Treatment for Nerve Pain
Nerve pain results from a problem in your central nervous system, brain, and spinal cord. It usually occurs due to an injury or disease or maybe some chronic disease. The most common reasons are an injury to your brain, spine, or nerves.
Some people suffering from nerve pain describe it as agonizing and burning; others feel tingling. Chronic nerve pain is extremely discomforting and hard to endure.
Furthermore, nerve pains have high levels of intensity and may result in a change in nerve functions, both at the source of origin and surrounding areas. In certain mild conditions, nerve pain may come and go, but this is usually a chronic condition.
Painful Radiculopathy
Radiculopathy relates to pinching or constriction of a nerve root in the spinal column. This nerve constricting can occur at different areas running along the spine, cervical, thoracic, etc.
Radiculopathy symptoms may vary depending on the nerve location, but the most common signs are usual pain, numbness, tingling effects, and weakness.
The majority of patients suffering from chronic low back pain with radiculopathy have neuropathic symptoms. Gabapentin and nortriptyline may help lower the intensity of lumbar or cervical radicular chronic pain.
If you have persistent and continuous bouts of pain, consult a specialist or neurologist.
What Is the Best Treatment for Nerve Pain?
Neuropathic patients will mostly find the following medicines as a relief for nerve pain.
· Amitriptyline (for curing depression and headaches)
· Duloxetine (patients with bladder problems also take this medicine)
· Pregabalin and gabapentin (both medicines may cure anxiety, epilepsy, and headaches)
Early Clinical Diagnosis of Neuropathic Pain
You may observe that nerve pain may be due to neuropathic or nociceptive. In either case, both use your nervous system pathways to enhance their circulation. Nociceptive condition is due to reasons like trauma, ischemia, arthritis, etc., and it is easy to identify. On the other hand, neuropathic pain is difficult to diagnose.
Treatments for Neuropathic Pain
You will find several different methods and medicines that help reduce nerve pain. Your best choice depends on the type and cause of your nerve pain.
Some common treatments for neuropathic pain are:
Anticonvulsants
The drugs may help people with nerve pain. This drug is often the first choice for soothing nerve pain. Initially, doctors used to recommend these drugs for people having epileptic symptoms and seizure effects. Further research made it clear that its use may help slow nerve pain intensity.
Antidepressants
Like anticonvulsants, certain antidepressants may be the first-choice drug for treating people with nerve or neuropathic pain.
Antidepressants bear two more types:
Tricyclic Antidepressants
People are using these drugs for years, and these may play an important role in managing nerve pain intensity and its symptoms. However, it’s not a good option for heart patients.
SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)
This a new antidepressant that may help reduce your nerve pain significantly. These are safe drugs for elderly people with heart issues.
Therefore, using antidepressants may have some more benefits considering that chronic pain often leads to depression. The antidepressants may help improve your mood besides comforting your never pain.
Painkillers
Some powerful opioid painkillers can help deal with severe nerve pain. They are as effective and good as an antidepressant or anticonvulsant can be. Their reaction is quick and brings fast relief to pain.
Topical treatments
You may use painkilling gels and lidocaine patches and apply them to the affected area. These gels work in small areas.
Other Treatments for Nerve Pain
Electrical Stimulation
In this procedure, the brain receives an electric signal from nerves. If you have nerve pain, the brain will identify the damaged nerve. It has three variants.
· Transcutaneous Electrical Nerve Stimulation (TENS). It’s a small device that transmits mild or moderate electric current through your skin. While TENS is a simple and painless method, the evidence that it may help with nerve pain is mixed.
· Percutaneous Electrical Nerve Stimulation (PENS). It is also known as electro-acupuncture that delivers electric stimulation to your nerves through acupuncture needles. This method is not very common.
· Repetitive Transcranial Magnetic Stimulation (RTMS). This stimulation method uses electro-magnetic impulses to reduce nerve pain.
Other electric stimulation methods are complex and may require surgery. Like spinal cord stimulation involves an electric device in your body that sends electric impulses to your spinal cord. It may help reduce the pain, but rare citing for its use.
First-Line of Treatment for Different Nerve Pain
Topical treatment
Lidocaine, Capsaicin, and Transdermal Substances
These are alternatives for painkillers or electrical stimulus methods. Topical medication brings along multiple and diversifying guidelines for their usage.
Lidocaine
Topical lidocaine may reduce peripheral never pain and comes as gels, liquids, creams, eye drops, patches, and sprays. All the different forms of lidocaine help in preventing nerves from sending distress signals to your brain; thus, reducing your nerve pain. The application of lidocaine application helps numb the painful area.
