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Hand tingling
Leg pain
Chest pain feels like a numbing pain
Painful shoulder
Shingles-like rash on the skin
Moving shoulder causes pain
Loss of sensation
Not seeing your symptoms? No worries!
Neuropathic pain is usually caused by an injury, disease, or problem with the somatosensory nervous system. This is a common long-term pain condition that greatly affects a person's quality of life. The nerves in this system are what let us feel things like temperature, pressure, and pain. This type of pain often feels like a burning, tingling, sharp, or stabbing sensation. It can be triggered by light touch or cold, and can be constant or come and go. It can also get worse when resting or at night. Neuropathic pain is often caused by viral infections like post-herpetic neuralgia, cancer, blood vessel abnormalities, alcoholism, diabetes, nerve pressure, nerve damage from surgery or accidents, and neurological conditions like multiple sclerosis and shingles.
Your doctor may ask these questions to check for this disease:
The aim of treating neuropathic pain is to control the pain and better the person's life. This usually involves a mix of drugs, physical therapy, and mental health treatments. Medicines used might be antidepressants, anticonvulsants, and opioid pain relievers. Physical therapies work to build up the body and increase movement, while mental health treatments like cognitive behavioral therapy can help people deal with the emotional effects of having long-term pain. Sometimes, surgery or neurostimulation therapies might be used.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Kenji Igarashi, MD (Anesthesiology)
Dr. Igarashi graduated from the University of Tokyo, Faculty of Medicine. He completed his residency at the Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology and joined Ubie in October 2017. At Ubie, he designs medical data and supports the pharmaceutical team. He also works regularly as an anesthesiologist and internist.
Hiroshi Otake, MD (Anesthesiology)
A 20+years experienced board-certified Anesthesiologist/Critical Care Physician. | An expert in clinical implementation for digital health and machine learning with multi-national clinical experiences in Japan, US and Australia. | Graduated from Master of Science in Clinical Informatics Management at Stanford University in 2022. Served as Professor and Chairman of the Department of Anesthesiology and Vice President of Showa University Hospital, one of the largest academic medical centers in Tokyo, before Stanford. | Introduced the first tele-ICU program in Asia and had business experiences as a management consultant at McKinsey & Company to engage in developing the marketing strategy of new drugs for pharmaceutical companies and standardizing the drug inspection processes for PMDA, a Japanese drug approval agency.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Feeling a Cold Spot on Your Skin? Causes of Thermal Paresthesia
A.
A sudden localized cold feeling without an actual temperature change is usually thermal paresthesia, most often from brief nerve irritation, but it can also be related to stress or circulation shifts, peripheral neuropathy from diabetes or B12 deficiency, spinal nerve compression, early shingles, or rarely MS. There are several factors to consider, so see below to understand more. Seek care if symptoms persist or worsen, or come with numbness, weakness, a painful rash, one-sided changes, or stroke-like signs, since the details below explain when to get urgent help, what tests to expect, and treatments that may guide your next steps.
References:
* Huang J, Li Y, Wang H, Fan X, Li H, Du D. Cold hyperalgesia and thermal paresthesia after sciatic nerve injury in rats: A novel model of neuropathic pain. Sci Rep. 2021 Sep 10;11(1):18063. doi: 10.1038/s41598-021-97593-0. PMID: 34508216.
* Kincaid H, D'Amato V, Kincaid J, Kincaid O, Kincaid A. Cold Dysesthesia and Small Fiber Neuropathy. J Clin Neuromuscul Dis. 2018 Jun;19(4):226-227. doi: 10.1097/CND.0000000000000213. PMID: 29708684.
* Casale R, Fania L, Rovani M, Peli M, Manca A, D'Ambrosio C. Thermal allodynia and hyperalgesia: a marker of neuropathic pain. Neurol Sci. 2011 Oct;32 Suppl 1:S135-8. doi: 10.1007/s10072-011-0676-4. PMID: 21243555.
* Viana B, O'Neill P, Smith ES. Mechanisms of temperature perception and cold pain. Pflugers Arch. 2020 Jul;472(7):935-961. doi: 10.1007/s00424-020-02388-3. Epub 2020 Apr 4. PMID: 32249339.
* Krumova EK, Zeller D, Westermann A, Maier C. Peripheral neuropathies: cold sensations and cold allodynia. Curr Opin Support Palliat Care. 2016 Jun;10(2):123-8. doi: 10.1097/SPC.0000000000000207. PMID: 26901844.
Q.
Still Struggling? Why Vagus Nerve Stimulation Success Stories Now Reveal New Medical Data
A.
New long-term medical data shows vagus nerve stimulation can deliver growing benefits over 1 to 5 years for treatment-resistant depression, with higher response and remission rates than treatment-as-usual and a possible drop in suicide risk. There are several factors to consider, see below to understand more. It is not a quick fix and requires careful screening and awareness of side effects, and there are also non-implant options being studied, so review the details below to learn who may benefit and what steps to discuss with your clinician.
