, advice, and sometimes neural mobilization techniques are recommended based on the results of the examination.^{13, 14}

For sciatica—another name for sciatic pain—non-surgical treatments are often tried first. Physical therapy is one such option. Severe nerve damage, progressive weakness, or certain signs of a medical emergency, however, require prompt medical evaluation.⁵

To learn more about sciatica, please consult our complete guide to sciatica.

Peripheral Neuropathy

Peripheral neuropathy affects the nerves outside the brain and spinal cord. Diabetes is a common cause. It can cause burning, tingling, pain, or a loss of sensation, often starting in the feet. Neuropathy is not always painful.¹⁵

Treatment may combine endurance exercises, such as walking or cycling, strength training, balance exercises, and activity modifications. A study of 17 people with diabetic neuropathy found reduced pain and symptoms after ten weeks of exercise, as well as an increase in the number of small nerve fiber branches in a skin biopsy. Nerve conduction—the transmission of signals as measured by electrical tests—had not changed in a conclusive manner. Without a control group, this study does not allow for the improvements to be definitively attributed to exercise.¹⁶

Complex Regional Pain Syndrome (CRPS)

CRPS is a condition in which pain in a limb persists and exceeds what would be expected based on the initial event. It may be accompanied by changes in color or temperature, swelling, increased sensitivity, and difficulty moving. The diagnosis is based on a combination of signs and symptoms and the exclusion of other possible causes.¹⁷

Type I CRPS does not involve any identified nerve damage, unlike Type II. A Cochrane review of 34 trials, involving a total of 1,339 people, found the effects of various physical therapy interventions on pain and functional limitations in CRPS to be highly uncertain. This primarily reflects the fact that the studies were small and had significant limitations; it is not evidence that all treatments are ineffective.¹⁰ Exercises, sensory training, and motor imagery are among the recommended options. In a trial of 51 participants with Type I CRPS or phantom limb pain, six weeks of graded motor imagery reduced pain and functional limitations more effectively than physical therapy and standard medical care.¹⁸ A 2013 review also found favorable results for graded motor imagery compared to standard physical therapy, but the studies are few in number and generally of low quality.¹⁹

Phantom Limb Pain

Phantom limb pain is felt in an amputated limb. A review by Flor reports that it can affect up to 80% of amputees. Changes in the remaining nerves, the spinal cord, and the brain, as well as psychological factors, may contribute to the symptoms. This pain is distinct from pain located in the remaining part of the limb.²⁰

Mirror therapy is one of the approaches being studied for phantom pain. Some small studies have reported pain relief. However, a review of five trials comparing mirror therapy to a sham technique did not find reliable evidence of a benefit regarding pain or functional limitations. The decision to try this technique therefore depends on your situation and the response you experience.²¹

Post-herpetic neuralgia

Postherpetic neuralgia is pain that persists after shingles, a reactivation of the varicella-zoster virus that causes a painful rash. Medical management may include medication. Once the skin has healed but remains sensitive to touch, a gradual desensitization process may be discussed with your healthcare provider. This practice does not replace treatment for shingles.^{22, 23, 24}

Post-surgical neuropathic pain

Surgery can sometimes damage a nerve and lead to persistent neuropathic pain. However, not all pain following surgery is caused by nerve damage. Depending on the healing process and postoperative instructions, physical therapy supports the restoration of movement and can help improve tolerance to touch.²⁵

What to expect during your first consultation?

The first consultation for neuropathic pain includes a discussion of your symptoms, an examination of sensation and movement, and then a plan tailored to your goals. The physical therapist also looks for signs that would warrant a medical referral.²⁶

A detailed history

The physical therapist will ask you how long the pain has lasted, how it started, what makes it worse, and what provides relief. Your descriptions—such as “burning,” “electric shocks,” or “tingling”—guide the examination. However, they alone are not enough to confirm neuropathic pain. Your other health issues, medications, and how your condition affects your daily activities round out this discussion.²

The physical therapist looks for allodynia—that is, pain caused by a normally painless touch—or hyperalgesia, which is increased pain in response to a normally painful stimulus. These signs describe your reaction. On their own, they do not prove either nerve damage or a specific sensitization mechanism.²

Neurological evaluation

The physical therapist checks for sensitivity to touch and, if necessary, to other sensations, as well as reflexes and muscle strength. The distribution of the results helps determine which nerve or nerve root may be affected. The exam also assesses your gait and balance when these abilities are impaired.⁵

