Nerve/Neuropathic Pain

Neuropathic or nerve pain is a chronic pain condition caused by damage or dysfunction in the nervous system. It is a distinct type of pain that can significantly impact daily life, and if left untreated, can lead to long-term complications. In Singapore, with an ageing population and increasing chronic health issues, neuropathic pain is a growing concern.

What Is Nerve/Neuropathic Pain? What Are the Types of Nerve/Neuropathic Pain?

Neuropathic pain arises when nerves in the peripheral or central nervous system are damaged or malfunction, leading to abnormal signalling to the brain. Unlike typical pain caused by injury or inflammation, nerve pain results from issues within the nerves themselves.

There are several types of neuropathic pain, which are often classified based on their origin:

1. Peripheral Neuropathic Pain: This type arises from damage to the peripheral nerves, which are the nerves outside the brain and spinal cord. Conditions such as diabetic neuropathy or nerve compression syndromes like carpal tunnel syndrome fall under this category.
2. Central Neuropathic Pain: This occurs when there is damage to the brain or spinal cord, typically from conditions such as stroke, multiple sclerosis, or spinal cord injuries.
3. Entrapment Neuropathies: These occur when a nerve is compressed or trapped, leading to pain, such as in sciatica or trigeminal neuralgia.

What Causes Nerve/Neuropathic Pain?

Several underlying conditions can cause or contribute to the development of nerve pain, including:

• Diabetes: Diabetic neuropathy is one of the most common causes of nerve pain, especially in Singapore, where diabetes rates are on the rise.
• Injury: Physical trauma, such as a car accident, sports injury, or surgery, can damage nerves, leading to neuropathic pain.
• Infections: Certain infections, like shingles (herpes zoster) [link to Shingles], HIV, or Lyme disease, can cause nerve damage.
• Chronic diseases: Conditions such as multiple sclerosis, cancer, or kidney disease can lead to neuropathic pain over time.
• Chemotherapy: Some cancer treatments can damage nerves, causing chemotherapy-induced peripheral neuropathy.
• Alcoholism: Excessive alcohol consumption can lead to nerve damage, known as alcoholic neuropathy.

What Are the Symptoms of Nerve/Neuropathic Pain?

Neuropathic pain is often described as a burning, tingling, or shooting sensation. It may also present as:

• Sharp, stabbing pain: Sudden and intense episodes of pain that feel like electric shocks.
• Numbness or tingling: A common symptom where affected areas feel numb or experience "pins and needles" sensations.
• Allodynia: Pain from stimuli that do not normally cause pain, such as light touch or even the brush of clothing on the skin.
• Hyperalgesia: Heightened sensitivity to pain, where a minor stimulus causes significant discomfort.
• Muscle weakness: In some cases, neuropathy can affect muscle control, leading to weakness or lack of coordination.

Is Nerve/Neuropathic Pain Painful?

Neuropathic pain is highly painful and can be debilitating if not properly managed. It is often described as burning, shooting, or stabbing pain and can be severe enough to limit mobility or daily activities. Additionally, neuropathic pain can be persistent and may not respond to typical over-the-counter pain relief, requiring specialised treatment.

Who Is at Risk of Getting Nerve/Neuropathic Pain in Singapore?

Several factors increase the risk of developing nerve pain:

1. Diabetes: As one of the most common causes of neuropathic pain, individuals with poorly controlled blood sugar levels are at higher risk.
2. Ageing population: Older individuals are more prone to nerve damage due to degenerative conditions, diabetes, and other age-related health issues.
3. Chronic health conditions: Conditions like cancer, multiple sclerosis, or HIV put individuals at higher risk for developing neuropathic pain.
4. Previous injury or surgery: Individuals who have experienced physical trauma, surgery, or repetitive strain injuries are more likely to develop nerve pain.
5. Chemotherapy: Patients undergoing cancer treatments are at higher risk of nerve damage due to certain chemotherapy drugs.

How Is Nerve/Neuropathic Pain Diagnosed?

Diagnosing neuropathic pain typically involves a thorough medical history and physical examination to assess the symptoms and potential causes. Some of the diagnostic tools include:

1. Nerve conduction studies (NCS) [link to NCS]: This test measures how fast electrical signals travel through the nerves to detect any damage.
2. Electromyography (EMG) [link to EMG]: EMG measures the electrical activity in muscles to assess the function of the nerves controlling them.
3. Imaging tests: MRI [link to MRI] or CT scans [link to CT] may be performed to detect any structural damage to the nerves or spine that could be causing the pain.
4. Blood tests: Blood tests may be ordered to rule out conditions like diabetes, infections, or vitamin deficiencies that could contribute to neuropathy.

What Are the Treatment Options for Nerve/Neuropathic Pain in Singapore?

Treating neuropathic pain often involves a multidisciplinary approach, combining medications, physical therapy, and lifestyle changes. Treatment options include:

1. Medications:
   • Pain relievers: Over-the-counter medications may not be effective for neuropathic pain, so prescription medications, including anticonvulsants like gabapentin or pregabalin, and antidepressants like amitriptyline, are commonly used.
   • Topical treatments: Creams or patches containing lidocaine or capsaicin can provide localised relief.
   • Opioids: In severe cases, opioids may be prescribed, but they come with risks of dependency and side effects.
2. Nerve blocks and injections: Corticosteroid injections or nerve blocks [link to Nerve blocks] may help alleviate pain by reducing inflammation or numbing the affected nerves.
3. Physical therapy: Exercises to improve strength, flexibility, and mobility can be helpful in managing pain and preventing further nerve damage.
4. Transcutaneous electrical nerve stimulation (TENS): This therapy uses low-voltage electrical currents to relieve pain.
5. Lifestyle changes: Managing underlying conditions such as diabetes through diet and exercise is crucial to reducing nerve pain.
6. Surgery: In rare cases, surgical intervention may be needed to relieve pressure on nerves or repair damaged areas.

Nerve or neuropathic pain is a complex and often debilitating condition that requires careful diagnosis and treatment. Whether caused by diabetes, injury, or other factors, early intervention is essential to managing pain and preventing further complications. If you are experiencing symptoms of neuropathic pain, schedule a consultation with Dr Charles Siow to explore personalised treatment options for nerve pain in Singapore.