Neuralgia: Understanding The Causes And Managing Nerve Pain

The nerves throughout our bodies enable muscle movement, control essential functions, and process sensations like touch and temperature. They play a vital role in helping us experience the world around us. 

However, certain illnesses or medical events can cause nerve damage or put pressure on nerve endings. When this happens, you may experience a chronic pain condition, which, over time, can become life-limiting.

Although nerve pain is “invisible,” it is vital not to overlook its symptoms – nor settle for traditional therapies that are inefficient. Today, the comprehensive approach at NextPain Care focuses on addressing the underlying causes of your pain, aiming to enhance both your health and overall well-being.

Let’s dive into how we can manage nerve pain with NextPain Care’s whole-person approach.

What Is Neuralgia?

Neuralgia describes a condition caused by damaged, irritated, or injured nerves. The symptoms of nerve pain vary in intensity and nature over time, but they can develop into severe pain, loss of muscle control, and life-threatening complications.

To understand what nerve pain is, it is first important to look at how the nervous system works and what role it plays in the perception of pain.

The nervous system is composed of two main parts:

• The central nervous system: The nerves in the brain and spinal cord.
• The peripheral nervous system: The nerves located outside of the brain and spinal cord, across the body. The peripheral nervous system is composed of three types of nerves:
  • Sensory nerves: These nerves are responsible for transmitting signals to the brain related to pain, touch, temperature, and vibration.
  • Motor nerves: These nerves are in charge of transporting signals relating to muscle movement.
  • Autonomic nerves: These nerves control all bodily functions we don’t have direct control over, such as heartbeat, digestion, sweating, and breathing.

Each of these nerves plays a role in identifying, interpreting, and responding to pain signals:

• Sensory nerve fibers located across the body respond to external stimuli of touch. If there has been an injury or potential injury, special nerve fibers called nociceptors activate. The impulses they create immediately travel through the spinal cord to the brain.
• The spinal cord acts as a highway for all motor and sensory signals that travel from the nerves in the peripheral nervous system to the brain. This is where an immediate response to pain – or reflex – occurs. In practice, reflexes are what cause you to move your hand away from a source of heat when you experience a burning sensation.
• Traveling onwards, the pain signals reach the brain, where they are processed and interpreted. The brain kickstarts the healing process and the body’s response to injury. It also categorizes the type and intensity of the pain you’ve experienced. As the brain processes pain signals, other reactions may occur such as crying, increased heart rate, and excessive sweating.

When the nerves in the peripheral nervous system become damaged or irritated, the normal transmission of pain signals to the spinal cord and the brain is disrupted. This translates into nerve pain, which causes symptoms like excessive pain in response to stimuli that should be painless, as well as numbness, muscle spasms, and extreme sensitivity to touch.

Types Of Nerve Pain

Nerve pain can manifest in many forms. You may begin to experience numbness in the toes and fingers, shooting or burning pain, and “pins and needles” or tingling sensations. However, not all types of nerve pain are the same – nor do they have the same cause and symptoms.

Below, we’ll look at the most common forms of nerve pain:

• Trigeminal neuralgia: This condition occurs when blood vessels press on the trigeminal nerve, a set of cranial nerves that stems from the top of the ear and runs across the side of the face. This is a lifelong condition that affects only one side of the face and causes excruciating bouts of shooting pain, so intense as to prevent talking, eating, or drinking. Around 150,000 people are diagnosed with trigeminal nerve pain each year.

• Postherpetic neuralgia: This refers to lasting nerve pain in the areas of the skin that have been affected by shingles. Shingles is a viral infection caused by the varicella-zoster virus, which is also responsible for causing chickenpox.
• Occipital neuralgia: This form of nerve pain affects the occipital nerves, and spinal nerves that originate in the neck and help control the head. Occipital nerve pain may be caused by poor posture, tense neck muscles, pinched nerves, infections, diseases such as diabetes, and head or neck injuries. It causes shooting and throbbing pain that radiates from the base of the skull along the scalp.
• Peripheral nerve pain: Also known as peripheral neuropathy, this refers to pain caused by direct damage to the nerves in the peripheral nervous system. Diabetic neuropathy is the most common form of peripheral neuropathy.
• Intercostal neuralgia: This affects the nerves located just under the ribs. It causes sharp or burning pain sensations that radiate through the chest, upper back, and upper abdomen, as well as muscle twitching and pressure around the chest.

