Pain Management Specialist Advice

Nerve Pain and Nerve Damage

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Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

There are three types of nerves, or neurons, in the body:

1. Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
2. Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.
3. Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Nerve pain and nerve damage can be mild. But, because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.

What Are the Symptoms of Nerve Pain and Nerve Damage?

With nerve damage there can be a wide array of symptoms. Which ones you may have depends on the location and type of nerves that are affected. Damage can occur to nerves in your brain and spinal cord. It can also occur in the peripheral nerves, which are located throughout the rest of your body.

Autonomic nerve damage may produce the following symptoms:

• inability to sense chest pain, such as angina or heart attack
• too much sweating (known as hyperhidrosis) or too little sweating (known as anhidrosis)
• lightheadedness
• dry eyes and mouth
• constipation
• bladder dysfunction
• sexual dysfunction

Damage to motor nerves may produce the following symptoms:

• weakness
• muscle atrophy
• twitching, also known as fasciculation
• paralysis

Sensory nerve damage may produce the following symptoms:

• pain
• sensitivity
• numbness
• tingling or prickling
• burning
• problems with positional awareness

In some instances, people with nerve damage will have symptoms that indicate damage to two, or even three, different types of nerves. For instance, you might experience weakness and burning of your legs at the same time.

What Causes Nerve Pain and Nerve Damage?

There are more than 100 different types of nerve damage. The various types may have different symptoms and may require different types of treatment.

More than 20 million Americans are afflicted with peripheral nerve damage. This type of damage becomes increasingly more common with age. In one out of every three people with peripheral nerve damage, the damage comes from diabetes. In another third, the cause of the nerve damage remains unknown.

While not an exhaustive list, the following are some of the possible causes of nerve pain and nerve damage:

• Autoimmune diseases. A variety of different types of autoimmune diseases can produce symptoms of nerve pain and nerve damage. These include: multiple sclerosis, Guillain-Barré syndrome (a rare condition in which the immune system attacks the peripheral nerves), myasthenia gravis, lupus, and inflammatory bowel disease.
• Cancer. Cancer can cause nerve pain and nerve damage in multiple ways. In some instances, cancerous masses may push against or crush nerves. In other cases, certain types of cancer may result in nutritional deficiencies that affect nerve function. Additionally, chemotherapy and radiation may produce nerve pain and nerve damage in certain individuals.
• Compression/trauma. Anything that results in trauma or compression of nerves can result in nerve pain and nerve damage. This includes pinched nerves in the neck, crush injuries, and carpal tunnel syndrome.
• Diabetes. About 50% of people with diabetes suffer from nerve damage, which becomes more likely as the disease progresses. Diabetic neuropathy is a serious complication and may affect all three types of neurons. Sensory nerves are most often affected, causing burning or numbness. If you have diabetes and are experiencing symptoms of nerve pain or nerve damage, you should consult a medical professional as soon as possible.
• Drug side effects and toxic substances. Various substances that are taken into the body intentionally or unintentionally have the ability to cause nerve pain and nerve damage. These include medications, such as chemotherapies for cancer and certain drugs used to treat HIV. Toxic substances that may be ingested accidentally, including lead, arsenic, and mercury, may also cause damage to your nerves.
• Motor neuron diseases. The motor neurons are nerves in your brain and spinal column that communicate with the muscles throughout your body. Diseases that affect these nerves, including amyotrophic lateral sclerosis, also called ALS or Lou Gehrig’s disease, can result in progressively worsening nerve damage.
• Nutritional deficiencies. Deficiencies of certain nutrients, including vitamins B6 and B12, may produce symptoms of nerve pain and nerve damage, including weakness or burning sensations. Nutritional deficiencies that cause nerve damage may also result from excessive alcohol ingestion or develop after gastric surgery.
• Infectious disease. Certain infectious diseases have the ability to affect the nerves in your body. These conditions include Lyme disease, the herpes viruses, HIV, and hepatitis C.

How Are Nerve Pain and Nerve Damage Treated?

In many instances, nerve damage cannot be cured entirely. But there are various treatments that can reduce your symptoms. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. That way you can reduce the likelihood of permanent damage.

