Perhaps one of the most difficult side effects of any of the 100 identified causes of neuropathy is chronic pain. Whenever it’s possible, experts like to determine the cause of the pain before recommending treatment.
In particular, doctors want to make sure the pain is really is a nerve (neuropathic) pain. Peripheral neuropathy is pain in the limbs; arms/legs, hands/feet. Sometimes pain in those locations may not really be nerve pain. They might, for example, actually fall into a category called "myelopathic," meaning there’s compression on the spinal cord.
While surgery can sometimes help such compressions, it rarely helps neuropathic pain. “You obviously don’t want to operate if the pain isn’t likely to respond to surgery,” said Jack Stern, M.D., in an interview. Stern is assistant clinical professor of neurosurgery at Yale University School of Medicine in Connecticut.
Determining the Cause
Sometimes a test called the EMG can help determine if a pain is truly neuropathic. Another method experts use is listening to the type of pain the patient describes.
“Patients with neuropathic pain usually describe it as ‘burning’ or ‘gnawing,’” Stern said. “Pains that are likely to respond to surgery, like a herniated disc, are more often described as ‘sharp’ and ‘shooting.’”
Even if the pain is idiopathic (meaning the cause can’t be determined) don’t despair. Most of the relief options now recommended apply whether or not the cause is known.
Typical Treatments
Sometimes a mild neuropathy will respond to just a simple over-the-counter drug like aspirin. “More commonly, we use what are called neuropathic pain agents," said A. Gordon Smith, M.D. in an interview. Gordon is associate professor of neurology and pathology at the University of Utah School of Medicine in Salt Lake City.
These agents are most often anti-seizure medicines like Lyrica and Neurontin, or certain anti-depressants. Some people are finding success with a lidocaine patch, or creams containing capsaicin, a natural substance that releases heat. Sometimes a combination of medications can effectively reduce pain.
An external support is another option your doctor may recommend, like an orthopedic insert or a specially designed shoe to even out an improper gait. A hand or foot brace can relieve nerve compression.
Trying Something Different?
More recently, not only patients, but even some doctors, are willing to explore less traditional pain fighters. “I have had patients who’ve had success with TENS stimulators and acupuncture,” Stern said. “Some people do better with holistic therapies,” Smith said and added, “If the person has already used a certain therapy, like acupuncture for treating knee pain, it’s more likely that therapy will relieve their neuropathic pain.”
Some supplements are being studied, like alpha-lipoic acid, but be careful. Even if the recommendation comes from a reliable source, what else does the recommendation say? Has a specific dosage been suggested? Are there any notes as to how this supplement acts with other medications? That's especially important given that many people with neuropathic pain are older adults who are often on several prescription drugs for other problems.
Lifestyle Changes Always Important
If the neuropathy is diabetic neuropathy (caused by actually diabetes or developing diabetes), better blood glucose control could minimize or even avoid severe pain and damage. That's why one of the first steps experts suggest for fighting neuropathic pain is simple dietary changes. Better blood glucose helps protect nerves and stop damage.
Among other lifestyle changes most often recommended:
- Stop smoking—It constricts the blood vessels, making it much easier for your symptoms to worsen.
- Reduce/avoid alcohol—Alcohol can induce, and then aggravate, neuropathic pain.
- Exercise—It can reduce cramps and improve muscle strength. In paralyzed limbs, it can help prevent muscles from wasting away. Just make sure to find an option that works with your abilities. Consider an indoor pool; water exercises are often less painful.
- Relaxation techniques—“It’s hard to think of anything stress helps, so stress management can be helpful,” Smith said. Among the options: meditation, yoga, tai chi, biofeedback, and deep breathing techniques.
- Rediscover friends--Many people let the pain disable them, which creates a vicious cycle of social isolation. Find ways to keep connected, whether it's having the bridge club over or making an effort to go out; e.g., to lunch or the movies.
- Connect (or reconnect) with faith—Not only can it be a great source of calm, but many people find support within their congregation.
Obviously, there are many options for fighting and coping with neuropathic pain. A combination of treatments (e.g., medication, social support, and dietary changes) may offer the best outcomes.”
Try and find an expert in peripheral neuropathy. Whoever the doctor, make sure they seem committed to helping the patient find a pain relief option. "If not, don’t be afraid to get a second opinion,” Smith concluded.
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