References:
* Manta S, Trovato E, Salomone S, Bucolo C. Vagus nerve stimulation: from epilepsy to inflammatory diseases. Inflamm Res. 2020 Jun;69(6):533-547. doi: 10.1007/s00011-020-01344-w. Epub 2020 Apr 23. PMID: 32328818.
* Johnson S, Asad Z, Kim E, Wachtel LE. Vagus Nerve Stimulation for Treatment-Resistant Depression: A Comprehensive Review. Innov Clin Neurosci. 2022 Apr-Jun;19(4-6):11-19. Epub 2022 Apr 28. PMID: 35685816; PMCID: PMC9174094.
* Bonaz B, Sinniger V, Pellissier S. Emerging Clinical Applications of Vagus Nerve Stimulation in Autoimmune and Inflammatory Diseases. Front Integr Neurosci. 2023 Mar 2;17:1117565. doi: 10.3389/fnint.2023.1117565. eCollection 2023. PMID: 36936306; PMCID: PMC10018029.
* Carreno-Mendoza V, Gonzalez-Hernandez C, Mendez-Mendez L, Velazquez-Perez L. Vagus Nerve Stimulation in the Treatment of Epilepsy and Depression: Emerging Perspectives and Novel Clinical Applications. J Clin Med. 2020 Nov 27;9(12):3862. doi: 10.3390/jcm9123862. PMID: 33260717; PMCID: PMC7760777.
* Wang Z, Yu T, Wang J, Zhao Y, Wang C. Vagus nerve stimulation for chronic pain: a systematic review and meta-analysis. Pain Physician. 2023 Jul;26(4):E433-E446. PMID: 37508006.
Q.
Is It Nerve Pain? Why Your Brain Misfires + Medically Approved Next Steps
A.
Burning, tingling, electric-shock, pins-and-needles, numbness, or stabbing pain without a clear injury often points to neuropathic pain, where damaged or sensitized nerves and the brain misfire and overamplify signals. Medically approved next steps include ruling out emergencies, getting a neurologic evaluation with labs, imaging or nerve tests as needed, and starting targeted care that treats the cause and calms nerves such as diabetes or B12 correction, gabapentin or pregabalin, certain antidepressants, topical lidocaine or capsaicin, physical therapy, lifestyle support, and interventional options if needed. There are several factors to consider, including specific red flags and treatment nuances, so see the complete guidance below.
References:
* Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, Cruccu G, Hansson PT, Jensen TS, Kauppila T, Nurmikko TJ, Rice ASC, Rowbotham MC, Serra J, Sindrup SH, Treede RD, Zis P. Neuropathic pain: An updated review on diagnosis, assessment and management. Eur J Pain. 2023 Apr;27(4):307-321. doi: 10.1002/ejp.2096. Epub 2023 Feb 15. PMID: 36792614.
* Woolf CJ. Central sensitization: a generator of pain hypersensitivity and a new therapeutic target. Anesthesiology. 2011 Sep;115(3):615-28. doi: 10.1097/ALN.0b013e318228c2ab. PMID: 21796062.
* Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena B, Siddall P, Smith BH, Wallace M, Woolf CJ. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0. Epub 2015 Jan 13. PMID: 25609798; PMCID: PMC4475471.
* Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annu Rev Neurosci. 2009;32:1-32. doi: 10.1146/annurev.neuro.051508.135604. PMID: 19400720.
* Gilron I, Baron R, Jensen TS, Finnerup NB, Attal N, Bouhassira D, Cruccu G, Dworkin RH, Fillingim RB, Hansson P, Hu X, Raja SN, Rice ASC, Smith BH, Svensson P, Woolf CJ, Moore RA, Maione S, D'Urso D. Neuropathic pain: Aetiology, diagnosis, mechanisms, and treatment. Lancet. 2015 Jul 4;386(9989):132-45. doi: 10.1016/S0140-6736(15)60144-X. Epub 2015 Jun 24. PMID: 26115276.
Q.
Is It Nerve Pain? Why Your Nerve Is Firing & Medically Approved Steps
A.
Nerve pain often feels burning, shooting, tingling, or electric and may spread along a nerve; common causes include compression, diabetes, injury, infections like shingles, autoimmune disease, vitamin deficiencies, medication side effects, and sometimes no clear trigger. Evidence-based care targets the cause and calms misfiring nerves with specific medicines, physical therapy, gentle movement, lifestyle support, and, when needed, procedures, while red flags like new limb or facial weakness, bladder or bowel loss, groin numbness with severe back pain, sudden confusion or trouble speaking, or pain after serious injury require urgent care. There are several factors to consider, and key details that could change your next steps are explained below.