Neural mobility assessment

Some tests examine how nerves respond to movement. For example, the physical therapist may lift your straight leg or position your arm in a way that puts pressure on the median nerve, which supplies part of the hand. The therapist then adjusts the position to observe the response. These tests assess sensitivity to movement; they do not directly indicate that a nerve is pinched.^{1, 5}

Assessment of psychological factors

The physical therapist may also discuss fear of movement, avoidance of activities, and the tendency to anticipate the worst possible outcomes—known as catastrophizing. These factors can influence your experience of pain and your participation in treatment.²⁷

Your pain is still real. Discussing your concerns allows us to support you and adjust the treatment plan. Taking these factors into account is part of your care, though it does not replace the evaluation of nerves and other tissues.

A personalized plan

At the end of the evaluation, the physical therapist will explain the issues identified, the goals, the options, and how to adjust the exercises. Together, you’ll choose a plan that takes into account your symptoms, your activities, and any other necessary care.

When should you seek emergency care?

If you have back pain or sciatica, certain symptoms require immediate evaluation in the emergency room:

• Sciatic pain affects both sides.
• Significant weakness or numbness—or weakness or numbness that is getting worse—affects both legs.
• A loss of sensation occurs around or under the genitals, or around the anus.
• You are experiencing a new difficulty starting to urinate, an inability to urinate, or unusual loss of bladder control.
• You no longer feel the urge to have a bowel movement, or you are losing control of your bowel movements in an unusual way.

These symptoms may indicate severe nerve compression. Don’t wait for a physical therapy appointment. Have someone drive you to the emergency room or call 911; do not drive yourself.²⁸

Rapidly progressing weakness accompanied by back or leg pain also requires urgent evaluation.²⁹

What treatment techniques are used?

Possible treatments for neuropathic pain include pain education, exercises, neural mobilization, motor imagery, mirror therapy, and desensitization. The choice depends on the specific condition being treated. A technique studied for complex regional pain syndrome (CRPS) or diabetic neuropathy may not necessarily have the same effects in another condition.

Understanding the Neurobiology of Pain

Pain education explains the mechanisms behind symptoms and how they relate to your daily activities. It is often provided alongside other forms of care. A 2011 review focused on adults with persistent muscle, joint, or back pain and reported favorable outcomes regarding pain, functional ability, and catastrophizing.³⁰

These findings support the use of tailored explanations, but do not prove that the same effect applies to every type of neuropathic pain. Education should be tailored to your specific situation: nerve damage may persist, and pain can also be influenced by the sensitivity of the nervous system, sleep, anxiety, and daily activities.³⁰

The explanations address the following questions, among others:

• Pain may persist when nerve damage remains or when the nervous system continues to react strongly, even if other tissues have healed.
• Hypersensitivity increases the nervous system's response to certain stimuli; it can make movement or touch more painful.
• Allodynia causes normally painless contact, such as the rubbing of clothing, to be painful.
• The treatment aims to improve your tolerance and your ability to perform daily activities by adjusting your movements, physical contact, and pain management strategies.

Neurodynamic techniques

Neurodynamic techniques, or neural mobilizations, use movements of the arm, leg, or spine to shift the nerves relative to the surrounding tissues. The physical therapist adjusts these movements based on the sensitivity and capabilities observed during the examination.¹⁴

There are two types of techniques:

• Sliding movements cause the nerve to move by combining motions that limit its stretching.
• Tension exercises further increase the length of the nerve pathway through controlled movements.

A study of cadavers donated to science confirmed that gliding movements produce greater displacement and less nerve stretching than tensioning movements. It measures a mechanical effect, not relief in patients. The choice of exercise depends on the examination; tensioning is not a mandatory step.³¹

A review that synthesized the results of 21 trials, involving a total of 914 people with pain originating in the spine and radiating down the leg, found a moderate to large reduction in pain compared with control interventions. The study protocols varied, and most trials had a high risk of bias, which limits confidence in the results.³²

Graded Motor Imagery

Graded motor imagery combines recognition and visualization exercises with mirror therapy. Studies in people with CRPS or phantom limb pain report a reduction in pain and functional limitations. These results are encouraging, but given the small sample sizes of the studies, it is not possible to guarantee the same benefit for every individual.^{33, 19}

It involves three steps:

Step 1: Recognizing Right and Left

You look at pictures of hands or feet and indicate whether they are on the right or left side. This first step focuses on limb recognition without requiring any movement.

