Could it be coming from a nerve?
It is a question many patients have without necessarily having the words to describe it precisely. Pain that burns, feels like electric shocks or is accompanied by numbness seems different from typical muscle or joint pain. And it is.
What is neuropathic pain?
Neuropathic pain occurs when there is a lesion or disease affecting the somatosensory nervous system. This may involve a peripheral nerve, for example in an arm, leg or the back, or, less commonly, a structure of the central nervous system such as the spinal cord or brain.
This is different from the sensitisation of the nervous system discussed in relation to chronic pain more generally. In sensitisation, the system can become more responsive without there necessarily being an identifiable lesion. Neuropathic pain, by contrast, is associated with a lesion or disease of the peripheral or central somatosensory nervous system. Depending on the situation, this may be identified through the clinical history, examination or additional investigations. Classic examples include pain that persists after shingles or pain associated with a compressed nerve.
Sensations that can provide clues
Neuropathic pain often has a particular character: burning, electric-shock sensations, pins and needles or tingling, and sometimes numbness.
The combination can seem contradictory, with an area feeling both numb and painful, but this can occur because the nerve fibres themselves are transmitting altered signals rather than the pain necessarily reflecting damaged tissue at the precise location where it is felt.
Why even clothing can hurt
In some people, an affected area becomes so sensitive that normally harmless contact, such as clothing, a bedsheet or a light touch, becomes painful.
This phenomenon is called allodynia. It illustrates an important difference from more typical pain: the problem is not necessarily the intensity of the contact itself, but the way that contact is processed by the nervous system.
Two different mechanisms
Nociceptive pain, the more common type, results from the detection of actual or potential tissue damage in structures such as muscles or joints. Specialised receptors transmit that information through a nervous system that is functioning normally.
Neuropathic pain arises from a problem affecting the sensory nervous system itself.
The two can coexist, and persistent pain can contain both nociceptive and neuropathic components.
What the location can tell us, and what it cannot
The location of the symptoms and the way the pain is described can provide useful clues. Pain following a particular pathway, or symptoms corresponding to the territory of a specific nerve, can point towards a neuropathic origin.
But these clues do not replace an examination.
The diagnosis of neuropathic pain is based primarily on the clinical history and examination, not on matching your symptoms against a checklist. Several conditions can produce similar sensations, and identifying the underlying cause matters because it influences what may actually be useful.
How I approach pain that may have a nerve-related component
When the symptoms suggest a neuropathic component, I first explore the precise character of the pain, how it has developed, where it is located, and which movements or positions trigger or alter it.
Understanding how long the symptoms have been present and what happened before they began also helps guide the next steps.
Depending on the situation, further medical assessment may be necessary before considering treatment.
When to seek prompt medical assessment
Neuropathic-type pain deserves medical assessment, but certain signs require more prompt evaluation.
These include new or developing muscle weakness alongside abnormal sensations, loss of bladder or bowel control, or neurological symptoms that appear suddenly and worsen rapidly.
In these situations, medical assessment should not be delayed simply to observe how the symptoms develop.
Sources and further reading
Kantonsspital Winterthur, "Neuropathien: Ursache, Behandlung"
Kantonsspital St. Gallen, "Nervenschmerzen: Ursachen, Symptome, Behandlung"
These resources provide further information on the mechanisms and diagnostic approach discussed above.
Frequently asked questions
Does numbness together with pain always mean neuropathic pain?
Not necessarily, but it is a combination worth assessing. Other conditions can produce similar sensations, and an examination helps distinguish between possible causes.
Does neuropathic pain go away with time?
That depends entirely on the cause. Some forms improve when the underlying cause is treated, while others can become chronic and require ongoing management.
Is imaging necessary to diagnose neuropathic pain?
Not always. Diagnosis begins with the clinical history and examination. Imaging or other investigations may be requested depending on what the assessment suggests.
Can stress make neuropathic pain worse?
Stress can influence how pain is perceived and experienced without being its cause. That is not a reason to minimise genuine neuropathic pain.
What is happening in your case?
This article describes general mechanisms. Identifying the precise origin of your pain requires an examination and a proper discussion rather than a generic answer.