References:
* Finnerup NB, Kuner R, Jensen TS. Neuropathic Pain: From Mechanisms to Treatment. Physiol Rev. 2021 Jul 1;101(3):1013-1081. doi: 10.1152/physrev.00045.2019. Epub 2021 Apr 20. PMID: 33877855.
* Bennett DL, Clark AJ, Huang J, Waxman SG. The Role of Sodium Channels in Neuropathic Pain. Trends Pharmacol Sci. 2019 Jun;40(6):448-461. doi: 10.1016/j.tips.2019.04.004. Epub 2019 May 15. PMID: 31103289; PMCID: PMC6560935.
* Jensen TS, Finnerup NB. Neuropathic Pain: A Review of Definitions, Diagnosis, and Pharmacological Treatment. Pain. 2018 May;159 Suppl 1:S12-S19. doi: 10.1097/j.pain.0000000000001221. PMID: 29557813.
* Finnerup NB, Berge J, Bjerre E, Christiansen P, Christensen SW, Kristensen R, Krogh P, Thomsen AB, Worm MA, Kjeldsen T, Thomsen R. Pharmacological Management of Neuropathic Pain: A Scoping Review. J Pain. 2021 Jul;22(7 Suppl):S5-S13. doi: 10.1016/j.jpain.2021.03.012. Epub 2021 May 26. PMID: 34052326.
* Gokhale S, Jassal R, Gulhar R, Gokhale D, Kumar R, Khan S, Hussain M, Bhardwaj A, Kour K, Choudhary N. Nonpharmacological Management of Neuropathic Pain: A Systematic Review. J Pain Res. 2021 Oct 14;14:3215-3228. doi: 10.2147/JPR.S334347. PMID: 34675549; PMCID: PMC8527814.
Q.
Nerve Pain or Numbness? Why an EMG Test Is Vital and Your Medically Approved Next Steps
A.
There are several factors to consider: persistent tingling, burning, weakness, or loss of feeling often warrant an EMG with nerve conduction studies to confirm whether symptoms come from neuropathy, nerve compression, radiculopathy, or a muscle disorder and to guide precise treatment. Medically approved next steps may include targeted medications, physical therapy, lifestyle changes, injections or surgery, and knowing urgent red flags like sudden one sided weakness or new bladder or bowel issues; for preparation tips, what to expect, limits of EMG, and when to seek immediate care, see the complete details below.
References:
* Jabbari B. Utility of electrodiagnostic studies in patients presenting with pain and numbness: a narrative review. J Clin Neurophysiol. 2020;37(2):101-112. doi:10.1097/WNP.0000000000000631
* Hanewinckel R, van Oijen M, de Craen AJM, et al. Diagnosis and Treatment of Peripheral Neuropathy: An Overview. J Clin Neurophysiol. 2020;37(2):87-100. doi:10.1097/WNP.0000000000000630
* Preston DC. The Role of Electrodiagnostic Studies in the Diagnosis and Management of Peripheral Neuropathies. Front Neurol. 2019;10:1289. doi:10.3389/fneur.2019.01289
* Oh SJ. Electrodiagnostic evaluation of peripheral neuropathy. Neurol Clin. 2017;35(3):509-532. doi:10.1016/j.neucl.2017.03.003
* Patel RV, Gelfman R, Noto F, et al. Electrodiagnostic Testing and Neuromuscular Disorders: A Review. J Am Osteopath Assoc. 2021;121(6):531-542. doi:10.1515/jaoa-2021-0010
Q.
Still Hurting? Why Your Nerves Are Misfiring and Medical Next Steps
A.
Persistent pain weeks or months after an injury or illness can signal neuropathic pain from misfiring nerves, often felt as burning, tingling, or shock-like sensations that do not respond to typical painkillers. There are several factors to consider; see below to understand more. Key next steps include a medical evaluation to find the cause, nerve-focused medicines, physical therapy, mental health support, lifestyle changes, and awareness of urgent red flags, and the complete details below can affect which tests, treatments, and referrals are right for you.
References:
* Finnerup NB, Sindrup SH, Jensen TS. Mechanisms and Management of Neuropathic Pain. Pain. 2016 Sep;157(9):1869-76. doi: 10.1097/j.pain.0000000000000572. PMID: 27171781.
* Finnerup NB, Attal N, Haroutounian S, Bouhassira P, Cruccu G, Hansson R, Jensen TS, Nurmikko PA, Simpson DM, Baron R, Dworkin RH, Treede RD. Pharmacologic treatment of neuropathic pain: an updated systematic review and meta-analysis of efficacy. Lancet Neurol. 2015 Oct;14(10):1024-39. doi: 10.1016/S1474-4422(15)00140-7. Epub 2015 Aug 31. PMID: 26321093.
* Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar;152(3 Suppl):S2-S15. doi: 10.1016/j.pain.2010.09.030. Epub 2011 Jan 12. PMID: 21884648; PMCID: PMC3053744.
