Nerve pain (neuropathic pain): causes, types & treatment

Neuropathic pain is a chronic condition that causes intense and often debilitating symptoms. However, what makes neuropathic pain so challenging to deal with is the lack of obvious cause combined with pain that usually worsens over time. To find out what you need to know about neuropathic pain, including possible treatments, keep reading.

What is neuropathic pain?

Neuropathic pain is a type of pain that stems from disruption to nerves and pain signalling. The condition is one of the most common chronic pain types, and, left untreated, usually becomes worse over time. However, it's unusual for neuropathic pain to occur out of the blue; instead, it's often the result of an infection, disease, or injury.

Nerve pain (also called neuralgia) is difficult to treat because, unlike nociceptive pain (e.g. stepping on an object or stubbing your toe), the cause may be unknown. With nociceptive pain, we can see and understand the injury. Neuropathic pain, however, is all to do with how the brain interprets pain signals and the nerves that carry those signals.

Pain signalling and how it works

It's only when you consider how complex our pain signalling systems are that you realise why neuropathic pain is so challenging to treat and manage.

Pain may feel near-instant, but there are actually dozens of stages a "pain signal" has to travel through before we react. Processing pain relies on two key components, the dorsal horn and the thalamus. The former is a nerve centre located at the base of the spine, while the latter is a part of the midbrain responsible for organising pain signals.

Using a typical example of pain (stepping on an object), nerves in the foot carry the pain signal to the dorsal horn for processing before that signal is transferred to a different set of neurons and sent up to the thalamus. After that, the signal moves on to our sensory and motor cortex so we can respond appropriately.

Neuropathic pain occurs when any of the above-outlined signalling or processing is disrupted. In theory, finding and treating said nerve or pathway should reduce or remove issues with pain. However, in reality, there are over seven trillion nerves in humans, and finding the issue is easier said than done.

What causes neuropathic pain?

It's unlikely that you'll wake up to neuropathic pain randomly. As we've highlighted, it's more likely the result of an existing injury, disease, or infection.

Injury

Neuropathic pain can occur from injury to muscle, tissue, or joints; but remember, it's not the tissue itself that's damaged, but the nerves. For example, after crushing your hand, the bones and muscle may heal, but the nerves can remain permanently damaged, thus triggering instances of neuropathic pain.

Specifically, injuries to the spine or brain are frequent triggers. Both of these areas not only modulate our pain response, but contain some of the highest concentrations of nerve endings. Because nerves run the entire length of our spine, from the dorsal horn to the base of the skull, a slipped disc, compression, inflammation, or spinal fracture can easily lead to neuropathic pain.

Disease

Another common precursor to neuropathic pain is disease, specifically cases of multiple sclerosis, diabetes, cancer, and several other autoimmune diseases. Fortunately, treatment of said diseases usually leads to a resolution in pain symptoms, but there is a risk that chronic cases can lead to permanent nerve damage.

Infection

Although an infection can cause neuropathic pain, cases are rare. Conditions that increase the risk of neuralgia include shingles, syphilis, and HIV. Again, symptoms usually rise and fall in line with the treatment of said infections, but in shingles, for example, neuropathic pain can persist (called postherpetic neuralgia).

Symptoms of neuropathic pain

The list of possible neuropathic pain symptoms is extensive, with each varying in duration and intensity. While no two cases of neuropathic pain are the same, common sensations include:

• Burning, itching, or shooting pain
• Tingling and numbness (pins and needles)
• Acute or spontaneous pain
• Evoked pain (due to specific stimuli)
• Depression and anxiety
• Difficulty sleeping
• Reduced sensation

Cases of neuropathic pain may differ, but they all share a common outcome—a significant impact on quality of life. Difficult-to-treat pain affects every aspect of daily life, including mobility, sex, work, and exercise.

Types of neuropathy

Despite the sheer breadth of neuropathic pain, the location of symptoms can give doctors some clues as to the root cause. Damage or dysfunction of nerves is called neuropathy, with several types of neuropathy affecting where on the body symptoms manifest.

• Focal neuropathy: Centring around the head, hand, torso, and leg, focal neuropathy is common in Bell's palsy and usually results from single nerve damage (mononeuropathy).

• Peripheral neuropathy: Affecting the peripheral nervous system, symptoms usually manifest in the feet, legs, arms, and hands.

• Autonomic neuropathy: Commonly impacted areas include internal organs and essential functions. Autonomic neuropathy can affect the heart, digestive system, and blood pressure.

• Compression mononeuropathy: Nerves need a steady blood supply to function correctly. Should that flow become disrupted by a compression injury, patients can experience numbness and tingling. One of the most common causes of compression mononeuropathy is carpal tunnel syndrome.

How to cope with neuropathic pain

Now that we know what causes neuropathic pain, the symptoms, and common types, it's time to move on to the most crucial aspects—management and treatment.

Given the mental and physical impact of neuropathic pain, coping techniques are crucial for the millions who suffer every year. The most effective strategy will vary on a case-by-case basis, but alongside regular contact with your doctor, the tips below can help you keep on top of symptoms.

Speak to others

With cases of neuropathic pain prevalent worldwide, there are millions of people to draw upon for coping techniques. Some cases may even bear similarities, allowing patients to understand their case better. Sharing the challenges faced may not directly reduce pain, but it can help manage secondary symptoms such as depression and anxiety.

Keep a record of symptoms

The primary challenge with neuropathic pain is isolating the root cause. Our nervous system is incredibly complex, and although pain manifests in a specific area, the issue could lie deep within the central nervous system. To support an accurate diagnosis, and to better understand the condition, careful monitoring is crucial.

Neuropathic pain sufferers should consider keeping a journal of symptoms, how long they last, their severity, potential triggers, and any actions that reduce pain. Collecting as many details as possible can help doctors treat individual cases more effectively.

