Describing the pain
When patients arrive in the doctor's office with nerve pain, they don't always know that's what it is. But their symptoms often stand out.
"Things that are typical for nerve pain is that it tends to be sharp, electric-like, shooting pain with a pins-and-needles sensation or tingling," says Dr. Suraj Muley, a neurologist and director of the neuromuscular division at Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix.
Clinicians say patients may also describe or experience:
-- Ice-cold sensation.
-- Sensitivity to touch.
"Also, nerve pain tends to be worse at night," Muley adds.
To get a better handle on exactly what's at the root of your discomfort and address it, experts say, it's important for patients to explore these questions with their doctors.
How do you know if it's nerve pain?
To treat any pain, clinicians first seek out the specific cause. Your nerves are integral to feeling any kind of pain, as well as other sensations. "Pain signals are sent to the brain by the nerves. Often this is due to inflammation or injury in body tissues like the muscles, skin or bones," says Dr. Ryan Jacobson, a neuromuscular neurologist at Rush University Medical Center in Chicago. But it's deemed nerve pain, or neuropathic pain, when that pain is caused by an injury to the nerves themselves. "So sometimes that can be an injury to one particular nerve, like carpal tunnel syndrome," Jacobson says. "Other times it's a more widespread nerve injury, or peripheral neuropathy."
How can we determine the cause of the pain?
To explore the cause, doctors first ask about symptoms, take a thorough medical history and examine the patient. This would take into account everything from sensory loss to abnormalities. For example, a physician may test a patient for sensory loss using, among other means, a pinprick. If the patient doesn't feel that and other things like a cotton wisp or tuning fork on the big toe, foot or ankle, that may point to the presence of neuropathy, explains Dr. Eva Feldman, a professor of neurology at the University of Michigan.
Where in the body a person is experiencing the pain, or if it's more generalized -- i.e. "all over" -- is also relevant. And certain conditions, such as diabetes, can cause nerve pain. Rare disorders like complex regional pain syndrome are caused by nerve injury. And some drug treatments like chemotherapy can damage nerves too. Certain sports injuries can cause nerve pain as well, like what's popularly referred to as a stinger, which involves a bundle of nerves between the neck and spine called the brachial plexus.
In addition to the treating physician talking to the patient about their health history and doing an exam, testing, including bloodwork, is routinely done to gain a better understanding of what's behind the pain. That may include a test called a hemoglobin A1c to check your average blood sugar levels to see if you may have diabetes or be at risk for it. Your doctor may also check if your vitamin B12 level is low, which can cause nerve dysfunction and numbness.
Is diabetes or prediabetes the cause of my nerve pain?
The leading cause of nerve pain today -- and specifically chronic peripheral neuropathy -- is diabetes. High blood sugar levels can cause nerve damage, undermining the nerves' ability to send signals and function properly.
"At least half of individuals with diabetes have neuropathy," says Feldman. Those who have high blood sugar that isn't yet full-blown diabetes, but instead the precursor prediabetes, also have an elevated risk. "About 30% of people with prediabetes have neuropathy," Feldman notes.
Today, more than 30 million adults in the U.S. have diabetes, and about 84 million have prediabetes, according to the Centers for Disease Control and Prevention. Additionally, being obese raises a person's risk for nerve pain and diabetes.
Should I see a neurologist?
Experts generally recommend starting with your primary care doctor if you think you're experiencing nerve pain.
Still, many patients may also need to see a neurologist -- a doctor specializing in the nervous system -- to determine the cause of nerve pain. If the initial bloodwork looking at your vitamin B12 level and hemoglobin A1c for diabetes comes back normal, and another common cause of neuropathy isn't to blame, further investigation may be needed to determine the cause of the nerve pain. If that's the case, "we can talk about more extensive testing," says Dr. Andrew Dorsch, a neurologist at Rush University Medical Center in Chicago. Once the source of the pain is better understood, the neurologist can provide treatment options.
Further tests would depend on the person's symptoms and their risk factors for different conditions. The next level of tests might include screening for autoimmune diseases or inflammatory diseases, looking at hormone function or identifying other metabolic and nutritional markers.
Another reason to see a specialist who has ample experience treating patients with nerve pain is to avoid unnecessary tests. "Sometimes seeing a neurologist to listen to the symptoms and do an exam can help narrow down the testing quite a bit," Jacobson says.
Do I need an EMG test?
One test that's worth asking about, Jacobson says, is an EMG, or electromyogram. This is "an electrical test, which is useful for detecting injury to the peripheral nerves." Those are the nerves outside the brain and spinal cord. This can help in figuring out if the pain is related to the injury of a specific nerve or nerve root or relates more broadly of all the nerves, as with peripheral neuropathy.
An EMG can help with assessing the health of nerves and diagnosing the cause of nerve pain, as well as determining what other tests might be needed if the cause of the pain still isn't clear. This test generally takes around an hour, though it can be as short as 30 minutes or as long as 90 minutes.
