Peripheral Neuropathy Pain: Important Things to Know

Peripheral neuropathy pain is the most common kind of neuropathic pain or nerve pain. Neuropathic pain differentiates itself from nociceptive pain in that the cause of the pain is nerve-related, rather than the nerve simply playing the role of pain messenger. All pain ultimately begins in our nerves, as signals move through the body into our brain – but only neuropathic pain involves some nerve damage or disease. 

Peripheral neuropathic pain is any pain generated by disease, destruction, or damage of the peripheral nerves, including every nerve outside the spinal cord and brain. 

Peripheral neuropathic pain can be long-lasting and chronic, resulting in a constant dull ache. It can be intermittent or random, usually followed by a period of numbness, prickling, or lack of any sensation whatsoever. Or it can be a sharp, burning sensation that comes and goes. As many as 10 percent of Americans suffer from neuropathic pain. 

The number of Americans suffering makes peripheral neuropathic pain complicated and nearly all-encompassing. Different categories of peripheral neuropathic pain exist to narrow down other types of pain experiences and nerve conditions. 

Types of Peripheral Neuropathy Pain

There are three types of Peripheral neuropathy pain: sensory nerve pain, motor nerve pain, and autonomic nerve pain. 

• Motor nerves are responsible for relaying commands to the muscles under our conscious control. They let us move. 
• Autonomic nerves work in the background to keep us breathing, digesting, sweating, and ensuring the heart functions. They let us live. 
• Sensory nerves are responsible for the transmission of stimulus and other information. They let us feel. 

Any pain can be a mixture of all three. As such, doctors may use different terminology to describe how much of any given type of nerve is being affected by the pain, such as “predominantly sensory,” “motor-sensory,” or “autonomic pain condition.” Pain conditions involving just a single nerve are called mononeuropathies. When multiple nerves have been affected, it is a polyneuropathy. 

Remember that there are well over 100 examples of peripheral neuropathy pain, from a singed nerve after a chemical burn to demyelinated nerves caused by diabetes. Further categorizing these neuropathies as sensory, motor, or autonomic help us understand what kind of nerves may have been affected and how. 

For example, damage to the autonomic nervous system can cause irregular heartbeat, digestive problems, breathing issues, and excessive sweating. It can cause widespread pain and pain associated with heart and respiratory problems. 

What Causes The Pain? 

Many peripheral neuropathy pain conditions are length-dependent, meaning they begin at the extremities and move inwards. There are a few reasons for this, the chief being how our heart circulates oxygenated blood throughout the body. Another reason is that diabetes alone accounts for about a third of all peripheral neuropathy cases. 

Places of the body with poorer circulation may be more heavily affected by symptoms of alcohol poisoning, diabetes, viral infection, and other common causes of peripheral nerve damage. In these cases, symptoms start most strongly in the hands and feet and work inwards. In many of these conditions, an infection, a hostile environment, or even the body’s antibodies attack, destroy nerves, and reduce blood flow to healthy tissue, leading to nerve and other tissue death. 

For non-length-dependent conditions, pain symptoms may start in the torso, significantly when autonomic nerves have been affected. The nerves are affected because most autonomic processes occur in the torso, including heartbeat, breathing, and digestion. From here, pain may spread sporadically throughout the rest of the body. 

Some common causes of peripheral neuropathic pain include: 

• Excessive alcohol use
• Diabetes
• Viral infection
• Progressive CNS conditions
• CPRS
• Hereditary nerve conditions
• Chemotherapy
• Radiation therapy
• Limb loss
• Inflammation 
• Auto-immune diseases
• Post-surgical complications
• Nerve compression

Identifying Peripheral Neuropathic Pain

Pain is pain. How do we differentiate nociceptive pain (i.e., the transmission of pain signals) from neuropathic pain (i.e., nerve damage)? 

There are a few telltale signs. Certain conditions and circumstances are much more likely to result in neuropathic pain, giving doctors a clue to look for nerve damage. Some symptoms are also much more likely to be the result of a neuropathic condition than an example of nociceptive pain, such as bouts of pain followed by a sudden loss of strength or sensation, numbness, pins, and needles, or partial paralysis. 

Spontaneous pain – without an apparent stimulus or cause – is another common symptom, as is tremendous pain, such as feeling a burning sensation or extreme discomfort at a slight touch or brush or feeling stabbed after a pinprick. 

Nerves do not heal quickly. Physical exams can give doctors further clues about patients’ nerve function by testing their reflexes, strength, and ability to respond to stimuli. Imaging tests can provide more insight as to the extent of the damage and a patient’s prognosis or chance of recovery. 

Treatments for Peripheral Neuropathy

Treatments for peripheral neuropathic pain number in the hundreds, just as the conditions do. The treatment plan will always depend on the patient’s medical history and circumstances. 

For example, alcohol-related neuropathy will require intensive substance use treatment, medication to reduce and address pain, and help stimulate nerve healing depending on the severity of the damage. 

Peripheral nerves can be remyelinated, given the right physical environment. The body sees to that through its mechanisms. But proper treatment may require supervision on the patient’s part, including residential treatment and mental health therapies, invoking family to help reduce addictive stimuli and tackle the (often painful) withdrawal symptoms. 

Some conditions are much harder to treat. Progressive nerve diseases, such as Parkinson’s, have no effective cure. Treatments may slow the disease but might not reverse nerve damage, especially to the central nervous system. Pain killers are one of the primary ways to deal with side effects. The same goes for terminal diseases, where pain treatment focuses on improving the quality of life in the final years rather than overcoming illness. 

Aside from medication and medical interventions, doctors may also work with families to introduce lifestyle and mental health initiatives. Depression and other mental health conditions are expected in pain patients and can worsen pain, actively inhibiting recovery and increasing pain sensitivity. Doctors will also provide any extra information on peripheral neuropathy that will help treat it better.

Improving a person’s mental health can improve pain resilience and reduce symptoms. Lifestyle changes, such as better eating habits and more movement and exercise, can lead to a better quality of life, less pain, and faster recovery. 

These treatments and recommendations are all a part of pain management, addressing pain holistically through various biological, psychological, and social interventions.