Neuropathic pain: Causes, types, and treatment (2023)

Damage or injury to the nerves in the central or peripheral nervous system can cause neuropathic pain.

Some people may experience chronic pain in the body as a sharp, burning sensation, while others experience numbness and tingling.

Injury or disease can damage the nerve fibers, disrupting the pain signals the nerves send to and receive from other parts of the body.

Nerve damage can distort existing signals, create new signals, or prevent the usual signals from transferring. Also, it can sometimes make non-pain signals feel painful. These problems can cause painful symptoms, which can range from mild to severe.

Damage to the nervous system affects the senses, so people may have changes in the way they experience touch, temperature, movement, and pressure.

This article looks at the causes, types, and symptoms of neuropathic pain, as well as some treatment options.

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Various health conditions can cause damage to the nerves, leading to neuropathic pain. These include:

  • diabetes
  • cancer and cancer treatments, such as chemotherapy
  • neurological conditions, such as multiple sclerosis (MS)
  • neurodegenerative conditions, such as Parkinson’s disease
  • stroke
  • shingles
  • HIV
  • Hansen’s disease (leprosy)
  • Guillain-Barre syndrome
  • blood vessel disease
  • vascular malformations
  • autoimmune conditions

Injury can cause tissue and nerve damage or put excess pressure on the nerves. This may occur during surgery or as a result of a serious accident, such as one that leads to a spinal cord injury.

Certain infections, such as shingles, can sometimes damage the nerves and cause neuropathic pain.

Excessive alcohol consumption can also lead to neuropathy. This may be due to the alcohol causing nutritional deficiencies and toxic damage to nerves.

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Sometimes, certain medications can also cause neuropathic pain.

In some cases, however, there may be no clear cause of neuropathic pain.

There are many different types of neuropathy that affect different nerves and parts of the body.

Damage to one nerve is called mononeuropathy, while damage to two or more nerves in different areas is called multiple mononeuropathy.

In most cases, there is damage to many nerves, which is called polyneuropathy.

The sections below will look at some different types of neuropathy and explain which body parts they tend to affect.

Peripheral neuropathy

Peripheral neuropathy is a type of nerve damage that affects the peripheral nervous system. The peripheral nervous system sends signals between the central nervous system and the rest of the body.

Peripheral neuropathy can affect the extremities of the body, including the:

  • feet
  • legs
  • arms
  • hands

Autonomic neuropathy

Autonomic neuropathy affects the nerves that control the internal organs and regulate essential functions such as breathing and digestion.

Autonomic neuropathy can cause a range of problems that can affect the heart, blood pressure, and digestive system.

Focal neuropathy

Focal neuropathy is usually damage to a single nerve within one of the following bodily locations:

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  • head
  • hand
  • torso
  • leg

Bell’s palsy is a type of focal neuropathy. This condition causes a sudden weakness or paralysis on one side of the face.

Focal neuropathy can also cause double vision and sudden weakness or pain in the front of the thigh and other areas of the body.

Proximal neuropathy

A rare type of nerve damage is proximal neuropathy. This type of nerve damage is usually only on one side of the body and can affect the hip, buttock, or thigh.

Proximal neuropathy can cause severe pain and difficulty with movement, as well as weight and muscle loss.

Diabetic neuropathy

Diabetes causes high blood sugar in the body. Over time, this can damage the blood vessels that supply vital oxygen and nutrients to the nerves.

The decrease in oxygen and nutrients makes it difficult for the nerves to function as usual.

Diabetic neuropathy can include any of the above types of neuropathy, but up to 50% of people with diabetes will have peripheral neuropathy.

Compression mononeuropathy

Compression mononeuropathy refers to damage to a single nerve from a compression injury or blood vessel disease. Narrowing of the blood vessels can restrict blood flow to the nerves, affecting how they function.

Injury or repetitive strain can cause compression in nerves as they pass over a joint or through a tight passage in the body.

Carpal tunnel syndrome, which refers to compression of the median nerve at the wrist, is the most common example.

People may experience tingling, numbness, or swelling in the fingers, particularly when using the hands or sleeping at night.

Phantom limb syndrome

Phantom limb syndrome is a type of neuropathic pain. People may experience sensations or pain in a missing limb. The pain may be burning, prickling, or shooting.