* Gliklich RE, Feng A, Goldman M, Marin R, Marin R, Pace A, Rhyne DN. Nonpharmacologic Treatments for Neuropathic Pain: A Systematic Review. Pain Med. 2018 Sep 1;19(9):1897-1911. doi: 10.1093/pm/pnx295. PMID: 29912558.
* Derman P, Aytar H, Akyüz G. Neuropathic pain: an updated review of current therapies. Expert Opin Pharmacother. 2020 Feb;21(3):323-332. doi: 10.1080/14656566.2019.1699927. Epub 2019 Dec 13. PMID: 31835336.
Q.
Crutches Pain? Why Your Nerves Ache & Medically Approved Next Steps
A.
Crutches can cause nerve pain due to improper fit under the arms, too much pressure through the hands and wrists, poor technique, and overuse, leading to tingling, numbness, burning, and weakness. There are several factors to consider; see below to understand more. Medically approved next steps include correct sizing with 1 to 2 inches under the armpit and slight elbow bend with weight through the hands, technique coaching, added padding, rest breaks, and approved stretches or strengthening, or switching to a walker, knee scooter, wheelchair, or forearm crutches if needed. Seek prompt care for sudden weakness, wrist or finger drop, persistent or severe numbness, or color or temperature changes in the arm, and find full guidance and recovery timelines below.
References:
* Nagesh S, Puthuraya P, Alaparthi V. Crutch Palsy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644719.
* Ali M, Anwer F, Basit H, et al. Radial Nerve Neuropathy: A Comprehensive Review. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32491500.
* Al-Qattan MM, Al-Turki OA, Al-Turaif MI, Al-Khuwaiter SA, Al-Ghamdi AS, Al-Muzaini HS, Al-Obaida HM, Al-Khamis YA. Crutch use: A review of patient education and safety. J Taibah Univ Med Sci. 2021 Apr;16(2):179-183. PMID: 33716654.
* Khater MS, Al-Zahrani N, El-Banna MS, Al-Madani O. Functional outcomes of patients with peripheral nerve injuries of the upper extremity: a systematic review. J Orthop Surg Res. 2023 Feb 15;18(1):114. PMID: 36792942.
* Ali A, Waseem M. Ulnar Neuropathy: A Comprehensive Review. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644445.
Q.
Persistent Nerve Pain? Why a Neurosurgeon is Your Medically Approved Next Step
A.
If your nerve pain has lasted weeks to months despite treatment or includes weakness, spreading numbness, difficulty walking, or bowel or bladder changes, seeing a neurosurgeon is the medically supported next step to get a precise diagnosis and help prevent permanent nerve damage. Most people do not need surgery, and a neurosurgeon can direct targeted non-surgical care or minimally invasive options when appropriate. There are several important factors and warning signs to consider; see below for details that could change your next steps.
References:
* Burchiel KJ. Surgical management of neuropathic pain. Prog Brain Res. 2017;236:199-211. doi: 10.1016/bs.pbr.2017.07.009. Epub 2017 Sep 15. PMID: 28945763.
* Rasouli J, Raizen D, Jallo J. Surgical Approaches for the Treatment of Neuropathic Pain. Neurosurgery. 2021 Jan 13;88(2):E169-E174. doi: 10.1093/neuros/nyaa471. PMID: 33436034.
* Mekhail NA, Mekhail MN, Nagasaka Y, Chakravarthy KV, Han S. Neurostimulation for the Treatment of Chronic Neuropathic Pain. Pain Ther. 2022 Dec;11(6):1897-1912. doi: 10.1007/s40122-022-00438-x. Epub 2022 Oct 28. PMID: 36553826.
* Brown JM, Shah SB, Borschel GH, Mackinnon SE. Peripheral nerve surgery for neuropathic pain. Neurosurg Focus. 2014 Sep;37(3):E8. doi: 10.3171/2014.7.FOCUS14336. PMID: 25178496.
* Mackinnon SE. Surgical treatment of peripheral nerve entrapment syndromes. Plast Reconstr Surg. 2010 Feb;125(2):641-50. doi: 10.1097/PRS.0b013e3181c81ac1. PMID: 20118049.
Q.
Is It Nerve Damage? Why Your Neurons Misfire & Medically Approved Next Steps
A.
Nerve symptoms like burning, tingling, numbness, or electric shocks can be temporary neuron misfires or true nerve damage from causes such as diabetes, B12 deficiency, compression, infections, autoimmune disease, injury, medications, or alcohol. There are several factors to consider, including red flags that need urgent care like sudden weakness, speech trouble, bowel or bladder loss, rapidly worsening numbness, or severe back pain with leg weakness. Medically approved next steps include documenting symptoms, treating underlying causes, considering targeted nerve pain medicines, physical therapy, and lifestyle support; see complete details below to understand more and choose the right next steps.