Step 2: Visualize the movement

Imagine moving the affected limb without actually moving it. This exercise may cause pain in some people, as demonstrated by a study involving adults with persistent arm pain. The physical therapist will therefore adjust the duration, the imagined movement, or the stage of the program based on your response.⁸

Step 3: Use the mirror

You place a mirror so that you can see the reflection of the opposite limb in place of the affected or missing limb. You then observe its movement. The reflection creates a visual impression of movement; the exact mechanism behind any potential relief remains unclear.¹⁸

There are still few published studies on graded motor imagery, and their quality is inconsistent. A 2013 review included two studies comparing the program to standard physical therapy—involving a total of 63 participants—and found a beneficial effect on pain. The small sample sizes of the studies and their limitations limit confidence in the results.¹⁹

Mirror Therapy

Mirror therapy can be offered on its own or as part of graded motor imagery. Its use and the results studied vary depending on the problem:³⁴

• Regarding phantom limb pain, some studies report relief, but trials comparing the treatment to a sham technique yield inconclusive results.²¹
• For SDRC, small studies report improvements in pain and mobility, though confidence in the results is limited.^{33, 10}
• After a stroke, mirror therapy can improve movement and daily activities. The results regarding pain are less clear and do not necessarily apply to neuropathic pain originating in the brain.³⁵
• For other types of neuropathic pain in a limb, the healthcare professional determines whether the patient’s medical history and physical examination warrant a trial; the results of one condition do not automatically apply to another.

The pioneering study from 1996 examined ten amputees. The mirror restored the sensation of movement in six of them. It also relieved spasms—those painful, involuntary contractions—in four of the five people who experienced them. These observations support the role of visual information, but a small study of this kind does not prove its effectiveness for all types of nerve pain.³⁴

Desensitization

Desensitization helps build tolerance to physical contact when the skin is very sensitive. It involves textures or movements selected in consultation with your healthcare provider. The goal is to make everyday activities, such as washing or putting on clothes, more tolerable.^{36, 23}

The program is tailored to your needs and can follow these steps:

1. Identify the types of contact with your healthcare provider that you tolerate best.
2. You have brief interactions at a frequency agreed upon with your professional.
3. You gradually increase the duration, pressure, or variety of textures depending on your response.
4. You reassess which activities have become more manageable and adjust the plan if symptoms worsen too much.

The textures can include cotton, silk, velvet, linen, denim, or a soft brush. The order in which you use them depends on your tolerance, not on a set progression. If the pain becomes unbearable, stop the exercise and talk to your healthcare professional about adjusting it.²³

Therapeutic Exercise

Appropriate exercise can improve certain abilities and alleviate certain symptoms associated with neuropathies. Researchers are investigating several possible explanations, including changes in blood flow, nervous system response, and the release of substances produced by the body, such as endorphins, which play a role in pain control. Some of these mechanisms have been studied primarily in animals; this does not prove that each mechanism explains pain relief in a person.³⁷ A review of 41 trials comparing exercise groups with inactive or non-exercising groups found benefits primarily in diabetic neuropathy and neuropathy associated with chemotherapy, a cancer treatment. According to the trials, these benefits related to balance, mobility, certain symptoms, or quality of life.³⁸ The program takes several objectives into account:

• Endurance exercises build the ability to sustain physical effort, such as walking or cycling.
• Balance exercises help develop body control while standing or moving.
• Strength training is designed to make it easier to perform tasks that require strength, such as getting up from a chair.
• The activity plan takes your sleep, mood, and fatigue into account to support your participation.
• A gradual return to normal activities helps limit the loss of physical fitness resulting from a long period of inactivity.

Walking, biking, or swimming can help build endurance, depending on your health and your access to these activities. The program may also include balance and strength training. For diabetic neuropathy, a 2022 review supports combining endurance training with balance and movement control exercises. Reduced sensation in the feet also requires attention to skin care, footwear, and injury risks.^{38, 15}

How does graded exposure help people resume their activities?

Graduated exposure helps you resume activities you’ve been avoiding by approaching them in steps tailored to your fears and abilities. Together with your therapist, you choose a meaningful movement and a manageable first step. In a study of four people with persistent lower back pain and a strong fear of injury, fear and limitations decreased during graded exposure. This study compared treatment stages for each individual; it did not demonstrate the same outcome for all types of neuropathic pain.³⁹

How Avoidance Can Limit Activities

Temporarily avoiding a movement can protect an injury or allow the body to adapt. When fear leads to permanently giving up many activities, it can also reduce opportunities to move and regain confidence. The assessment helps distinguish between necessary precautions and restrictions that can be adjusted.²⁷

Fear, pain, and a reduction in activity can influence one another. This connection is not the same for everyone and does not mean that you are responsible for your symptoms.

