One of the most discussed questions in pain management is, “can damaged nerves heal?” Today we’ll discuss how nerve damage can be managed, and the best ways to move forward.
Medical researchers have been concerned with ways to reverse the damage and induce proper healing in central nervous system (CNS) injuries for decades. While nerve damage can be repaired, most instances of healing nerves occur in the peripheral nervous system, and damage to the spinal cord or brain is often final.
Understanding why some nerves heal and others don’t and how the healing process works, to begin with, it helps to refresh our memory on the basic structure of a nerve cell, and its function within the nervous system.
Can Damaged Nerves Heal? Why Nerves Heal Poorly
Nerves relay information through electrical impulses, through physical connections with other nerve cells. Axons, the long body of the nerve cell, are protected by a covering called the myelin sheath. Damage to the myelin sheath can destroy the cell and prevent the regeneration of important cell elements such as the axon terminals.
Different growth markers and mechanisms trigger the regeneration of the myelin sheath, and the reconnection of nerve cells between one another, reconstituting nerves themselves. Important cell elements that play a central role in the regeneration of peripheral nerve cells are the Schwann cells, as well as neuron fibroblasts.
These are absent in the neurons that make up the central nervous system, one of the reasons why damage to the spinal cord cannot be undone by the body. But unconventional therapies, from gene therapy to stem cell research, may one day help our bodies achieve the impossible, and reverse cases of paraplegia and other types of CNS damage.
However, healing peripheral nerve damage is not quite straightforward, either. This leaves us with the question, can nerve damage heal? While some of our nerves can regenerate their myelin sheathing and achieve healing, there are many environmental factors that play a role in how successful this process ends up being.
Natural regeneration in the body is very imperfect and is usually accompanied by scar tissue. Because nerve cells require a precise composition to accurately relay information throughout the body, damage to a nerve and subsequent regeneration can lead to long-term pain (chronic pain) and aberrant nerve signaling, caused in part due to improperly healed nerves, or scar tissue around the nerve.
Different therapies, interventions, surgical methods, and unique new inventions can help nerves heal better, bridge the gap caused by physical or chemical damage, and promote the growth of new nerve cells.
Peripheral Nerve Damage and Healing
Peripheral nerve damage is the most common type of nerve damage, as it can occur anywhere in the body outside of the spinal cord and brain. Common causes of peripheral nerve damage, or neuropathy, include:
- Diabetic neuropathy
- Alcoholic neuropathy
- Burns, cuts, and injuries
- Guillain-Barre syndrome
- Carpal tunnel syndrome and other cases of impingement
- Autoimmune diseases (lupus, rheumatoid arthritis, multiple sclerosis, and more)
Doctors utilize nerve conduction tests, EMGs, and physical examinations to determine potential peripheral neuropathy and the extent of the damage. Magnetic resonance imaging (MRIs) can also help provide clearer insight into soft tissue injuries, and potentially damaged, inflamed, or impinged nerves.
As with other tissue, nerves have a much better chance of healing when they aren’t severed. Once a peripheral nerve is cut, its chances of growing back together are low, but not impossible. For example, if your hand is amputated in an accident, and sewn back together in time, it is possible for a skilled surgeon to ensure that you can still get some movement out of your hand. However, it is unlikely that you would ever have the same mobility you once did.
When nerves are severed, the likelihood of natural repair depends entirely on the gap between both severed nerves. If the gap is almost nonexistent, the nerves may fuse together, and function may be restored.
But as the gap increases, stitching, nerve grafts, and reconstructive surgery become central to regaining nerve function. Complicated surgical interventions that target and help repair severed nerves include:
- Transfers – A surgeon can rewire a healthy nerve from one of your own nerves to the injured nerve to speed up recovery and movement.
- Repair – A surgeon can carefully reconnect two ends of a severed nerve with a small suture.
- Gap reconstruction – When the gap is too great to be sutured, an autograft or a processed donor nerve is taken from a cadaver will be used to reconstruct the damaged nerve.
- Targeted muscle reinnervation – Surgeons can rewire healthy nerves to the site of an injury, in cases where an injured nerve is causing pain, and even help treat phantom pain, and reassign nerves for the use of prosthetics.
- And much more.
On the other hand, the damage is done to a nerve through impingement, inflammation, or chemical reactions. Such as the stripping of myelin sheaths through blood sugar levels or blood alcohol concentration may heal better than a totally severed nerve.
Can Damaged Nerves Heal? Advances in Medical Science
The repair and regeneration of peripheral nerves are some of the most heavily researched areas in medical science. We aren’t at a point where we can undo paraplegia or reverse cell death in the brain, but we have made headway in better understanding the chemical signaling in the body.
Another important avenue of research in the treatment of neuropathy is remyelination, usually through medication. Many of these studies are performed on rodents. It may be some time before human trials produce anything that makes its way into the market. However, every year brings new discoveries for the treatment of neurodegenerative diseases and nerve repair.
The Role of Pain Management
Because so much nerve repair centers around helping the body repair itself through physical intervention and chemical signaling. One of the most important aspects of successfully treating neuropathy is addressing its single greatest symptom: pain.
Pain management plays a vital role in the long-term treatment of neuropathy, especially in progressive illnesses, chronic diseases, and recurring injuries. While medication is a big part of it, long-term treatment for pain is multimodal.
Pain specialists can help you identify a treatment plan that fits your needs, circumstances, and means.