Capsaicin
Topical creams containing capsaicin may help reduce peripheral neuropathy pain.
You may apply it on the skin, as capsaicin will cause high-sensitivity that may help lower your pain level. Capsaicin reacts through binding to the TRPV1 receptor and C-nerve fibers.
Moreover, its initial application result is painful and, depending on persistent use, will gradually reduce the nerve pain. It promises good results for diabetic patients as well.
Transdermal Substances
Transdermal substances are not common for treating nerve pain. However, some evidence suggests that ketamine, diclofenac, and clonidine form a transdermal substance.
Diclofenac may help reduce the burning effects but have little to no effect in reducing neuropathic pain. In contrast, clonidine may reduce pain levels in diabetic neuropathic patients by 30%.
Second-Line of Treatment
Combination Therapy
No single drug can have the same effects on different patients with nerve pain. Neuropathic patients may use a combination of medicines to relieve their pain. A combination therapy plays a more effective role in managing neuropathic pain.
It is a combination of various pharmacological treatments. Like a modern combination of pregabalin with SNRIs is an option for treating those patients who cannot withstand a high-dose monotherapy.
Another combination therapy for treating neuropathic patients includes gabapentin and opioids. It may give your better pain relief than opioids or gabapentin alone.
However, for patients suffering from diabetic peripheral neuropathy, a combination of nortriptyline and pregabalin may help lower the pain than monotherapy. A combination of imipramine and pregabalin may also help reduce your pain.
Tramadol and Tapentadol
Tramadol is quite effective when it comes to reducing nerve or neuropathic pain. It is also good for treating people with post-operative pain, sciatica, and back pain. Its maximum safe dose is 400 mg per day.
It’s a second-line treatment in most health guidelines. But it can work as a first-line treatment for patients dealing with cancer-related neuropathic pain.
Tapentadol
Tapentadol is like an opioid, a pain reliever. It acts in selective centers of your brain to calm down the pain levels. You may have seen its use to relieve nerve pain or peripheral neuropathy in diabetic people.
Third-Line of Treatment
Serotonin Reuptake Inhibitors/ Anticonvulsants
Doctors recommend the third-line of treatment when the first two are not helping you overcome nerve pain. Consulting a doctor is a must for getting third-line treatment.
This treatment may involve using serotonin reuptake inhibitors and anticonvulsants such as lamotrigine, carbamazepine, and or sodium.
Interventional Therapies
Epidural Injection
Epidural injections may help you give immediate relief from severe pain. Epidural steroid injections reduce sciatic nerve pain by lowering your inflammation. Secondly, it may improve mobility in your lower back and legs.
The doctor should tell you if you can take this injection with or without steroid for treating herniation or radiculitis. This injection may be good for those patients who do not find other therapies effective.
There are certain techniques that your doctor may suggest to you about administering this injection. The Transforaminal approach may give you the best result than the Interlaminar technique.
Pulsed Radiofrequency
Its viability may not be in common; however, pulsed radiofrequency (PRF) lasts for about six months. In comparison, the effects of epidural injection may not last even three months. Hence, pulsed radiofrequency is best for neuropathic pain.
Fourth-Line of Treatment
Neuro-stimulation
It’s an excellent method for patients suffering from
· Transcutaneous Electric Nerve Stimuli (TENS)
· Spinal Cord Stimulation (SCS),
· Peripheral Nerve Stimulation (PNS),
· Deep Brain Stimulation (DBS)
· Nerve Root Stimulation (NRS)
Further, you can use this method for patients with repetitive transcranial magnetic stimulation (RTMS) and epidural motor cortex stimulation (MCS).
Neuro-stimulation also helps in curing neurological disorders like Parkinson's disease, refractory pain, epilepsy, and migraine.
Results and Conclusions
As of now, neuro-stimulation is under investigation. It has a high potential and scope for relieving chronic nerve pain patients of any type. More and more add-ons for neuro-stimulation are coming up in the near future, like neural sensing, novel target-specific stimulation, etc.
Conclusion
Neuropathic or nerve pain can be unbearable and chronic. At times, it may be very difficult to diagnose. Its slow response in tests suggests it’s a complex disease and requires subsequent treatment.
You may need a multidisciplinary and well thought, step-wise approach and methods to cure it. For this, you need to understand the core reason for any type of nerve pain. It is advisable to consult a neurologist in case of chronic nerve pain.