How Graded Exposure Works

The professional helps you identify the activities that worry you and that are important to you. You start with a modified version, then observe your reaction before increasing the difficulty.

If you find the experience easier to tolerate than expected, it can boost your confidence. Pain does not necessarily decrease at every stage. Progress is also measured by the activities you’re able to resume and the reduction in your limitations. A 2024 review of psychological approaches to neuropathic pain reports improvements in several studies, but the programs vary widely and the trials are often small.⁴⁰

Behavioral experiences

Your physical therapist may suggest a practical exercise: write down what you’re afraid of when performing a movement, try an adapted version, and then compare what actually happened with what you expected.

If you tolerate the activity better than expected, you can take that into account for the next step. If your symptoms worsen too much, the professional will adjust the exercise or reassess the problem. The goal is to learn from your actual response.

How long does the treatment last?

Treatment for neuropathic pain can last several weeks, with a schedule tailored to its cause, your abilities, and your response to treatment. The programs studied provide guidelines without specifying a specific duration for your treatment: the graded motor imagery trial lasted six weeks, while Kluding’s exercise program lasted ten weeks.^{18, 16}

An Initial Period of Several Weeks

The first few weeks are spent setting up the program, learning the exercises, and observing how you respond. The frequency of your appointments is determined based on your needs and the exercises you can continue doing at home.

Gradual Progress

Progress may be measured in terms of walking time, tolerance of pressure, sleep, or a specific activity. You and your physical therapist will choose benchmarks to determine whether the plan is helping you.

Long-term follow-up

Appointments can be spaced out once you have a good handle on your program and are making satisfactory progress. Follow-up visits also serve to adjust your exercises and identify any difficulties that require a second opinion.

Fluctuations are normal

Pain can vary from day to day. A flare-up does not automatically mean that a new lesion has developed or that the treatment is failing. You can temporarily reduce the duration or intensity of your activities, then resume them as tolerated. However, any unusual worsening of symptoms, new weakness, or new numbness should be reevaluated.⁶

When is a multidisciplinary approach necessary?

A multidisciplinary approach, which brings together several professions, is helpful when neuropathic pain requires medical care, adjustments to daily activities, and psychological or social support. Coordination can begin early if these needs are present; there is no need to wait until physical therapy has failed.⁹

Cases that benefit from a team approach

There are several situations that may call for coordinated care:

• Persistent pain disrupts many aspects of your life and requires support that goes beyond exercise alone.
• Symptoms in several regions require an assessment of their causes and their impact on your activities.
• Severe depression or anxiety requires appropriate support in addition to physical care.
• Previous treatments have not achieved the desired results, and the plan must be reevaluated.
• A complex condition, such as SDRC, may require multiple approaches to relieve pain and resume daily activities.

The team members

A team can include several professionals, depending on your needs:

• A physical therapist who works with people experiencing pain assesses their physical abilities and provides guidance on exercises and adaptations.
• A doctor specializing in pain management evaluates the medical causes and treatment options.
• A psychologist is here to support you as you cope with anxiety, distress, and difficulties adjusting.
• An occupational therapist works with you on daily activities, work, and environmental adaptations.
• A nurse can assist with patient education and follow-up care.

Healthcare professionals can share goals and relevant information with your consent. This coordination helps ensure that recommendations regarding medications, activities, and psychological support are consistent.

Pain clinics

A pain clinic may be recommended when symptoms remain difficult to manage or require specialized treatment. Your doctor and physical therapist can discuss appropriate resources with you.

How does Physioactif support people with neuropathic pain?

Physioactif supports people with neuropathic pain by assessing their challenges, providing a tailored exercise plan, and offering advice related to their daily activities. The follow-up takes into account any other necessary care and how you respond to treatment.

Treatments Tailored to Nerve Pain

Based on your assessment, the plan may include pain education, exercises, neural mobilization, or progressive work on sensory perception and activities. Motor imagery or mirror therapy may be discussed in situations where they are appropriate. The benefits and limitations of these options should be explained.

A thorough assessment

The evaluation focuses on the symptoms, sensitivity, strength, and movements that are causing you problems. Your goals and the impact of the pain on your daily life also help guide the treatment plan.

