by Janet Jay
Most of the time when you injure yourself, it hurts, it heals, and you feel fine again. But once in a while, that process goes awry. In response to trauma, the body’s nerves may react in a way that can lead to a different, chronic form of pain, called neuropathy. Some studies have found that approximately 30-50% of individuals have pain following trauma.
Neuropathy, or nerve pain, has many potential causes and may manifest in a variety of ways. Sometimes it’s caused by the nerve actually being severed: neuropathy is extremely common among patients who have severed a nerve or had a limb amputated.
However, damage can also result from the nerve being compressed, injured, or crushed—even if not actually cut. These are most frequently caused by an injury incurred during an accident, a fall, or playing sports, or any other activity that can stretch, compress, crush or cut nerves. This includes compression of the nerves due to repetitive stress, for example, carpal tunnel syndrome.
“Many patients, and even some physicians, are unaware that the nerve doesn’t have to be completely cut for it to cause pain,” said Dr. Kyle Eberlin, a plastic surgeon and peripheral nerve surgeon who serves as Associate Professor of Surgery at Massachusetts General Hospital and Harvard Medical School. “It would be worthwhile for patients to understand that nerve injuries can come in many different shapes and sizes, and you don’t actually have to sustain a laceration to have a nerve injury that causes pain.”
How to distinguish nerve pain
It’s important to be proactive about any neuropathic pain you may experience: the sooner after the initial trauma the nerve pain is treated, the better the chance of limiting damage and preventing further complications. But differentiating between acute pain from an injury and nerve pain that may be the start of an ongoing problem isn’t always simple or straightforward.
“When talking with patients, one important consideration is the quality of the pain,” said Dr. Eberlin. “Does it radiate through your arm or leg? Does it feel like an electric shock? When does it hurt, and what things make it better? So if someone says, ‘it feels like electricity running down my leg, and it’s really painful,’ it certainly sounds like nerve pain.”
These symptoms are typical responses to a sensory nerve injury. Nerve pain can also include pain brought on by normally non-painful stimuli or an increased level of pain to already painful stimuli.
What are neuromas?
Another common complication in this situation is called a neuroma.
“Any time a nerve is injured, the body attempts to regenerate the nerve toward its intended target,” explained Dr. Eberlin. “If that doesn’t happen in an organized way, it forms a neuroma, which is essentially painful scar tissue at the end of the nerve.”
Approximately 20% to 30% of all neuromas are painful, with the severity of the pain ranging from mild to incapacitating. Some studies have shown 60–80% of amputees experience phantom limb pain, and traumatic neuromas account for chronic pain in approximately 25% of major limb amputees.
If you have a neuroma, your doctor may tap directly on the tumor-like bump or on known pathways for peripheral nerves in order to elicit the nerve pain you’ve been experiencing.
Whether there’s a visible neuroma or not, your doctor may try injecting a local anesthetic (known as a nerve block) to determine the cause and location your pain is coming from. Other diagnostic options include bone scans, MRIs, X-rays, and sympathetic nervous system tests.
Options for treatment
“From a patient’s perspective, getting to the right doctor – specifically a peripheral nerve surgeon following a nerve injury – is probably the most important thing that can be done,” said Dr. Eberlin. “An important message for patients is to not lose hope that nerve pain can be improved. It’s our job as physicians to sort out what the problem is and what we can do to help.”
Once you have a diagnosis, you and your doctor will work together to establish a treatment plan. There are a wide range of options out there to treat neuropathic pain, including medication, electroceuticals, physical therapy, and surgical interventions that range from outpatient nerve blocks to inpatient procedures to repair or remove the injured nerve. But because of the risk of injuring nerves further during the operation, your doctor will try other treatment options before considering surgery.
For instance, physical therapy is one of the most important elements in recovering from nerve pain. Some patients find relief from similar options like desensitization techniques, relaxation techniques (such as meditation), massage therapy, heat and cold therapy, or acupuncture.
Over-the-counter pain relievers help some patients, but your doctor may also prescribe an antidepressant or anticonvulsant medications, which have been found to be helpful for nerve pain. Corticosteroids may be prescribed to reduce the inflammation that may be exacerbating your pain. The nerve blocks that your doctor may have used as a diagnostic tool can also be used as a short-term treatment strategy, although the benefits usually only last 1–2 weeks.
New technology, expanded choices
In recent years a wide variety of new devices have been approved that relieve pain by disrupting the electrical signals that nerves transmit. These devices range from a simple TENS (transcutaneous electrical nerve stimulation) unit to a spinal cord stimulator or other type of surgically implanted neuromodulator. This signal-blocking technology can be particularly effective for neuropathic pain.
Surgery is usually reserved for patients not responding to more conservative treatments. However, for patients whose pain makes it necessary, there are a variety of surgical procedures to reconnect, rebuild, or redirect nerves, or simply try to make them less painful.
Finally, psychological factors play a major role in any comprehensive treatment of nerve pain after trauma. This doesn’t mean that the pain is “all in your head,” but anxiety and depression have been shown to have an outsized effect on neuropathic pain. Some patients may benefit from the type of comprehensive approach provided by a pain clinic or from finding a psychiatric provider experienced with patients with chronic pain.
Whatever your injury or specific symptoms, there are many options for treating neuromas and nerve pain after trauma.
“We are in the middle of a paradigm shift in the surgical management of nerve pain. There are many new techniques and procedures that can be done to help patients with these difficult problems,” said Dr. Eberlin. “There are new surgical options and new technologies that will continue to revolutionize the care of many patients with neuropathic pain – I am really excited about the future and for new developments in this field.”
Learn more about neuropathic pain and U.S. Pain’s 2021 KNOWvember campaign.
This campaign was created through support from Axogen, Inc. and Vertex Pharmaceuticals. U.S. Pain Foundation developed the content without review from sponsors. This information is educational only and should not be used as a substitute for advice from a health care professional.