Often, the first goal of treatment is to address the underlying condition that’s causing your nerve pain or nerve damage. This may mean:

• regulating blood sugar levels for people with diabetes
• correcting nutritional deficiencies
• changing medications when drugs are causing nerve damage
• physical therapy or surgery to address compression or trauma to nerves
• medications to treat autoimmune conditions

Additionally, your doctor may prescribe medications aimed at minimizing the nerve pain you are feeling. These may include:

• pain relievers
• tricyclic antidepressants
• certain anti-seizure drugs

Complementary and alternative approaches may also help alleviate your nerve pain and discomfort. These include:

• acupuncture
• biofeedback
• hypnosis
• meditation

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Sciatica can be an incredibly painful and debilitating condition characterised by intense pain running from the lower back down through the buttocks and along the back of each leg. This massage oils has been specially designed to help reduce inflammation of nerve fibres and muscles. This massage oil is made with a exact blend of oils reputed to help reduce painful spasms associated with sciatica, assist restful sleep, lubricate local muscles and fibres aiding restoration, increase pain free mobility and reduce the inflammation in and around the spinal column. It has also been reported to assist blood flow when used on areas prone to pins and needles or general circulation problems. The building blocks of the oils radically decrease the inflammation around your back, specifically acting on the muscles surrounding the spinal cord. This combination may help remove the build up of toxins, reducing painful inflammation and resulting in amazing relief. Our natural sciatica treatment has produced fantastic results when dealing with painful sciatica. To use- Shake well before use. Warm the oil in your palms before applying with fingertips in long, firm strokes. Apply a small amount four times per day, follow the pain down the limb and massage well in. It is important that the limbs are massaged upwards towards the heart.  READ MORE

SC2000 Cream From Abluo 60ml.
Developed for people suffering from sciatica which is an incredibly painful and debilitating condition characterised by intense pain running from the lower back down through the buttocks and along the back of each leg. Users of Abluo SC2000 Cream have reported wonderful results when used to treat sciatic conditions. The deep penetrating oils permeate the body, helping to reduce inflammation, loosening both nerve fibres and muscles in order for your trapped spinal cord to slip back to its proper state. In essence, our powerful sciatica treatment cream helps reduce the inflammation in and around the spinal column. The building blocks of the oils can radically decrease the inflammation around your back, specifically acting on the muscles surrounding the spinal cord. This combination also may help remove the build up of toxins, reducing painful inflammation and resulting in amazing relief. This natural SC2000 treatment has produced fantastic results when dealing with painful sciatica. Key benefits- This product may relieve painful sciatic conditions, increase pain free mobility, reduce inflammation and tenderness, resolve muscles spasms and promote restful sleep. Usage- Apply a small amount four times per day starting at the point of pain on the spine, neck or shoulder. Then apply the cream form the furthest point massaging upwards towards the heart. This problem effects lower back, leg, neck, shoulders and arms. The cream may help to bring down inflammation of both the nerve fibres and the muscles helping to combat pain spasm and thus assist restful sleep. Relief is usually found after 2 to 3 days

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St. Johns Wort Organic Infused Oil 100ml.
St. John’s wort oil is used for bruises, is anti-inflammatory, and is often used by herbalists to help speed healing of wounds and sores. St. John’s wort oil has antiphlogistic qualities, in other words, it helps to reduce inflammation. Externally it is applied to bruises, sprains, burns, skin irritations, or any laceration accompanied by severed nerve tissue. The German government allows such external St. John’s wort preparations to be labeled for the treatment or after treatment of sharp or abrasive wounds, myalgias (muscular pain) as well as first degree burns. This is not a new herbal treatment, but one that has been handed down for hundreds of years. Once known to pharmacists as “red oil” or “Hypericum liniment,” it was still available in pharmacies in the early twentieth century. The practice of soaking the flowers in olive oil, infusing the oil in the sun, then using the oil internally as a diuretic and external application for wounds dates at least to the time of the first edition of Gerarde’s Herball (1597). READ MORE

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Muscle Ease Massage Oil
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Pain management and sciatica

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.

What are the symptoms of sciatica?

Common symptoms of sciatica include:

• pain in the buttock or leg that is worse when sitting
• burning or tingling down the leg
• weakness, numbness, or difficulty moving the leg or foot
• a constant pain on one side of the buttock
• a shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.