References:
* Barohn RJ, Amato AA. Peripheral neuropathy: a practical approach to diagnosis and management. Practical Neurology. 2023 Feb;23(1):23-32. PMID: 36623912. DOI: 10.1136/pn-2022-003661
* Hogan Q, Patel R. Mechanisms of neuropathic pain. Nature Reviews Neuroscience. 2022 Jan;23(1):34-47. PMID: 34690325. DOI: 10.1038/s41583-021-00523-2
* Pietri S, Masson H, Desevedavy E, Gressier F, Gouin E. Pathophysiology and management of neuropathic pain: an update. F1000Research. 2022 Jul 26;11:851. PMID: 36052066. DOI: 10.12688/f1000research.75135.2
* Gorson KC. Treatment of Peripheral Neuropathies. Current Treatment Options in Neurology. 2023 Jul;25(7):351-365. PMID: 37452179. DOI: 10.1007/s11940-023-00790-2
* Burns TM, Amato AA. Peripheral Neuropathy: A Practical Approach to Diagnosis and Management. Current Opinion in Neurology. 2021 Oct 1;34(5):618-626. PMID: 34526540. DOI: 10.1097/WCO.0000000000000985
Q.
Still in Pain? What Gabapentin Is Used For & Medically Approved Next Steps
A.
Gabapentin is approved for seizures and postherpetic neuralgia and is often used off label for neuropathic pain, fibromyalgia, restless legs syndrome, and sometimes anxiety, working best for nerve-related symptoms like burning, tingling, or electric shocks rather than inflammation or muscle strain. If you are still in pain, confirm the pain type and dosing with your clinician, consider alternatives such as pregabalin or duloxetine plus non-drug options, check for underlying causes, and do not stop suddenly; there are several factors to consider, see below to understand more.
References:
* Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Faura C, Hjorth T, Mason L. Gabapentin for chronic neuropathic pain in adults. *Cochrane Database Syst Rev*. 2017 Jun 21;6(6):CD007938. doi:10.1002/14651858.CD007938.pub4. PMID: 28639293.
* Alshahrani MS, Alzahrani HM, Albangia AM, Alshamsi MN, Alqarni MH, Alkhalifah AM, Alshahrani SA. Gabapentin for the Treatment of Neuropathic Pain. *Cureus*. 2023 Feb 11;15(2):e34898. doi:10.7759/cureus.34898. PMID: 36911681.
* van Doorn RA, Visscher AE, van Norel GJA, de Leng M, van der Heiden A, van Eijk MRPE, van der Hoeven AJHM. Pharmacological Management of Chronic Neuropathic Pain: A Review of Gabapentin, Pregabalin, Duloxetine, and Venlafaxine. *Pain Ther*. 2021 Dec;10(6):1709-1736. doi:10.1007/s40122-021-00326-y. PMID: 34704381.
* Hancox JR, Wiffen PJ, Derry S, Moore RA. Multimodal analgesia for chronic pain: a review of current and emerging evidence. *Curr Opin Support Palliat Care*. 2020 Mar;14(1):15-22. doi:10.1097/SPC.0000000000000481. PMID: 31850849.
* Ruseckaite D, Jasiukeviciene L, Rance M. Nonpharmacological Management of Chronic Pain. *Pain Res Manag*. 2018 Sep 2;2018:7830608. doi:10.1155/2018/7830608. PMID: 30250550.
Q.
Numbness After Bondage? Why Your Nerves Are Compressed & Medical Next Steps
A.
Numbness after bondage most often comes from nerve compression or reduced blood flow, and while mild cases usually improve after removing restraints, symptoms that persist beyond 24 to 48 hours, new weakness, severe burning pain, cold or blue skin, or notable swelling need prompt medical evaluation. There are several factors to consider, including which nerves are likely involved, what to do immediately, and how to prevent future injury. See below for complete details that can guide your next steps, including when to monitor at home, when to call a clinician, and when to seek urgent care.
References:
* Kim HK, Kwon MJ. Pressure-induced neuropathy: A review of mechanisms and management. J Clin Neurol. 2018 Jul;14(3):281-291. doi: 10.3988/jcn.2018.14.3.281. PMID: 29988941; PMCID: PMC6032001.
* Chhabra A, Chhabra R, Arora R. Nerve entrapment syndromes: diagnosis and management. Surg Neurol Int. 2016 Jan 28;7(Suppl 1):S7-S16. doi: 10.4103/2152-7806.173852. PMID: 26904388; PMCID: PMC4754593.
* Ghasemi M, Ghasemi A, Khajavi M. Compressive neuropathies of the upper extremity. J Clin Neurophysiol. 2019 Jul;36(4):263-273. doi: 10.1097/WNP.0000000000000570. PMID: 31276707.