Almost 80% of people who have undergone amputation will experience phantom limb syndrome. Mixed signals from the brain and spinal cord may be the cause of phantom limb syndrome.

Symptoms will often decrease in the 6 months following surgery, but they can continue for years.

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Trigeminal neuralgia

Compression or damage to the trigeminal nerve in the head can cause trigeminal neuralgia. Stroke, MS, and facial surgery can all cause damage to the trigeminal nerve.

This type of neuropathy can cause intense pain in the face. Everyday activities such as brushing the teeth and washing the face may trigger pain.

Postherpetic neuralgia

Postherpetic neuralgia (PHN) is a complication of shingles. PHN can affect areas of the body where a shingles rash was present.

Around 10–18% of people with shingles will develop PHN, and older adults with shingles are more likely to experience it.

Thoracic or lumbar radiculopathy

Thoracic or lumbar radiculopathy is a type of mononeuropathy that affects one or both sides of the chest or abdominal wall.

People with type 2 diabetes are more likely to experience this type of neuropathy. They often recover with time.

Some symptoms of neuropathic pain can include:

  • severe pain, which may feel like shooting, throbbing, or burning
  • electrical-like sensations
  • numbness
  • a tingling sensation, or “pins and needles”
  • reduced use of the senses, such as difficulty sensing temperatures
  • skin that appears mottled or red
  • itchiness
  • changes in pain associated with the weather

Neuropathic pain can also cause people to be overly sensitive to touch. For example, people may find that the slightest pressure or friction from clothing or a gentle touch can aggravate the nerves and cause pain.

Chronic pain can affect day-to-day life and affect a person’s quality of life. Some side effects of neuropathic pain may include:

  • difficulty sleeping, due to pain
  • depression
  • anxiety


(Video) Neuropathic pain.

Some symptoms of neuropathy will ease over time. Treating or managing the underlying cause may help relieve symptoms of neuropathic pain.

People with chronic neuropathic pain may need treatment to relieve painful or debilitating symptoms.

Taking nonsteroidal anti-inflammatory drugs is not usually effective for neuropathic pain.

Other medications that may help relieve nerve pain include:

  • antiepileptic drugs
  • antidepressants
  • opioids
  • capsaicin cream
  • lidocaine patch
  • injections or nerve blocks, which may be a combination of steroids, opioids, and anesthetics

A doctor may also suggest treatment with a transcutaneous electrical nerve stimulation (TENS) machine. A TENS machine delivers a small electrical impulse to the area of pain through an electrode attached to the skin.

The impulse may stimulate specific nerves and block pain signals. This can help the muscles relax and ease painful symptoms.

If a TENS machine is not effective, a person may want to try percutaneous electrical nerve stimulation (PENS). PENS works in a similar way to TENS, but a health professional will instead use a needle to place the electrode under the skin rather than on top of it.

Some people find that acupuncture relieves some neuropathic pain. This may help stimulate the nervous system and provoke a healing response to ease the pain.

Surgery can also provide relief from severe cases of some types of nerve damage, such as compression mononeuropathy.

Damage or injury to the nerves can cause neuropathic pain. Symptoms can range from mild to severe.

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People may experience burning or shooting pain, tingling, numbness, or a loss of some sensation.

Treatment options include medication for pain relief, electric stimulation, or, in some cases, surgery.

Some types of neuropathic pain may ease or resolve over time, while other types will require long-term pain management.


What are four common types of neuropathic pain? ›

The most common causes for neuropathic pain can be divided into four main categories: disease, injury, infection, and loss of limb.

What is best treatment for neuropathic pain? ›

The main medicines recommended for neuropathic pain include:
  • amitriptyline – also used for treatment of headaches and depression.
  • duloxetine – also used for treatment of bladder problems and depression.
  • pregabalin and gabapentin – also used to treat epilepsy, headaches or anxiety.

How many types of neuropathic pain are there? ›

These disorders include postherpetic neuralgia, post-traumatic neuropathy, postsurgical neuropathy, cervical and lumbar polyradiculopathies, pain associated with HIV infection, leprosy and diabetes mellitus, complex regional pain syndrome type 2 and trigeminal neuralgia30.

What is the first line treatment for neuropathic pain? ›

First line treatment in neuropathic pain is pregabalin, gabapentin, duloxetine and amitriptyline. Second choice drugs are topical capsaicin and lidocaine, which can also be considered as primary treatment in focal neuropathic pain. Opioids are considered as third choice treatment.