What Causes Nerve Pain?

Nerve pain can stem from a combination of causes and risk factors. However, in up to 30% of cases, nerve pain is idiopathic, meaning that it has no obvious cause and develops spontaneously.

Nonetheless, obtaining an adequate diagnosis of what’s causing your chronic pain is the first step to finding an adequate line of treatment. 

So, let’s look at the most likely causes of nerve pain:

• Injury to your brain, spine, or nerves: Nerve damage can occur as a consequence of brain or spinal cord injury. However, collisions, fractures, or ruptured ligaments may also damage nerves in the peripheral nervous system by compressing or crushing them. In severe cases, traumatic injuries can detach the nerves from the spinal cord.
• Lack of blood supply in nerves: Blood vessels are responsible for supplying nerves with essential oxygen and nutrients. When the blood supply is severed, nerve fibers begin to deteriorate and disappear. One of the most common causes of the lack of blood supply to nerves is uncontrolled blood sugar, which, over time, causes blood vessel damage. Because of this, it is estimated that over half of people with diabetes will develop nerve damage and, consequently, nerve pain.
• Excessive consumption of alcohol: Alcohol, as well as smoking tobacco, has a neurotoxic effect, which means that it damages the nerves’ protective sheath (called myelin). Excessive consumption of alcohol can increase the risk of suffering from nerve pain. It is estimated that up to 66% of people with an alcohol-use disorder have nerve damage to some extent.
• Exposure to certain medications, especially chemotherapy: Some medications are toxic to the peripheral nervous system. Classes of medications that may cause nerve damage include those for blood pressure, pharmaceuticals to fight infections like HIV, and medicines to control autoimmune diseases. Anti-cancer medications may also cause temporary nerve damage, and it is estimated that up to 85% of people undergoing chemotherapy will suffer from nerve pain.
• Low vitamin levels: Certain nutritional deficiencies are linked to dysfunction of the nervous system. You may be at greater risk of nerve pain if you have low levels of copper or vitamins B1, B6, B9, B12, and E.

Other factors that may contribute to nerve pain and damage include autoimmune diseases, hormonal imbalances, kidney or liver dysfunction, and infections like HIV.

Medical Conditions Associated with Nerve Pain

Usually, nerve pain develops as a consequence of nerve damage, as well as diseases or dysfunction of essential systems in the body. Below, we’ll look at the medical conditions that may be at the root of nerve pain.

Peripheral Neuropathy

Peripheral neuropathy is the term used to describe damage to nerves located in the peripheral nervous system, or outside of the brain and the spinal cord. 

Alone, it does not describe the underlying condition that may be the real cause of nerve damage, nor does it detail the type, location, and intensity of your symptoms. Affecting over 20 million people in the US alone, peripheral neuropathy is the most common form of nerve pain.

Peripheral neuropathy can affect any nerve in the peripheral nervous system and, depending on which type of nerve is damaged, you may experience different symptoms and complications:

• Damage to sensory nerves: Causes numbness, tingling sensations, excessive pain in response to normally painless stimuli, extreme sensitivity to touch, and inability to feel heat or cold.
• Damage to motor nerves: Causes involuntary muscle movements, cramps, and twitching. In severe cases, you may become unable to move some muscles, and disuse can lead to muscle shrinkage.
• Damage to autonomic nerves: Leads to a form of neuropathy known as autonomic peripheral neuropathy, which causes severe complications such as digestive dysfunction, loss of bladder or bowel control, and irregular heartbeat.