For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse.

Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control.

What causes sciatica?

Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine.

Additional common causes of sciatica include:

• lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
• degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
• spondylolisthesis (a condition in which one vertebra slips forward over another one)
• pregnancy

Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft

Pinched nerve

What is pinched nerve?

The term pinched nerve describes one type of damage or injury to a nerve or set of nerves. The injury may result from compression, constriction, or stretching. Symptoms include numbness, “pins and needles” or burning sensations, and pain radiating outward from the injured area. One of the most common examples of a single compressed nerve is the feeling of having a foot or hand “fall asleep”. Pinched nerves can sometimes lead to other conditions such as peripheral neuropathy, carpal tunnel syndrome, and tennis elbow. The extent of such injuries may vary from minor, temporary damage to a more permanent condition. Early diagnosis is important to prevent further damage or complications. Pinched nerve is a common cause of work-related  injuries.

Is there any treatment for a pinched nerve?

The most frequently recommended treatment for pinched nerve is rest for the affected area. Corticosteroids – steroids that ease inflammation – can help alleviate pain. In some cases, surgery is recommended. Physiotherapy may be recommended, and splints or collars may be used.

What is the prognosis for a pinched nerve?

With treatment, most people recover from pinched nerve. However, in some cases, the damage is irreversible.

Treatment for diabetes nerve pain

Nerve pain caused by diabetes, called diabetic peripheral neuropathy, can be severe, constant and difficult to treat. It may start as a tingling sensation, followed by numbness and pain. But there are two key points that everyone with diabetes and peripheral neuropathy should know:

• Controlling your blood sugar levels can help prevent worsening nerve pain and improve your overall health at the same time.
• Medications can help relieve nerve pain, make you more comfortable and improve your quality of life.

“We know that better glucose control is the single most important factor” in preventing neuropathy, slowing its progress once you have it, and relieving many symptoms, says Dr Christopher Gibbons, director of the Neuropathy Clinic at the Joslin Diabetes Center in Boston in the US.

If you have diabetes and peripheral neuropathy, talk to your doctor about ways to better control your blood sugar. You may need to take insulin for better control, says Gibbons.

Once you are doing all that you can to keep blood sugar levels under control – including diet, meal planning, exercise and medication – you should assess with your doctor which pain medication is best to relieve your remaining symptoms.

Fortunately, medications can help relieve nerve pain from peripheral neuropathy so you can function at near-normal levels. You have many pain relief medicines from which to choose. But you may need to try several different types of pain relievers before you find the one that helps you.

Over-the-counter pain relievers for diabetes nerve pain

Some people find relief for mild diabetes nerve pain on their chemist’s shelves. Common pain relievers and some topical creams may help, depending on the severity of pain.

“As a first line of treatment, these can be very helpful,” Gibbons says.

Anyone with diabetes should talk to their doctor before taking any medication. Even over-the-counter medications can interact with other medicines or cause severe side effects in people with diabetes.

Here are some over-the-counter pain relief options to consider:

NSAIDs (nonsteroidal anti-inflammatory drugs). These medicines reduce inflammation and relieve pain. NSAIDs available without a prescription include aspirin and ibuprofen.

But NSAIDs can cause harmful side effects such as stomach irritation and bleeding in some people if taken for weeks or months. When taken long-term they can also lead to kidney and liver damage, which may be more likely in people with diabetes.

However, says Gibbons, “In many cases, especially with younger people who are relatively healthy, the risk is quite low.”

Paracetamol and other over-the-counter medicines containing paracetamol relieve diabetes nerve pain without reducing inflammation. These medications do not cause the stomach irritation that NSAIDs do. However, taking more paracetamol than recommended can lead to liver damage. It is important to read labels and check with your pharmacist. Do not take more than 1g paracetamol four times a day (that is, no more than 8 x 500mg tablets per 24 hour period).

Other topical creams. Salicylate is a chemical similar to aspirin, and is found in some pain-relieving creams. Hydrocortisone creams contain corticosteroids, which are anti-inflammatory medicines that can help relieve pain. Both are available in chemists,  but there is no clear evidence that they help relieve nerve pain from peripheral neuropathy.

