Understanding why nerve pain behaves the way it does can make sense of treatments that might otherwise seem strange, and help you stick with them long enough to work.

Key points

• • Nerve pain comes from damage or irritation to the nerves themselves, rather than from injured tissue.
  • It often feels burning, shooting, electric or tingling, and can make light touch painful.
  • Common painkillers like paracetamol, anti inflammatories and opioids usually do not work well for it.
  • Nerve pain medicines are started at a low dose and increased slowly, and can take several weeks to help.

What makes nerve pain different?

Most pain is a warning signal from injured or inflamed tissue, like a sprained ankle or a sore back after lifting. Nerve pain, also called neuropathic pain, is different. It comes from the nerves themselves being damaged or irritated, so they send pain signals even when there is no new injury to warn you about.

Many things can cause it. Common ones include diabetes, shingles, a trapped nerve in the back such as sciatica, some cancer treatments, multiple sclerosis, and nerve injury after surgery or trauma. Sometimes no clear cause is found.

How do I know if my pain is nerve pain?

People often describe nerve pain as burning, stabbing, shooting or like an electric shock. It may come with numbness, tingling or a feeling of pins and needles in the same area. Many people find it worse at night.

One of its most distinctive features is pain from things that should not hurt, like a light touch, a breeze or the brush of fabric. This is called allodynia. Only a doctor can confirm nerve pain, usually from your description and an examination, and sometimes with nerve tests.

Why don't regular painkillers work?

Paracetamol and anti inflammatory medicines mainly work on pain from injured or inflamed tissue. Nerve pain comes from nerves that are misfiring, so these medicines have little to act on. Opioids also tend to work poorly for nerve pain, while still carrying their usual risks.

That is why nerve pain is usually treated with medicines that calm overactive nerve signals instead. If you have been taking regular painkillers with little benefit, it is worth asking your doctor whether nerve pain could be part of the picture.

Which medicines are used for nerve pain?

The main options are certain antidepressants, used at lower doses than for depression, and certain anti seizure medicines. Being prescribed one of these does not mean anyone thinks you are depressed or have epilepsy. They are used because they quiet the nerve signals that drive the pain. For pain in one small area, creams or patches containing a local anaesthetic or capsaicin, the substance that makes chillies hot, may also help.

These medicines are started at a low dose and increased gradually, so it can take several weeks to know whether one is working. Drowsiness, dizziness, dry mouth, weight gain and ankle swelling are common early on, and often ease as your body adjusts. Do not stop suddenly, and check with your pharmacist before combining them with opioids or alcohol, as the drowsiness can add up.

What else helps with nerve pain?

Treating the cause where possible makes a real difference, such as keeping blood sugar within target if diabetes is involved. Physiotherapy, pacing, good sleep habits and psychological therapies for pain all have a role, and pain management programs bring these together.

If nerve pain has left an area numb, especially the feet, check the skin regularly for cuts or blisters you might not feel. Small injuries can become bigger problems when they go unnoticed.

How Ace can help

Because nerve pain medicines are increased slowly, it helps to have someone keeping track with you. Ace pharmacists can explain your dose increase schedule, help you manage side effects while your body adjusts, and check for interactions with your other medicines. Get started with Ace.

References

healthdirect. Medicines for nerve pain.

healthdirect. Nerve pain (neuralgia).

Painaustralia. Neuropathic (nerve) pain.

healthdirect. Peripheral neuropathy.

This article is for general information only and does not constitute medical advice. Talk to your doctor about the cause of your pain and the right treatment for you.