Peripheral neuropathy manifests itself with the “dying-back phenomenon”: the nerves located further from the spinal cord and brain are the first ones to be affected. This means that you’ll begin to experience pain and numbness in the toes, fingers, feet, and hands first.

Over time, the symptoms of peripheral neuropathy become more severe and start to affect other areas of the body.

Sciatica

Affecting up to 40% of people at least once in their lifetime, sciatica accounts for most cases of low back pain.

This condition occurs when the sciatic nerve is compressed, pinched, or irritated by anomalies such as:

• Herniated intervertebral disc in the spinal column
• Overgrowth of bone 
• Abnormal tissue growth (i.e.: tumors)

The sciatic nerve is one of the longest nerves in the body, running from the lower back to the lower leg, and passing through the hips and buttocks. When it becomes compressed or damaged, you may experience shooting pain, numbness, and tingling sensations radiating from the lower back through the legs. 

In severe cases, sciatica can cause severe chronic pain, weakness, and temporary loss of movement, making it difficult to walk, stand, or climb stairs.

Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space in the ankle where the posterior tibial nerve, which runs down the leg, passes through. Tarsal tunnel syndrome is a disorder that occurs when this nerve becomes compressed or pinched within the tarsal tunnel, leading to pain and discomfort in the foot and ankle.

Lupus

Lupus – or systemic lupus erythematosus (SLE) – is an autoimmune disease that occurs when the body’s immune system mistakenly attacks healthy tissues in the body. Over time, the resulting chronic inflammation begins to damage several body systems, including blood cells, brain, kidneys, skin, joints, and lungs. 

The persistent inflammation caused by lupus can also be detrimental to nerves and their surrounding tissues. In turn, nerve damage can cause nerve pain, as well as numbness, tingling, and loss of muscle control. 

If you have a predisposition to develop lupus, the onset of this disease may be triggered by a medical event such as an infection, or by certain medications or exposure to sunlight. One of the most common signs of lupus is a facial rash that spreads across both cheeks, but not all people with this disease will develop this particular symptom. 

According to the CDC, lupus affects over 200,000 American adults. 

Metabolic Syndrome

Metabolic syndrome stems from disorders of metabolism. Metabolism is the term for all of those chemical reactions and processes involved with breaking down nutrients (proteins, fats, and carbohydrates) and transforming them into acids and sugars, which are the body’s main sources of energy. 

Your body may be unable to process and absorb nutrients as it should if your body does not respond well to insulin if organs involved in the metabolic process don’t function properly, or if the cells responsible for producing energy are defective. 

These disorders can occur because of genetics, but your diet and lifestyle have a profound impact on how your metabolism works. For example, if you are overweight, the fat cells in excess can raise the levels of free fatty acids, which, in turn, disrupt the levels of hormones responsible for controlling blood sugar.

If you have metabolic dysfunction, you may have high blood sugar, abnormal levels of “bad” cholesterol and triglycerides, high blood pressure, and a larger waistline. These conditions can significantly increase the level of deadly diseases like stroke, diabetes, and heart problems.

Metabolic dysfunction can also lead to metabolic neuropathies. These are disorders that occur when uncontrolled levels of blood sugar, diabetes, and toxin build-up damage nerves in the peripheral nervous system.

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune neurological condition that affects nearly three million people worldwide and, if left unaddressed, can cause permanent disability. Multiple sclerosis develops when the body’s immune system attacks the protective sheath that coats the nerves (myelin) in the brain and the spinal cord.

Over time, the nerves affected by MS become unable to function properly, thus severing the connection between the central nervous system and the peripheral nervous system. The intensity of the symptoms of MS can vary, but they often develop into vision problems, weakness, tremors, difficulty walking, muscle spasticity, loss of balance, and chronic pain.

Herpes Zoster

Shingles is an infection caused by the varicella-zoster virus that affects the nerve fibers in the skin. It causes painful rashes that appear as a strip of blisters, usually affecting one side of the body. It can affect anyone, at any time and, although it isn’t life-threatening, it can be extremely painful. 