What vitamins treat nerve damage? ›

Vitamins B-1, B-6, and B-12 have been found to be especially beneficial for treating neuropathy. Vitamin B-1, also known as thiamine, helps to reduce pain and inflammation and vitamin B-6 preserves the covering on nerve endings.

What is the No 1 medical condition that causes neuropathy? ›

Diabetes. This is the most common cause. Among people with diabetes, more than halfwill develop some type of neuropathy.

What makes neuropathy worse? ›

High levels of stress and anxiety can amplify your pain. Physical stress and exertion can increase your nerve pain as well. Strenuous exercise and the accompanying soreness can contribute to nerve pain during the night. Living in a chronic state of stress will wreak havoc on your physical and mental health.

What is the latest treatment for neuropathy? ›

Intraneural Facilitation (INF) treatment effectively restores blood flow to damaged nerves, decreasing pain caused by diabetic peripheral neuropathy (DPN), according to a new study conducted by researchers at Loma Linda University Health.

Which medication is commonly prescribed for nerve pain? ›

There are three options:
  • Tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). ...
  • Serotonin–norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor).

What medications cause neuropathy? ›

Other drugs and substances that may cause neuropathy include: Colchicine (used to treat gout) Disulfiram (used to treat alcohol use) Arsenic.
Drugs used to fight infections:
  • Chloroquine.
  • Dapsone.
  • Isoniazid (INH), used against tuberculosis.
  • Metronidazole (Flagyl)
  • Nitrofurantoin.
  • Thalidomide (used to fight leprosy)
Jan 28, 2021

How do you reverse neuropathic pain? ›

For most, a combination of different treatments is the best way to combat neuropathic pain.
Some common treatments include:
  1. Medication. Your doctor might prescribe medication to relieve pain or treat the underlying condition causing your symptoms. ...
  2. Physical therapy. ...
  3. Dietary changes. ...
  4. Surgery.
Nov 10, 2021

What tests are done for neuropathic pain? ›

Confirming if you have a neuropathy

a nerve conduction test (NCS), where small metal wires called electrodes are placed on your skin that release tiny electric shocks to stimulate your nerves; the speed and strength of the nerve signal is measured.

What are the 7 types of pain? ›

Types of pain
  • Acute pain.
  • Chronic pain.
  • Neuropathic pain.
  • Nociceptive pain.
  • Radicular pain.

What is the best treatment for neuropathy in your feet and legs? ›

Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help.

What foods should I avoid with neuropathy? ›

Foods to Avoid: Foods that are high in sugar – Sugar can aggravate nerve pain and discomfort, so it is best to avoid foods that are high in sugar. This includes sugary snacks, desserts, and processed foods. Fried foods – Fried foods are unhealthy and can worsen neuropathy symptoms.

What is the strongest drug for nerve pain? ›

The most effective antidepressants for neuropathic pain are tricyclic antidepressants (TCAs) and serotonin–noradrenaline reuptake inhibitors (SNRIs).

What are the most common types of neuropathy? ›

Peripheral neuropathy is the most common, but there is also proximal, cranial, autonomic and focal neuropathy. Your symptoms can stem from one nerve being affected (mononeuropathy), all your nerves (poly) or two nerves being damaged (multiple mononeuropathy).

What type of pain is neuropathic pain? ›

What is neuropathic pain? Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body. The pain is usually described as a burning sensation and affected areas are often sensitive to the touch.

What are the 5 types of pain? ›

While there are many different types of pain, we'll only discuss the four most common types of pain in this article.
  • Acute Pain. ...
  • Chronic Pain. ...
  • Neuropathic Pain. ...
  • Nociceptive Pain.
Jun 25, 2021

What are 5 sensations that can be affected by neuropathy? ›

Sensory neuropathy
  • prickling and tingling sensation in the affected body part pins and needles.
  • numbness and less of an ability to feel pain or changes in temperature, particularly in your feet.
  • a burning or sharp pain, usually in the feet.

What do neurologists do for neuropathy? ›

Treatment for Peripheral Neuropathy

Our neurologists prescribe medication to treat neuropathy. A procedure called plasma exchange can help some people with peripheral neuropathy achieve remission.


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