Nerve pain, also known as neuropathic pain, refers to pain caused by damage or dysfunction in the nervous system. It’s estimated that neuropathic pain affects up to 8% of the population. Nerve pain can be chronic and debilitating, significantly impacting a person’s quality of life. Understanding what can trigger or worsen nerve pain is important for managing symptoms.
What causes nerve pain?
Nerve pain occurs when nerves themselves become damaged or injured. This damage sends incorrect signals to the brain that are perceived as pain. Common causes of nerve damage leading to pain include:
- Diabetes (diabetic neuropathy)
- Shingles (postherpetic neuralgia)
- HIV
- Multiple sclerosis
- Stroke
- Injuries or trauma
- Cancer and chemotherapy
- Autoimmune diseases like lupus or rheumatoid arthritis
- Alcoholism
- Nutritional deficiencies (B vitamins in particular)
- Nerve compression or entrapment (carpal tunnel syndrome, sciatica)
- Infections like shingles or HIV
- Spinal problems like slipped discs
In some cases, an identifiable cause cannot be found. The nervous system itself is just dysfunctional and sends pain signals spontaneously.
What are the symptoms of nerve pain?
Nerve pain can manifest in many different ways. Common symptoms include:
- Shooting, stabbing or burning pain
- Tingling or numbness
- Increased sensitivity to touch or temperature
- Muscle weakness
- Difficulty moving the affected body part
- Changes in skin, hair or nail growth in the painful area
The pain is often described as a shooting, stabbing or burning sensation. It may feel like an electric shock. Sometimes it comes and goes, while other times it is constant. The severity can range from mild to excruciating.
Nerve pain often affects a particular region of the body, depending on the location of the damaged nerve. For example, diabetic neuropathy usually causes pain in the feet and legs. People with MS often have nerve pain in the face. Postherpetic neuralgia arises in areas where someone had shingles.
What can trigger or worsen nerve pain?
Certain factors can exacerbate or trigger a flare up of nerve pain symptoms. Identifying and avoiding potential triggers is an important part of managing chronic nerve pain. Common triggers include:
Touch or Pressure
For many people with nerve pain, touch or pressure on the affected area can provoke severe pain. This condition is known as mechanical allodynia. Even light stimulation like clothing brushing against the skin can be agonizing. Restrictive clothing, shoes or jewelry should be avoided. Weight loss may help reduce flare ups from touch if nerve pain is located in the feet, legs or other weight-bearing areas.
Cold Temperatures
Nerve pain often worsens with exposure to cold. The exact reason is unclear, but cold may impact how nerves function. Being outside on cold or windy days, as well as air conditioning in the summer, can trigger symptoms. Keeping the affected area insulated and warm may help.
Heat
While some find cold intolerable, heat can also increase nerve pain for some people. Hot weather, showers, baths, saunas and heating pads can provoke flare ups. It’s important to determine whether hot or cold temperatures aggravate your symptoms so that they can be avoided.
Stress and Emotional Upset
Many chronic pain conditions including nerve pain can intensify during times of stress or emotional distress. Stress can impact nerves, brain chemistry and pain perception. Finding healthy ways to manage stress through relaxation, mindfulness, counseling or other means may help stabilize pain levels.
Overactivity and Strain
Since nerves are damaged in areas affected by nerve pain, activity that further strains or irritates those nerves can lead to worsening pain. Repeated strenuous movements, improper technique and poor posture can all contribute to flare ups. Gentle stretching and light exercise may help improve flexibility and range of motion. Braces can sometimes provide extra support and take pressure off nerves.
Medications
Certain medications have nerve pain as a potential side effect. Chemotherapy drugs, HIV drugs, antiseizure drugs and some heart medications are known to sometimes provoke nerve pain. It’s important to be aware of this possible side effect when starting new medications. Always talk to your doctor about adjusting dosages or trying a different medication if nerve pain develops or worsens after beginning a new prescription.
Blood Sugar Spikes
For people with diabetes, nerve pain symptoms often fluctuate depending on their blood sugar levels. When blood sugar spikes too high (hyperglycemia), nerve pain can flare up as well. Maintaining stable blood sugar levels can help minimize changes in pain levels.
Alcohol Use
Drinking alcohol, especially heavily and regularly, is known to exacerbate nerve pain. The exact mechanisms are unclear, but even one drink can trigger pain for some people. Limiting alcohol intake is recommended to help avoid increasing nerve pain symptoms.
Injuries and Compression
Because nerves are already damaged, any additional injuries, inflammation or compression on those nerves can worsen pain. Common culprits include fractures, sprains, cuts, bruises, joint damage or herniated discs applying pressure to nerves. Preventing further injury and getting prompt treatment for any new damage can help minimize resulting pain spikes.
Infections
Infections that impact nerves, from shingles to HIV, can cause severe flare ups of nerve pain. Preventing exposure and getting treated at the first sign of infection is important. Even minor skin or tissue infections around areas of nerve damage can exacerbate pain.
Changes in Weather and Barometric Pressure
Some research indicates that shifts in weather and barometric pressure may increase pain for those with chronic nerve pain and other pain conditions. The direct cause is unclear. Tracking pain levels in relation to the weather can help determine if this is a contributing factor.