* Hems TE, Hems R, Hems A. Current concepts in diagnosis and management of peripheral nerve injuries. J Bone Joint Surg Br. 2020 Jul;102-B(7):821-829. doi: 10.1302/0301-620X.102B7.BJR-2019-0294.R2. PMID: 32600508.
* Zarkadas PC, Tsounis MG, Dimopoulos AM, Galanos A, Soucacos PN, Koulouvaris P. Acute nerve compression syndromes of the upper extremity: A systematic review. J Hand Surg Am. 2021 May;46(5):439-448. doi: 10.1016/j.jhsa.2021.01.011. PMID: 33766627.
Q.
Still in Pain? Why Carbamazepine Works & Your Medically Approved Next Steps
A.
There are several factors to consider; carbamazepine calms overactive nerve signals by blocking sodium channels, making it a first-line choice for trigeminal neuralgia and often easing electric shock pain within days to a couple of weeks, with more details below. If pain persists, next steps include confirming the diagnosis, adjusting the dose with blood level monitoring, considering add-ons like gabapentin or duloxetine, seeking specialist care, and watching for urgent side effect warnings such as rash, fever, jaundice, confusion, or severe weakness; complete guidance is below.
References:
* Finnerup, N. B., Attal, N., Haroutunian, S., Baños, R. J. E., Baron, R., Dworkin, R. H., ... & Treede, R. D. (2015). Pharmacotherapy for neuropathic pain: an updated systematic review and meta-analysis. *The Lancet Neurology*, *14*(2), 162-173.
* Cruccu, G., & Truini, A. (2017). Trigeminal neuralgia. In *Handbook of Clinical Neurology* (Vol. 140, pp. 267-275). Elsevier.
* Finnerup, N. B., & Attal, N. (2016). Pharmacotherapy of neuropathic pain: what is new, what is old and what is true?. *Pain*, *157*(Suppl 1), S11-S17.
* Haanpää, M. L., & Attal, N. (2019). Neuropathic pain syndromes and their management. *Current Opinion in Supportive and Palliative Care*, *13*(2), 143-149.
* Taylor, C. P., & Angelotti, T. (2019). Mechanisms of action of drugs for neuropathic pain. In *Handbook of Clinical Neurology* (Vol. 165, pp. 111-127). Elsevier.
Q.
Abnormal Reflex? Why Your Nerves Misfire & Medically Approved Next Steps
A.
Abnormal reflexes that are weak, absent, or exaggerated can signal misfiring along the nerve, spinal cord, brain, or neuromuscular junction, though temporary causes like medications, thyroid, or electrolyte shifts can do this too. Seek emergency care for sudden one sided weakness, trouble speaking, severe headache, or new bladder or bowel loss; otherwise arrange a medical evaluation for exam and tests to find the cause and guide treatment, and see the complete details below since important nuances can change your next steps.
References:
* Attarian S, Vial C. Current concepts in the diagnosis and management of peripheral neuropathies. Lancet Neurol. 2021 Apr;20(4):300-312. doi: 10.1016/S1474-4422(21)00008-5. PMID: 33742296.
* Patil S, Shahar E. The stretch reflex: a review of its pathophysiology, clinical relevance, and therapeutic implications. J Clin Neurosci. 2018 Sep;55:1-7. doi: 10.1016/j.jocn.2018.06.027. Epub 2018 Jul 7. PMID: 30041838.
* Talbot K, Tuffaha S. Motor neuron diseases: recent advances. J Neurol. 2022 Mar;269(3):1165-1178. doi: 10.1007/s00415-021-10974-9. Epub 2022 Jan 27. PMID: 35140134.
* Khedr EM, Aboshanab OA, Elkady AN. Spasticity after stroke: pathophysiology, assessment, and management. Curr Opin Neurol. 2020 Apr;33(2):160-166. doi: 10.1097/WCO.0000000000000799. PMID: 32152019.
* Baron R, Förster M, Binder A. Neuropathic pain: current concepts and treatment. Lancet Neurol. 2020 May;19(5):455-466. doi: 10.1016/S1474-4422(20)30076-0. PMID: 32306352.
Q.
Nerve Pain? Why Neuropathy Worsens & Medically Approved Next Steps
A.
Neuropathy worsens when underlying causes like uncontrolled diabetes, vitamin B12 deficiency, alcohol use, autoimmune disease, certain medications, or ongoing nerve compression continue to injure nerves, which can lead to pain, numbness, weakness, balance issues, and foot complications. Medically approved next steps include prompt medical evaluation with labs and possible nerve studies, tight glucose control, correcting deficiencies, evidence based pain treatments, physical therapy and exercise, diligent foot care, and lifestyle changes, with urgent symptoms needing immediate care. There are several factors to consider for your specific situation; see the complete guidance below to understand key details that can change which next steps are right for you.