An EMG test involves inserting small needles with electrodes into muscles to detect electrical signals given off by the muscle. It can be uncomfortable. However, doctors say most patients are able to tolerate it; though it's important to let the doctor know if you're experiencing significant pain during or after the procedure.
What should we do if the cause of my pain isn't immediately clear?
Although symptoms of nerve pain may be readily distinguishable from other types of pain, frequently it's not so simple to zero in on the exact cause of that nerve pain.
"It is not uncommon that we have to monitor patients to determine the cause," Muley says. If the cause of the nerve problem isn't obvious initially, he suggests following up with a visit to the neurologist every three to six months.
Along with evaluating the patient and continuing to discuss symptoms, it may also be necessary to do additional testing. In some cases, the cause is never known. So it's important to have a frank discussion about the likelihood that additional medical visits or testing will help determine that. Also, discuss with your doctor how pain might be addressed more generally if the cause remains a mystery.
Regarding treatment options, can medication help?
Just as the causes of nerve pain are widely varied, so are the options for managing it.
Some patients whose symptoms affect their quality of life and function may choose, for example, to take a daily medication to reduce the levels of pain. "There are a number of different medications that are useful for nerve pain or neuropathic pain," Jacobson says. "Most of those medications were invented or developed for other purposes first, such as epilepsy or mood." Besides anticonvulsants and antidepressants, pain relievers may also help.
Ask, too, how long it may take for medication to be effective. "Many of the medications are effective within a few days," Jacobson says. "Others take many days or weeks to have an effect. Often a slow increase in the dose is needed."
Check on risks of any medication in advance as well.
"The specific side effects will depend on which medication is chosen," Jacobson says. "As all of these medications work on the nervous system, some amount of sedation or fatigue are fairly common side effects to several of the medications that are considered."
Could physical therapy or exercise relieve the pain?
Staying active and following a prescribed exercise regimen may also help to relieve nerve pain, depending on the cause.
One example: For neuropathy, moderate aerobic activity for 150 minutes per week after getting clearance from or under the supervision of a physician can be beneficial. "This can include activities such as brisk walking -- at least 2.5 miles per hour -- swimming or biking less than 10 miles per hour, Feldman says.
Others with radiculopathy, which is due to a compressed or pinched nerve in the spine, may also be able to relieve symptoms including pain with physical therapy. This PT focuses on the area of the pain with specific exercises for the neck or back done under the supervision of a physical therapist, Feldman notes. For example, you might do a controlled head turn or neck bend for a pinched nerve in the neck.
"Physical activity in general is often helpful. Often exercise can improve symptoms," Jacobson says. He notes that it can also be preventive, by staving off conditions like diabetes that can cause nerve pain.
Are there other options to treat nerve pain, including alternative therapies?
Again, depending on the type of nerve pain that you're experiencing, there are many different approaches that may be suggested to treat your pain.
For instance, acupuncture is often recommended for treating neuropathy. Some patients report pain relief, and clinicians say acupuncture may help. Still, the data is somewhat limited regarding use on the therapy, which involves inserting thin needles into the body at strategic points for nerve pain. A 2017 Cochrane analysis of available research found there isn't enough to support or refute acupuncture for neuropathic pain.
Given the myriad options offered for nerve pain, experts recommend first talking to your doctor about any approach you're considering to manage your pain. It's important to determine upfront what evidence might support any suggested treatment as well as discuss risks.
What lifestyle changes would help my pain?
Certainly, just as factors like a lack of sleep can exacerbate pain, paying attention to the three pillars of health -- sleep, diet and exercise -- can sometimes be helpful in lessening discomfort.
Properly managing diabetes is key to preventing diabetic neuropathy. That's all the more important given how many people with the chronic condition suffer from nerve pain. "It's a very common, prevalent problem in a very common, prevalent disease," Feldman reiterates. As such, experts emphasize the critical importance of also addressing prediabetes to prevent diabetes and reduce the risk of nerve damage. That means making sure to follow recommended lifestyle changes, such as eating a healthy diet that spreads carbs throughout the day, exercising regularly and losing weight.
"Another common cause of nerve pain in the United States is alcohol abuse," Jacobson says. And research finds that smoking is a risk factor for neuropathic pain as well. So kicking the habit, if you light up, and making sure to only drink in moderation may also help.
Questions to ask your doctor about nerve pain:
-- How do you know if it's nerve pain?
-- How can we determine the cause of the pain?
-- Is diabetes or prediabetes the cause of my nerve pain?
-- Should I see a neurologist?
-- Do I need an EMG test?
-- What should we do if the cause of my pain isn't immediately clear?
-- Can medication help?
-- Could physical therapy or exercise relieve the pain?
-- Are there other options to treat nerve pain, including alternative therapies?
-- Would lifestyle changes help to manage the pain?