Make time for relaxation and mindfulness

The mental impact of neuropathic pain is just as severe as the physical symptoms. Although it seems unrelenting at times, one of the best ways to stay positive is to practise relaxation and mindfulness techniques. Both will help reduce tension and may even dampen acute pain. Warm baths, meditation, spending time in nature, and light exercise (if possible), can all help improve mental health.

How is neuropathic pain treated?

Despite the challenging nature of neuralgia, there are ways to make life more bearable, and in some cases cure the condition entirely. However, because all instances of neuropathic pain are unique, the treatment must match the situation.

Medication

A frequent treatment option is medication, although the type of medication varies according to the condition.

NSAIDs

Available over the counter, nonsteroidal anti-inflammatory drugs (NSAIDs) are a frequent and easily accessible treatment for neuropathic pain. While they don't target the source of pain specifically, they can help alleviate mild cases.

Prescription medication

Only available from a doctor, prescription medication doesn't always target the source of pain, but it can make symptoms more manageable. More potent opioid medications come with a long list of side effects, and the disadvantages may outweigh the benefits. Other options include prescription-strength creams or ointments, but, again, these won't treat the root cause.

Antidepressants

Antidepressant work to address the psychological impact of neuropathic pain, and play a crucial role in the coping techniques outlined above. However, some antidepressants (tricyclic and serotonin inhibitors) can directly address nerve damage, although these are specific to the type of neuropathy.

Implantable devices

Although invasive, implantable devices mimic the electrical signals involved in pain signalling. If neuropathic pain results from irregular or disrupted signalling, the device helps restore balance, reducing symptoms. In most cases, implantable devices are one of the last treatment options for neuropathic pain.

Nerve blockers

Nerve blockers can provide temporary relief from neuropathic pain by doing exactly what they say—blocking nerves. If a specific nerve or region of nerves is responsible for the pain, steroids and pain medications can interrupt signalling to reduce symptoms.

Lifestyle adjustments

Sometimes, simple lifestyle changes can reduce or remove neuropathic pain altogether. If symptoms become more severe after performing a specific action, patients should investigate how they can adjust their daily routines or habits to minimise aggravation. Stretching, exercise, and physical therapy can all help manage or treat neuropathic pain.

What is CBD?

Now that we've covered the traditional options for neuropathic pain treatment, it's time to move on to the potential role of CBD. The non-toxic compound has been investigated for its links to pain management in several preclinical studies, but how effective could it be at dealing with neuropathic pain?

To understand whether CBD can help with neuropathic pain, we need to cover some of the compound's key features. First, CBD (short for cannabidiol) is a non-toxic molecule found inside hemp. According to the World Health Organization^[1], it has a good safety profile and is well-tolerated in humans.

Second, the compound has a unique mechanism of action, working alongside the body's key systems, rather than blocking or overloading as some medications do. This aspect of CBD is crucial for neuropathic pain sufferers because many cases are chronic. Patients need an effective option that is safe to take daily and doesn't impact other areas of well-being.

CBD for neuropathic pain: Can it help?

It's important to understand that many of the studies involving CBD are still in preclinical phases. While we don't have definitive answers on the compound's efficacy for pain management, we can explore some of the mechanisms involved^[2] and their possible applications.

CBD for spinal cord injury

The spinal column is the central axis to our entire skeleton, and any damage to such an integral and sophisticated part of the body comes with significant consequences. Although neuropathic pain is a frequent symptom of spinal injuries, it can also be accompanied by paralysis, loss of sensation, muscle weakness, and limited mobility.

While no amount of CBD will ever heal a spinal injury, some preclinical studies suggest it can support treatment programmes by benefitting sleep, mood, and general well-being. Given the severely limiting nature of most spinal injuries, a boost in any of these areas could prove vital to improving quality of life.

How to take CBD for neuropathic pain

Because every pain sensation and instance of neuropathic pain is different, there isn't any general guidance for taking CBD. Reassuringly, the compound is non-toxic and well-tolerated, so you shouldn't have to worry about any adverse effects from regular consumption.

If you're interested in taking CBD for neuropathic pain, you should experiment with different products and administration methods to find the most effective solution for you.

• If an instance of nerve pain centres on a particular extremity, a CBD cream may be the most suitable option as the effect is localised.

• If pain is hard to pinpoint, a high-strength CBD oil may be a better alternative so it can circulate the body internally.

What dosage of CBD is best for neuropathic pain?

The ideal dosage of CBD differs for everyone. Experienced users may get better results from a high-strength concentration (20% CBD or more), but even a mild CBD concentration can boost well-being.

If you're entirely new to CBD, it's best to start with a low-concentration product. By increasing the concentration and frequency gradually, you not only give your body time to adjust to CBD, but you can fine-tune the experience to your needs.

The Cibdol dosage calculator is an excellent tool for establishing a baseline dose. While it won't tell you exactly how much CBD to take, it will provide a recommended concentration and product type based on a few simple lifestyle questions.

Is CBD safe for neuropathic pain?

CBD is an all-natural compound extracted from industrial hemp. It does not possess any psychotropic side effects, and as such is suitable for daily consumption. There are a handful of other possible side effects, but these appear incredibly mild—if they appear at all.

Cannabidiol products can, however, upset the balance of some prescription medications. Given the prevalence of these medications in traditional neuropathic pain treatment programmes, we recommend discussing any concerns with a doctor first.

With many cases of neuropathic pain becoming chronic, and therefore requiring daily management, CBD is a non-toxic option that works with the body, not against it. However, everyone's CBD experience differs, so it's essential to start slowly and introduce the compound gradually. Once accustomed to its effects, the dose can be increased accordingly.