Neuropathy and Nerve Pain

What is peripheral neuropathy?
Peripheral neuropathy is a condition where the nerves in the body become damaged, which causes symptoms like pain, numbness, or weakness. It is typically the result of an underlying condition but, in about 20% of cases, it is simply a degenerative condition of the nerves themselves and there is no underlying condition.

The most common cause of peripheral neuropathy is diabetes or pre-diabetes. The worse the glucose control, the worse the neuropathy. Hypothyroidism, autoimmune conditions such as lupus or rheumatoid arthritis, peripheral artery disease, and poor nutrition are among the many other causes of neuropathy. Finding the cause of the neuropathy is very important because the worse the underlying cause gets, the worse the neuropathy gets.

What type of pain is caused by peripheral neuropathy?
Typically neuropathy causes a variety of paresthesias (abnormal sensations) and dysesthesias (painful sensations). Paresthesias are often described as tingling or pins and needles sensation, numbness, and itching. Dysesthesias are sharp, stabbing, jolting (like an electric shock), burning, discomforting, and pain to the touch.

In addition to pain, the loss of sensation can become so severe the person may lose the ability to walk steadily and fall down frequently. These falls can be quite traumatic and lead to fractures.

How is peripheral neuropathy treated?
The first step is to identify and treat the underlying cause. Therapy and a home exercise program can improve pain control and physical function.

There are a variety of medications, including certain antiepileptics and antidepressants, that can help control the pain. Correcting nutritional imbalances is very important. Some patients find acupuncture, biofeedback, or transcutaneous electrical nerve stimulation (TENS) helpful.

For patients who don’t respond to medications or can’t tolerate the side effects, we offer spinal cord stimulation. This uses an electrical signal to block the pain and is very effective for neuropathic pain. With spinal cord stimulation, we can stop or greatly reduce oral pain medications, which is much more tolerable for many patients, particularly those on multiple medications.

The goal is restoring comfort, mobility, and quality of life with treatment plans tailored to individual needs.

How does peripheral artery disease (PAD) cause nerve pain?
PAD causes inadequate blood flow to the legs, which directly damages the nerves in the legs and feet. This limited circulation can lead to various complications like numbness, pain, or even ulcers. It’s a serious condition that deserves prompt attention.

If medications, stents, and surgery have not controlled the pain, spinal cord stimulation is a safe and effective option that can improve blood flow, ease pain, and help maintain mobility. We follow trusted standards with a proven record of success to care for patients with nerve pain from PAD. Full eligibility criteria and referral info →

What is Complex Regional Pain Syndrome (CRPS)?
Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a type of nerve pain that can affect one or more areas of the body. It can cause severe, long-lasting pain, usually in an arm or leg, after an injury or surgery. The pain can feel like burning, stabbing, electric shocks, or pins and needles.

Unlike most peripheral neuropathies, the source of the pain in CRPS is the autonomic nerves of the peripheral nervous system (see below). Because of this, CRPS may be accompanied by swelling, changes in skin color or temperature, and sensitivity to touch.

What treatment options are available for CRPS?
We use the full spectrum of treatments available, including sympathetic nerve blocks with intravenous ketamine administration, and spinal cord stimulation. It’s important to start treating CRPS as soon as possible because it can become harder to treat over time. Sometimes, the condition can be reversed, but, if this is not possible, our goal is always to control the pain.

The nervous system is divided into two parts – central (brain and spinal cord) and peripheral (somatic and autonomic). The somatic nerves control sensation on the skin and movement. They are the nerves that allowed me to type this in.

The autonomic nerves, like the name implies, control the automatic functions of the body and they provide sensation to the internal organs. These organs include the heart, lungs, liver, pancreas, stomach and intestines, bladder, and genitals. When someone has visceral pain, it means pain from these organs. This type of nerve pain is different from other types of pain.

The automatic functions are things you don’t have to think about such as making your heart beat, digest food, breathe, control blood pressure and circulation, etc. Because CRPS affects these nerves, it can sometimes cause heart rate abnormalities and digestive problems in addition changes in skin color and temperature noted above.

Sympathetic nerve blocks specifically treat the autonomic nerves, which is why they are used for CRPS and for visceral pain in some cancer patients.