A progressive and respectful approach

The progression is tailored to your response and your goals. Please let us know if any exercises significantly worsen your symptoms or if you experience lingering effects after a session. This information will help us adjust the program or reassess the situation.

Coordination with other professionals

If your condition requires medical, psychological, or other professional care, your physical therapist can refer you to the appropriate resources and help coordinate care with your consent.

How to book an appointment?

You can schedule an appointment with a Physioactif physical therapist through our online service or by calling a clinic. In Quebec, a private consultation with a physical therapist does not require a doctor’s prescription. However, some insurance plans may require one in order to reimburse the cost of treatment.²⁶

Describe your symptoms and the issues that led you to seek care. Bring a list of the medications you are taking and any relevant medical information.

If you have any questions before booking an appointment, please don't hesitate to contact us. We can help you determine if our approach is suitable for your situation.

To learn more about our physiotherapy services, please visit our dedicated page.

Frequently asked questions about physiotherapy for nerve pain

Frequently asked questions about physical therapy for neural pain include the benefits of treatment, pain during exercises, treatment duration, medications, mirror therapy, persistent symptoms, how it differs from chronic pain, electrical stimulation, and insurance coverage.

Can physiotherapy really help nerve pain?

Physical therapy can help some people reduce pain and resume activities. A trial of graded motor imagery and a review report benefits for people with CRPS or phantom limb pain.^{18, 19} The exercises have also yielded favorable results in certain cases of diabetic or chemotherapy-related neuropathies.³⁸ The choice depends on your specific condition, and individual results may vary.

Will the techniques be painful?

The movements and contact are tailored to your tolerance level. You may experience some discomfort, even during an imagined exercise. Please report any severe pain or persistent worsening of symptoms so that the program can be adjusted. You can ask to stop a technique or discuss an alternative option.

How long until I see results?

Time frames vary depending on the cause and the desired outcome. The studies described here measured the effects of six-week programs of graded motor imagery and ten-week exercise programs for diabetic neuropathy. These time frames do not guarantee your recovery. Follow-up care also determines which activities you can resume.^{18, 16}

Should I continue my medication during treatment?

Medications and physical therapy can complement each other. Continue to follow your prescriber’s instructions and talk to them or your pharmacist about any side effects or difficulties you’re experiencing. Do not change your doses on your own.

Does mirror therapy really work?

Mirror therapy has shown promising results in some small studies on CRPS and phantom pain, but the findings remain inconclusive.¹⁹ For phantom pain, a review of trials comparing the technique to a sham intervention did not support a reliable benefit.²¹ An individual trial should therefore be monitored and adjusted based on your response.

Why does the pain persist if the nerves have healed?

Tissue improvement does not always mean that the nerves have fully regained their function. Damage may persist, and changes in sensation may also contribute to your symptoms. The healthcare professional reassesses these possibilities. Follow-up care aims to improve your symptoms and functional abilities while taking these changes into account.^{9, 3}

Can exercise make my nerve pain worse?

Exercise may temporarily worsen symptoms. An increase in pain alone does not indicate a new injury, but it should guide adjustments to the duration, intensity, or movement.³⁷ Appropriate exercise has shown benefits in several studies on diabetic neuropathies and those related to chemotherapy; however, this does not guarantee a lasting reduction in all nerve pain.³⁸

Is TENS effective for neuropathic pain?

Transcutaneous electrical nerve stimulation, often referred to as TENS, delivers an electrical current through electrodes—small pads placed on the skin. A Cochrane review concludes that the evidence is too uncertain to confidently conclude that it is effective against neuropathic pain.⁴¹ At Physioactif, the treatments presented in this guide are based on assessment, exercises, and adaptations tailored to your activities.

What is the difference from physiotherapy for chronic pain?

Neuropathic pain refers to pain caused by nerve damage or disease; chronic pain refers to pain that persists or recurs for more than three months.⁴² The same pain can therefore be both neuropathic and chronic. Many treatment approaches overlap, but nerve damage may require specific assessments and adjustments. See also our guide on physical therapy for chronic pain.²

Do my insurance plans cover this type of treatment?

Reimbursement depends on your insurance policy. Check the covered services, reimbursement limits, and whether a doctor’s referral is required before your appointment. Direct access to a physical therapist does not mean that all insurance plans provide reimbursement without conditions.²⁶

References

Links open in a new tab.

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11. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6. (Back to section: 1)
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16. Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26(5):424-9. (Back to sections: 1, 2, 3)
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