Neuropathic pain
How nerves signal and misfire
Pain that arises in the nervous system
Key takeaway for patientsNerve pain has identifiable causes, and some of them are treatable. Numbness, burning or tingling that persists should be assessed.
Most pain is a warning from injured tissue. Neuropathic pain is different: it arises from damage or disease in the nerves themselves. Injured nerve fibers fire spontaneously and become over-sensitive, producing burning, shooting or electric sensations.
With time the spinal cord and brain can amplify these signals, a process called central sensitization, so that light touch is felt as pain. Common causes include diabetes, vitamin B12 deficiency, shingles and nerve compression.
Key steps in neuropathic pain
- Nerve injury
- Metabolic, mechanical or infective damage to a nerve fiber.
- Ectopic firing
- Damaged fibers generate signals on their own.
- Peripheral sensitization
- Inflammatory mediators lower the threshold of nearby nerve endings.
- Central sensitization
- The spinal cord and brain amplify the incoming signal.
Factors that cause or worsen nerve damage
Finding the cause is the first aim of assessment:
- Raised blood glucose
- The commonest cause of peripheral neuropathy.
- Vitamin deficiency
- B12 in particular.
- Compression and injury
- At the spine, the wrist or elsewhere.
- Alcohol and some medicines
- Toxic to nerve fibers.
Clinical management and physician guidance
Assessment aims to find a cause, because some causes can be reversed.
- Neurological and laboratory assessment
- Examination of sensation and reflexes, with glucose, B12 and other tests; nerve studies where indicated.
- Physician-guided care
- Addressing the cause where there is one; the management of pain is decided by your physician, with specialist referral where needed.
- Monitoring and follow-up
- Symptoms and markers are reviewed over time, and the plan is adjusted to them.
Research focus in pain neurobiology
| Core focus area | Biological target | Clinical relevance |
|---|---|---|
| Ion channels | Sodium channels in sensory neurons | Spontaneous firing of injured nerves |
| Central sensitization | The dorsal horn of the spinal cord | Amplification of pain signals |
| Neuroinflammation | Glial cells | Persistence of pain |
| Nerve repair | Schwann cells and the myelin sheath | Regrowth after injury |
Frequently asked questions
- How is nerve pain different from other pain?
- It comes from the nerve itself, and is often burning or shooting, or comes with numbness.
- Can nerves recover?
- Peripheral nerves can regrow slowly, particularly when the cause is found and addressed.
- When is it urgent?
- Sudden weakness, loss of bladder or bowel control, or rapidly spreading numbness need urgent medical attention.
Academic references and literature
- Colloca L et al. (2017). Neuropathic pain. Nat Rev Dis Primers, 3, 17002. PMID 28205574.
- Costigan M, Scholz J, Woolf CJ (2009). Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci, 32, 1-32. PMID 19400724.
- Woolf CJ (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2-S15. PMID 20961685.
This guide belongs to the Healing & Recovery program