Prescription medicines for diabetes nerve pain

Many people need to turn to prescription medication to find relief for diabetes nerve pain. Your choices include:

NSAIDs. Although some nonsteroidal anti-inflammatory drugs are available over the counter, your doctor may suggest higher doses, or different NSAIDs, that require a prescription. People with diabetes are more at risk of kidney damage that can occur with NSAIDs. In addition, people with diabetes are at high risk of heart disease, and prescription NSAIDs may raise the risk of heart problems.

Antidepressants. Although antidepressants were developed for depression, these medicines have also become important in relieving chronic pain – whether the person is depressed or not. Doctors have been prescribing antidepressants for many years for pain control, says Gibbons. Antidepressants used to treat pain include:

• Tricyclic antidepressants (TCAs) primarily affect the levels of the brain chemicals norepinephrine and serotonin. “These are the most commonly used, the best studied, and the most effective of the antidepressants used for pain,” says Gibbons.
• Selective Serotonin Reuptake Inhibitors (SSRIs) are a newer form of antidepressant. These medicines work by altering the amount of the brain chemical serotonin. “These are very effective for depression, but less effective for pain,” says Gibbons. “They’ve been shown effective in some studies, but they’re clearly not as effective as TCAs for pain.”
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.

Antiseizure Medicines. Medications that prevents epileptic seizures can also relieve certain pain conditions, including neuropathy. “The majority of pain patients can be treated with any of these,” says Gibbons. The medicines work by controlling the abnormal firing of nerve cells – in the brain and in other parts of the body, like legs and arms, he explains.

• Gabapentin is the antiseizure drug most commonly used for nerve pain from peripheral neuropathy. “It’s quite effective in treatment of painful neuropathy,” says Gibbons. “It does tend to cause sedation or dizziness at higher doses. But if the dosage is increased slowly, it is quite well tolerated.”
• Pregabalin is a seizure medication that is NHS approved for painful neuropathy. “It is designed as the next generation of gabapentin,” says Gibbons. “But whether it’s going to be more effective with fewer side effects — that will take time to find out.”

Opioid Medicines. When pain is very severe, patients want immediate relief, says Gibbons. Sometimes people need strong painkillers, possibly in combination with gabapentin. “The combination gets people past that acute stage of pain while I can slowly increase the gabapentin.”

Tramadol is a painkiller that is a weak opioid (morphine-like) substance. The drug also weakly affects the brain chemicals serotonin and norepinephrine, similar to antidepressants, which reduces the perception of pain.”We often use tramadol as a back-up for what we call ‘breakthrough pain’ – pain that suddenly, for no apparent reason, is worse at times,” says Gibbons. Tramadol is a good replacement for over-the-counter stuff at those times.”

Neuropathy specialists shy away from strong narcotic opioid medications, he notes. Narcotics can cause severe constipation, and there is the potential for addiction. “There’s also a stigma about using a narcotic drug,” he says. “Depending on the type of work a person does, it could be a problem.”

Capsaicin. Found naturally in chilli peppers. “Capsaicin has been shown to relieve pain, but there is some concern,” Gibbons says. “It may not be the best approach.”

Capsaicin is thought to ease pain by reducing a chemical called substance P, which is involved in transmitting pain signals through the nerves. On a short-term basis, it is an effective approach, says Gibbons.

“But we are concerned about the long-term consequences. These same nerves play a big role in wound healing. We’re concerned that capsaicin could prevent wound healing, which is already a big problem for diabetes patients.”

More treatment options for diabetes nerve pain

For severe, intractable diabetes nerve pain, injections of local anaesthetics such as lidocaine are used to numb the painful area.

Doctors can also:

• Surgically destroy nerves or relieve a nerve compression that causes pain.
• Implant a device that relieves pain.
• Perform electrical nerve stimulation which may relieve pain. In this treatment, small amounts of electricity are used to block pain signals as they pass through the skin. “It’s debatable whether this is effective,” says Gibbons.

Other useful aides to improve quality of life and function include:

• Hand or foot braces can compensate for muscle weakness or help relieve nerve compression.
• Orthopaedic shoes can improve gait (walking) problems, which will prevent foot injuries.
• It may be possible to be referred to a Pain Clinic

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