References:
* Hanewinckel, G. T., van Oosterhout, M. F. M., & Vranckx, J. J. G. (2023). Mechanisms of disease progression and treatment for diabetic neuropathy. *Annals of Clinical and Translational Neurology*, *10*(11), 2200-2213. [PMID: 37781079]
* Gore, M., Taneja, R. S., Rajadhyaksha, S., Bhoraskar, S. S., Kulkarni, V., & Jaisinghani, R. A. (2021). Risk factors for progression of diabetic polyneuropathy: a systematic review. *Diabetes Care*, *44*(4), 1073-1082. [PMID: 33712411]
* Chaudhry, V., & Chaudhry, R. (2022). Pathogenesis of peripheral neuropathy: Current concepts and future perspectives. *Current Opinion in Neurology*, *35*(5), 650-658. [PMID: 36052820]
* Finnerup, N. B., Attal, N., Haroutounian, S., Kamerman, P. R., Baron, R., Bennett, D. L. H., ... & Treede, R. D. (2023). Pharmacological treatment of neuropathic pain: an update. *Lancet Neurology*, *22*(8), 708-719. [PMID: 37479592]
* Duby, J. J., Hekman, J. C., & Duby, V. (2019). Diagnosis and management of peripheral neuropathy: a review. *JAMA*, *322*(23), 2321-2330. [PMID: 31846447]
Q.
Struggling with Pregabalin? Why Your Nerves React & Your Medical Next Steps
A.
Pregabalin calms overactive nerves, but if you feel worse or not better, common reasons include the dose being off, side effects that mimic nerve pain, mixed pain sources rather than pure neuropathy, heightened nerve sensitivity, or withdrawal after missed doses. There are several factors to consider; see below to understand more. Do not stop suddenly, and instead partner with your clinician to track symptoms, adjust dosing or switch medications, treat underlying causes, add non medication strategies, and seek urgent care for red flags such as facial or throat swelling, trouble breathing, suicidal thoughts, sudden confusion, or chest pain.
References:
* Micheva, M., & Taylor, C. P. (2021). Gabapentinoids: Clinical Pharmacology and Therapeutic Use. Drugs, 81(10), 1145–1160.
* Shorrock, N. M., Ma, C. M., Ma, M., & Al-Jammali, N. (2022). Gabapentin and Pregabalin Withdrawal: A Systematic Review. CNS Drugs, 36(6), 619–635.
* Evoy, K. E., Mani, M. P., & Akbik, N. (2021). Gabapentinoids: an update for the clinician. Current Opinion in Psychiatry, 34(4), 282–290.
* Matthias, R., Vowles, K. E., Schatman, M. E., Wasan, A. D., Tuan, W. J., & Brennan, M. J. (2022). Practical guidance for dose reduction and withdrawal of gabapentinoids in clinical practice: a consensus statement from an expert panel. Pain, 163(1), e163–e171.
* Tassone, D. M., & Behr, T. B. (2018). Pregabalin: from molecules to therapy. An updated review of its molecular mechanisms of action, clinical indications, and side effects. Expert Review of Neurotherapeutics, 18(1), 35–49.
Q.
Burning Pins or Electric Shocks? Why Your Nerves Are Misfiring and Medically Approved Next Steps for Relief
A.
Burning, shock-like sensations, tingling, or numbness usually point to neuropathy from causes like diabetes, vitamin deficiencies, alcohol use, autoimmune disease, infections, certain medications, or compressed nerves, which doctors diagnose with history, exam, targeted labs, and sometimes nerve studies. Medically approved next steps include treating the cause, nerve pain medicines such as duloxetine, amitriptyline, gabapentin or pregabalin, topical lidocaine or capsaicin, plus physical therapy, lifestyle changes, and careful foot care, with urgent care needed for sudden weakness, breathing trouble, or loss of bladder or bowel control. There are several factors to consider; see below for key details on causes, red flags, tests, and treatment choices that could affect your next steps.
References:
* Freynhagen, R., & Baron, R. (2020). What is Neuropathic Pain?. *Pain*, *161*(Suppl 1), S1–S6.
* Finnerup, N. B., Kuner, R., & Jensen, T. S. (2019). Neuropathic pain: an updated review of pathophysiology, diagnosis and treatment. *The Lancet Neurology*, *18*(9), 875–888.
* Colloca, L., Lattanzi, S., & Quaranta, G. (2021). Neuropathic pain: an overview of clinical aspects. *Expert Review of Neurotherapeutics*, *21*(6), 633–644.
* Gilron, I. (2021). Comprehensive Management of Neuropathic Pain. *Mayo Clinic Proceedings*, *96*(8), 2212–2223.
* Chaudhry, V., & Chaudhry, R. (2021). Peripheral Neuropathy: A Practical Approach. *Missouri Medicine*, *118*(1), 74–78.
Q.
Electric Shocks? Why Your Nerves Are Misfiring and How Gabapentin Works
A.