Shingles are caused by the same virus that causes chickenpox. If you’ve had chickenpox, the virus will remain dormant in your body for the rest of your life, and it may reactivate as shingles several years after the first infection. 

When this happens, the virus can trigger inflammation in the nerve fibers, which leads to the most common complication of shingles: postherpetic neuralgia (PHN). Nerve pain and damage can be temporary or permanent and cause chronic pain that lasts long after the blisters have healed. 

It is estimated that one in three people in the US will develop shingles and that up to 18% of people who have had herpes zoster will suffer from PHN.

Risk Factors And Complications

Some risk factors may increase your risk of developing nerve pain and damage. These include:

• Duration of diabetes
• How long your blood sugar levels remain uncontrolled (glycemic control)
• Being overweight or obese
• Aging (as it contributes to the deterioration of nerve fibers and increases the risk of suffering from conditions like diabetes)
• Smoking
• Having a diagnosis of kidney disease

Nerve damage can progress from causing mild pain to becoming a life-limiting condition. If left unaddressed, you may risk severe complications, including:

• Severe numbness, which prevents you from experiencing pain. In turn, you may inadvertently expose areas of your body to extreme heat, cold, or injuries.
• If you can’t feel pain, you may let infections and wounds go untreated, which can increase the risk of ulcers and gangrene.
• Extreme sensitivity to touch (hyperesthesia) can make it difficult to carry out daily activities such as cooking or taking care of your personal hygiene. You may also experience sleep disruptions since the pain tends to become more noticeable at nighttime when there are no distractions.
• If motor nerves are affected, you may struggle with coordination and balance, and suffer from involuntary muscle movements and painful cramps.
• If autonomic nerves are affected, nerve pain can be bad enough to cause an erratic heartbeat, loss of bowel control, and impaired digestion.

When Is Nerve Pain No Longer Normal?

Sometimes, nerve pain is nothing more than a minor or temporary condition. For example, if you are undergoing chemotherapy, your nerve pain may be limited to the duration of the treatment. In some cases, you may even experience nerve pain due to a pinched or compressed nerve, such as if you have sciatica.

In these situations, home remedies and care can help relieve your symptoms and restore the health of your nervous system.

Nonetheless, not all nerve pain is equal – and learning to understand when you should seek immediate medical care can help you find an adequate line of treatment without delay and so avoid severe complications.

Some of the symptoms you should look out for include:

• Unexplained numbness or tingling in parts of your body (usually fingers and toes, but it can affect the hips, in the case of sciatica)
• Spasms and cramps that can cause you to lose muscle control
• Shooting or burning pain, usually radiating from your hands and feet
• Dropping objects when you are holding them
• Sharp pains in response to stimuli that should be painless (e.g., brushing your hair or washing your face)

You should also seek medical care if you experience other symptoms that indicate you may have high blood pressure, diabetes, or autoimmune conditions like celiac disease.

How Nerve Conditions Are Diagnosed

If you suffer from nerve pain, your doctor will carry out a range of tests to determine the nature, extent, and causes of your condition. Here are some of the diagnostic tests your healthcare provider may use:

• Blood tests: Blood tests can be used to identify nutritional deficiencies or high levels of toxins that may be damaging your nerves, as well as hereditary and genetic factors that can lead to autoimmune diseases.
• Biopsies: Biopsies involve collecting samples of skin containing nerve fibers for lab testing. They are used to determine the quantity and quality of nerve fibers under your skin.
• Electrodiagnostic tests: Tests such as nerve conduction tests (NCS), electromyograms (EMG), and quantitative sensory testing (QST) may be used to determine how well your nerves work and if you are able to respond to sensory stimuli.
• Neurological examinations: Neurological exams can help identify signs of disorders that may be affecting your brain or spinal cord.

Your doctor may also use imaging tests such as magnetic resonance imaging (MRI), computerized tomography (CT) scans, and nerve ultrasounds to check for anomalies such as abnormal tissue growth (e.g., tumors), structural problems, or pinched nerves.