Poor Sleep
Sleep disruption goes hand in hand with chronic pain. Lack of restorative sleep can make pain worse, while pain also interferes with sleep. Improving sleep quality and consistency through healthy sleep habits, treatment for sleep disorders, and other pain management techniques can help lessen the bidirectional relationship between pain and poor sleep.
What helps relieve nerve pain flare ups?
When nerve pain spikes or flares, there are several methods that may help reduce symptoms and regain control:
- Over-the-counter pain medications like NSAIDs or acetaminophen
- Prescription medications for nerve pain if prescribed – anticonvulsants, tricyclic antidepressants, lidocaine patches, opioids in some cases
- Topical treatments like capsaicin cream, lidocaine gels or ointments
- Icing or cooling the area if cold helps symptoms
- Heating pads if heat provides relief
- Gentle massage or vibration therapy
- Relaxation techniques like deep breathing, mindfulness, meditation
- Avoiding triggers like pressure on the affected area
- Rest and limiting activity that worsens symptoms
- Distraction techniques like reading, watching videos or listening to music
Seeking prompt medical treatment if flare ups are severe or recurring is also recommended. Long-term pain management with a doctor may include prescription medications, injection therapies, electrical stimulators, physical therapy, psychological treatment and other modalities.
When to see a doctor about nerve pain
It’s advisable to consult a doctor if you are experiencing the following related to nerve pain:
- Moderate to severe pain that does not improve with over-the-counter treatment
- Pain that interferes with your daily activities and quality of life
- Difficulty sleeping due to pain
- Pain that spreads or worsens over time
- Muscle weakness or numbness
- Significant changes in sensation or coordination
- Pain that cannot be explained by a recent injury or illness
- Frequent or severe flare ups
- Weight loss, fever, swelling or other concerning symptoms along with the pain
A doctor can help diagnose the underlying cause of your nerve pain and provide specialized treatment options to reduce symptoms and improve functioning. Leaving nerve pain untreated allows symptoms to worsen over time. Early intervention provides the best chance for effectively managing nerve pain.
When to go to the ER for nerve pain
Seek emergency medical care if you experience:
- Sudden, severe nerve pain
- Nerve pain accompanied by chest pain, shortness of breath or stroke-like symptoms
- Loss of bladder and bowel control
- Inability to move a part of your body
- Sudden paralysis or loss of sensation
- Unexplained fever, nausea or vomiting along with nerve pain
These signs can indicate a medical emergency requiring immediate treatment, such as:
- Spinal cord injury or disc herniation applying extreme pressure to nerves
- Blood clot causing stroke
- Guillain-Barre syndrome causing rapid paralysis
- Infection affecting the nervous system
Go straight to the ER or call 911 if your symptoms are profoundly alarming or debilitating. Some causes of acute nerve pain like strokes require emergency intervention to prevent permanent damage and disability.
Treatment options for nerve pain relief
If over-the-counter medications and home remedies don’t provide enough relief from nerve pain flare ups, many prescription treatment options are available. Common medical treatments for nerve pain include:
Pain Medications
- Anticonvulsants like gabapentin help calm down excitable nerve cells. They are often a first line prescription for nerve pain.
- Antidepressants like duloxetine and tricyclics also modulate nerves and have been shown effective, especially for chronic and neuropathic pain.
- Opioids like oxycodone may be options for short-term, severe nerve pain, but have risks of side effects and addiction.
- Topical anesthetics like lidocaine are available in cream, gel and patches to numb superficial nerve pain.
Medical Procedures
- Nerve blocks can temporarily block pain signals with anesthetics and steroids injected around affected nerves.
- Spinal cord stimulation uses implanted electrodes to interrupt pain signals traveling to the brain.
- Radiofrequency ablation applies heat to targeted nerves to disrupt pain signals.
Lifestyle Approaches
- Improving sleep through sleep hygiene and/or treatment of conditions like sleep apnea.
- Stress management via counseling, meditation, yoga, mindfulness, etc.
- Physical therapy and exercise to improve strength, flexibility and reduce pressure on nerves.
- Healthy diet and nutrition ensure adequate vitamins/minerals and help manage weight and conditions like diabetes.
- Cognitive behavioral therapy (CBT) to develop coping skills for chronic pain.
- Biofeedback helps train control over physiological processes affecting pain.
- Massage, acupuncture and other complementary approaches may also help relieve pain.
An interdisciplinary pain management plan combining medications, procedures, lifestyle changes and alternative approaches often provides the greatest relief from chronic neuropathic pain. Treatment needs to be tailored to each patient’s underlying condition, symptoms and health history.
Conclusion
Nerve pain can have a wide variety of triggers and flare ups that intensify symptoms. Identifying your own pain triggers allows you to avoid things that worsen your pain or provoke painful flare ups. Using medications, procedures, lifestyle changes and alternative therapies can also help manage nerve pain spikes when they occur. Working closely with your doctor to find an effective pain management plan provides the best chance for controlling this challenging chronic pain condition.