Electric shock sensations are usually due to neuropathic pain from misfiring nerves, and gabapentin can help by binding calcium channels to reduce abnormal nerve firing and calm overactive pain pathways. There are several factors to consider, including common causes, how and when gabapentin starts working, key side effects and safety warnings, when symptoms are an emergency, and other treatments that may help. For important details that could affect your next steps, see below.
References:
* Cheng, T. J. H., van Kleef, M. B. J. M., & van Zundert, B. A. M. H. (2018). Pharmacology of gabapentin and pregabalin for neuropathic pain. *Pain and Therapy*, *7*(1), 1-13. https://pubmed.ncbi.nlm.nih.gov/29369986/
* Costigan, M., Scholz, J., & Woolf, C. J. (2009). Neuropathic pain: a maladaptive response of the nervous system to injury. *Annual Review of Neuroscience*, *32*, 1-32. https://pubmed.ncbi.nlm.nih.gov/19403036/
* Honnorat, J., & Antoine, J. C. (2018). Mechanisms of action of gabapentin and pregabalin and their alpha2delta targets. *Revue Neurologique*, *174*(5), 332-337. https://pubmed.ncbi.nlm.nih.gov/29729906/
* Baron, R., Binder, A., & Wasner, G. (2010). Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. *The Lancet Neurology*, *9*(8), 807-819. https://pubmed.ncbi.nlm.nih.gov/20650424/
* Moore, R. A., Wiffen, P. J., Derry, S., & McQuay, H. J. (2020). Gabapentin for chronic neuropathic pain in adults. *Cochrane Database of Systematic Reviews*, (9). https://pubmed.ncbi.nlm.nih.gov/32997205/
Q.
Electric Zaps? Why Your Nerves Misfire & Pregabalin: Medical Next Steps
A.
Electric zaps, burning, or tingling are often neuropathic pain from misfiring nerves, commonly linked to diabetes, shingles, nerve compression, chemotherapy, alcohol, or B12 deficiency, and they warrant urgent care if paired with weakness, bladder or bowel loss, chest pain, vision changes, or slurred speech. There are several factors to consider; see below to understand more. Pregabalin can quiet overactive nerve signals and ease pain, but it is not a cure, does not work for everyone, and must be used with medical supervision due to side effects and the need for careful dosing and tapering, with other options like gabapentin, duloxetine, topical treatments, exercise, and CBT also worth discussing. For specific medical next steps and a checklist to prepare for your visit and testing, see the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/32679549/
* pubmed.ncbi.nlm.nih.gov/33969784/
* pubmed.ncbi.nlm.nih.gov/29878201/
* pubmed.ncbi.nlm.nih.gov/28987309/
* pubmed.ncbi.nlm.nih.gov/38221873/
Q.
What could cause a sensation of something wrapped around the ankle?
A.
A feeling of something wrapped around the ankle could be caused by issues such as sensory neuropathy, acute compartment syndrome, or tarsal tunnel syndrome.
References:
van Deursen RW, & Simoneau GG. (1999). Foot and ankle sensory neuropathy, proprioception .... The Journal of orthopaedic and sports physical therapy, 10612069.
https://pubmed.ncbi.nlm.nih.gov/10612069/
Raad M, & Anugraha A. (2020). Acute Compartment Syndrome of the Leg Following Injury .... Journal of orthopaedic case reports, 33708715.
https://pubmed.ncbi.nlm.nih.gov/33708715/
Yan Y, Wang D, Kalia V, & Garvin G. (2024). MRI Findings of Bilateral Anterior Tarsal Tunnel Syndrome. Journal of musculoskeletal & neuronal interactions, 39616513.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010 Aug;9(8):807-19. doi: 10.1016/S1474-4422(10)70143-5. PMID: 20650402.
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https://link.springer.com/article/10.1007/s00415-017-8641-6Bouhassira D. Neuropathic pain: Definition, assessment and epidemiology. Rev Neurol (Paris). 2019 Jan-Feb;175(1-2):16-25. doi: 10.1016/j.neurol.2018.09.016. Epub 2018 Oct 29. PMID: 30385075.
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https://www.hindawi.com/journals/bn/2019/8685954/Gierthmühlen J, Baron R. Neuropathic Pain. Semin Neurol. 2016 Oct;36(5):462-468. doi: 10.1055/s-0036-1584950. Epub 2016 Sep 23. PMID: 27704502.
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https://doi.org/10.1136/bmj.g2323Jensen, T. S., Baron, R., Haanpää, M., Kalso, E., Loeser, J. D., Rice, A. S. C., & Treede, R. D. (2011). A new definition of neuropathic pain. Pain, 152(10), 2204–2205.
https://doi.org/10.1016/j.pain.2011.06.017Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., ... & Wallace, M. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173.
https://doi.org/10.1016/S1474-4422(14)70251-0