What is nerve pain?
Nerve pain, known in medicine as neuropathic pain or neuropathy, arises from damage to or a functional disturbance of the nervous system itself. Unlike classic pain caused by tissue injury (for example, a sprained ankle), the cause here lies directly within the nerves – either in the peripheral nervous system (arms, legs, trunk) or in the central nervous system (brain, spinal cord).
The International Association for the Study of Pain (IASP) defines neuropathic pain as pain that occurs as a direct consequence of a lesion or disease of the somatosensory nervous system. Estimates suggest that around 7 to 10 per cent of people in Europe are affected – a number that is rising, partly due to the increase in diabetes mellitus and an ageing population.
Typical symptoms of neuropathic pain
Nerve pain differs noticeably from muscular or joint-related complaints. Those affected often describe it using terms that point to nerve involvement.
Common pain qualities
- Burning or stabbing, often even at rest
- Tingling or a "pins and needles" sensation (paraesthesia)
- Electric, shooting pains, comparable to brief electric shocks
- Numbness or the feeling of a "furry" patch of skin
- Allodynia: pain caused by stimuli that are not normally painful, such as a light touch or a bedsheet
- Hyperalgesia: increased pain sensitivity to otherwise minor stimuli
Symptoms often intensify at night and can significantly disturb sleep. Many of those affected also report accompanying issues such as exhaustion, difficulty concentrating or low mood.
Possible causes
Neuropathies are not an illness in their own right, but rather a symptom of a wide range of underlying conditions. A thorough diagnostic assessment is therefore essential.
Common triggers
- Diabetes mellitus: diabetic polyneuropathy is one of the most common forms
- Postherpetic neuralgia: pain following shingles (herpes zoster)
- Herniated discs and nerve root irritation (e.g. sciatica)
- Carpal tunnel syndrome and other entrapment syndromes
- Chemotherapy-induced neuropathy following oncological treatment
- Alcohol-related nerve damage
- Vitamin deficiency, particularly vitamin B12
- Autoimmune conditions such as multiple sclerosis
- Trigeminal neuralgia in the facial area
- Phantom pain following amputations
Diagnosis: tracing the causes
Careful diagnostic work-up forms the basis of any successful treatment and usually involves several steps.
Components of the assessment
- Patient history: detailed recording of pain characteristics, triggers and concomitant conditions
- Clinical neurological examination: testing of reflexes, sensation and motor function
- Laboratory tests: blood glucose, vitamin B12, thyroid values, inflammatory markers
- Electrophysiology: nerve conduction studies (NCS) and electromyography (EMG)
- Imaging: MRI when disc-related or central nervous causes are suspected
- Specialised tests: quantitative sensory testing (QST) or skin biopsies if small-fibre neuropathy is suspected
Treatment options for nerve pain
The treatment of neuropathic pain today follows a multimodal approach. The aim is not always complete freedom from pain, but rather a clear reduction in symptoms and an improvement in quality of life. Neuropathy treatment should be tailored individually to the cause, concomitant conditions and personal tolerability.
Treatment of the underlying condition
Where possible, treating the underlying cause comes first. Consistent blood sugar control in diabetes, correcting a vitamin deficiency or relieving an entrapped nerve can be crucial in preventing progression.
Medication for nerve pain
Classic painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) often have only limited effect on neuropathic pain. Instead, substance groups that act directly on nerve signal transmission are used:
- Anticonvulsants such as gabapentin or pregabalin – originally developed for epilepsy, they help to dampen overactive nerves
- Antidepressants in low doses, such as amitriptyline or duloxetine, influence pain-inhibiting pathways in the central nervous system
- Topical preparations containing lidocaine or high-dose capsaicin patches for locally limited pain areas
- Opioids are used cautiously and only in selected cases
All of these medications require a medical prescription, gradual dose adjustment and close monitoring for possible side effects.
Interventional procedures
For circumscribed, treatment-resistant pain, targeted procedures can offer an additional option:
- Therapeutic local anaesthesia and nerve blocks
- Infiltrations at nerve roots under imaging guidance
- Botulinum toxin type A is used in certain indications, for example in chronic headaches and nerve pain
- Neuromodulation such as transcutaneous electrical nerve stimulation (TENS) or, in selected cases, spinal cord stimulation
Non-pharmacological treatment approaches
Accompanying non-pharmacological measures are considered an important component and can complement the effect of medication.
- Physiotherapy to improve mobility, strength and coordination
- Occupational therapy for daily life, especially for hand and foot neuropathies
- Exercise therapy: regular, moderate activity may help to reduce pain
- Psychological pain therapy: behavioural therapy, mindfulness and relaxation techniques such as progressive muscle relaxation
- Acupuncture is experienced as helpful by some patients
- Nutrition: a balanced diet, reduction of alcohol and, where appropriate, targeted supplementation of B vitamins on medical advice
Living with neuropathic pain
Chronic neuropathic pain affects not only the body but also mental wellbeing and social participation. Sleep disturbances, anxiety or low mood are common companions. Being open about the condition, exchanging experiences in support groups and setting realistic treatment goals can help to manage daily life more effectively.
Practical tips for everyday life
- Keep a pain diary to better identify triggers and patterns
- Regular exercise at a level that is comfortable for you
- Maintain good sleep hygiene: fixed times, a quiet environment
- Stress management through relaxation techniques
- Realistic expectations: in pain medicine, a reduction of 30 to 50 per cent is already considered a good treatment outcome
When should you seek medical advice?
Persistent abnormal sensations, burning or shooting pains, numbness or feelings of weakness should be medically assessed – particularly if they last longer than a few weeks, intensify or are accompanied by functional limitations. The earlier the cause is identified, the better the chances of avoiding a chronic course.
Neuropathic pain is complex, but in many cases it can now be well managed. An individually tailored, multimodal treatment can help to ease symptoms and noticeably improve quality of life.
---
This article does not replace medical advice.