Neuropathic Pain

Neuropathic pain is attributed to alterations in the nervous system that sustain pain even after an injury has healed. Typically, the initial injury involves either the peripheral nerves or the central nervous system itself. It can be linked to various causes, including trauma and different diseases, such as diabetes.

There exist numerous neuropathic pain conditions, including diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia (resulting from “shingles”), post-stroke pain, and complex regional pain syndromes (also known as reflex sympathetic dystrophy or “RSD” and causalgia). Individuals experiencing neuropathic pain often describe it as peculiar and unfamiliar, characterized by sensations like burning or electric shocks. This pain may also be accompanied by heightened skin sensitivity.

Neuropathic pain can arise when there is damage or dysfunction in your nervous system. Pain signals can be generated from various components of the nervous system, including the peripheral nerves, the spinal cord, and the brain. The spinal cord and the brain collectively make up the central nervous system. Peripheral nerves extend throughout the body, reaching areas such as organs, limbs, fingers, and toes.

When nerve fibers are damaged, they can transmit erroneous signals to pain centers. Nerve function may undergo changes not only at the site of the nerve damage but also within regions of the central nervous system, a phenomenon known as central sensitization.

Neuropathy refers to a disruption in the function of one or multiple nerves. Approximately 30% of neuropathy cases can be attributed to diabetes. Identifying the precise source of neuropathic pain is not always straightforward, as numerous diseases are associated with this type of pain.

What Are the Symptoms of Neuropathic Pain?

Neuropathic pain can manifest with a variety of symptoms, and the specific symptoms an individual experiences may vary based on the underlying cause and location of the nerve damage. Common symptoms of neuropathic pain include:

1. Burning Sensation: Many people with neuropathic pain describe a persistent burning feeling in the affected area.
2. Tingling or Pins and Needles: Some individuals experience sensations of tingling, pins and needles, or prickling in the affected body part.
3. Electric-Shock-Like Pain: Sharp, shooting, or electric shock-like pain is a hallmark symptom of neuropathic pain. It often occurs suddenly and may be intense.
4. Numbness: Neuropathy can lead to areas of numbness or reduced sensation in the affected body part.
5. Hypersensitivity: In some cases, the skin in the affected area may become overly sensitive to touch or temperature changes, leading to discomfort or pain with even light contact.
6. Stabbing or Stinging Pain: Some individuals report sensations of stabbing, stinging, or pricking pain in the affected area.
7. Allodynia: Allodynia is a condition where normally non-painful stimuli, such as light touch or gentle pressure, elicit pain. It is a common symptom of neuropathic pain.
8. Evoked pain：Evoked pain refers to the experience of pain triggered by typically non-painful stimuli, including exposure to cold, gentle skin brushing, or pressure. This phenomenon is termed allodynia. Additionally, evoked pain can encompass an intensified response to stimuli that are typically painful, such as pinpricks and heat. This heightened sensitivity to painful stimuli is known as hyperalgesia.
9. Muscle Weakness: Neuropathic pain can be accompanied by muscle weakness or loss of coordination in the affected body part.
10. Changes in Sensation: There may be alterations in sensation, such as the perception of hot or cold feeling different than usual.
11. Radiating Pain: The pain may radiate from the initial site of nerve damage to other areas of the body. For example, sciatica often involves pain radiating from the lower back down the leg.
12. Spontaneous Pain: Neuropathic pain can occur without any apparent trigger, and individuals may experience spontaneous and unpredictable episodes of pain. Shooting, burning, stabbing, or electric shock-like pain; tingling, numbness, or a “pins and needles” feeling

The specific combination and severity of these symptoms can vary widely. Neuropathic pain is often chronic and can significantly impact an individual’s quality of life, leading to emotional distress and disability.

What Are the Causes of Neuropathic Pain?

Neuropathic pain can have various causes, all of which are related to damage or dysfunction in the nervous system. Some common causes of neuropathic pain include:

1. Peripheral Neuropathy: This is one of the most common causes of neuropathic pain. Peripheral neuropathy refers to damage to the peripheral nerves, which transmit signals between the central nervous system and the rest of the body. Conditions that can lead to peripheral neuropathy include:
   • Diabetes: Diabetic neuropathy is a frequent complication of diabetes.
   • Chemotherapy: Certain chemotherapeutic agents can cause nerve damage.
   • Alcohol Abuse: Chronic alcohol use can result in alcoholic neuropathy.
   • Infections: Conditions like shingles, HIV/AIDS, and Lyme disease can cause neuropathy.
   • Nutritional Deficiencies: A lack of essential nutrients, such as vitamin B12, can lead to nerve damage.
2. Nerve Compression or Entrapment: Conditions that compress or entrap nerves can result in neuropathic pain. Carpal tunnel syndrome is a common example, where the median nerve is compressed at the wrist.
3. Alcoholism Can Cause Pain: alcoholism can lead to various types of pain, both as a direct result of the effects of alcohol on the body and as a consequence of the lifestyle associated with excessive alcohol consumption.
4. Chemotherapy drugs: cisplatin, paclitaxel, vincristine, etc..
5. Radiation therapy
6. Amputation, which can cause phantom pain.
7. Spinal nerve compression or inflammation
8. Diabetes : diabetes can cause various types of pain, often referred to as diabetic neuropathy. Diabetic neuropathy is a common complication of diabetes and occurs when high blood sugar levels damage the nerves in the body. 
9. Facial Nerve Problems: Facial nerve problems can indeed cause pain, and there are various conditions that can affect the facial nerve, leading to different types of pain or discomfort. The facial nerve, also known as the seventh cranial nerve, is responsible for controlling the muscles of facial expression and transmitting sensory information from the face to the brain.
10. Trigeminal Neuralgia: This condition leads to sudden and severe facial pain due to irritation of the trigeminal nerve, which controls facial sensation.
11. Post-Herpetic Neuralgia: This type of neuropathic pain occurs after a shingles (herpes zoster) infection, where the pain persists long after the rash has healed.
12. Phantom Limb Pain: Individuals who have undergone amputation may experience pain in the missing limb.
13. Spinal Cord Injury: Damage to the spinal cord can result in neuropathic pain in the affected area or radiating down the limbs.
14. Central Sensitization: In some cases, the central nervous system becomes hypersensitive to pain signals, leading to pain amplification. This is associated with conditions like fibromyalgia and complex regional pain syndrome (CRPS).
15. Trauma or surgeries with resulting nerve damage.
16. HIV infection or AIDS: HIV infection and AIDS (Acquired Immunodeficiency Syndrome) can lead to various types of pain and discomfort. These pain symptoms can be caused by the HIV virus itself, its impact on the immune system, or related complications.
17. Multiple Sclerosis: This autoimmune disease can damage the protective covering of nerves (myelin), leading to neuropathic pain.
18. Certain Medications: Long-term use of certain medications, such as some antiretroviral drugs, can cause neuropathy.
19. Hereditary or Genetic Factors: In rare cases, genetic factors may contribute to the development of neuropathic pain conditions.
20. Complex regional pain syndrome: Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Sympathetic Dystrophy (RSD), is a chronic and often debilitating condition characterized by severe and persistent pain that typically affects one limb, often after an injury or trauma. CRPS is believed to result from an abnormal response by the nervous system to the initial injury, although the exact cause is not fully understood.

Identifying the precise cause of neuropathic pain is essential for determining the most effective treatment approach. Medical evaluation, diagnostic tests, and, in some cases, consultation with specialists, may be required to diagnose and manage neuropathic pain properly.

The Diagnosis of Neuropathic Pain

The diagnosis of neuropathic pain typically involves a comprehensive evaluation by a healthcare provider, such as a neurologist or pain specialist. The process may include several steps and diagnostic tools to determine the presence of neuropathic pain and its potential underlying cause. Here’s an overview of the diagnostic process:

1. Medical History: The healthcare provider will begin by taking a detailed medical history, including information about the patient’s pain, its characteristics, duration, and any relevant medical conditions or previous injuries.
2. Physical Examination: A physical examination is conducted to assess sensory changes, muscle strength, reflexes, and signs of nerve damage in the affected area.
3. Neurological Assessment: The healthcare provider may perform specific neurological tests to evaluate nerve function and identify signs of neuropathy.
4. Pain Assessment: The patient’s description of the pain is crucial. Neuropathic pain is often described as burning, shooting, tingling, or electric shock-like sensations. Information on the pain’s location and any factors that exacerbate or alleviate it is important.
5. Clinical Questionnaires: Patients may be asked to complete pain assessment questionnaires or surveys that help quantify and characterize their pain.
6. Diagnostic Tests: Various diagnostic tests may be ordered to help identify the underlying cause of neuropathic pain. These can include:
   • Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests evaluate nerve and muscle function and can identify nerve damage.
   • Imaging Studies: X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may be used to look for structural abnormalities or other causes of pain.
   • Laboratory Tests: Blood tests can help identify underlying medical conditions, such as diabetes or vitamin deficiencies, that may contribute to neuropathic pain.
7. Psychological Assessment: It’s important to assess the emotional and psychological impact of chronic pain, as conditions like depression and anxiety often co-occur with neuropathic pain.
8. Nerve Blocks or Injections: In some cases, a healthcare provider may perform nerve blocks or injections to help confirm the diagnosis and provide temporary pain relief.
9. Biopsy: In rare cases, a nerve biopsy may be recommended to evaluate nerve tissue directly.

Once the diagnosis of neuropathic pain is established, treatment options can be considered based on the underlying cause and the specific needs of the patient.

How is Neuropathic Pain Treated?

The treatment of neuropathic pain often involves a multidisciplinary approach and aims to alleviate pain, improve the patient’s quality of life, and address the underlying cause, if possible. Treatment options for neuropathic pain may include the following:

1. Medications:
   • Anticonvulsant Medications: Drugs like gabapentin (Neurontin) and pregabalin (Lyrica) are commonly used to manage neuropathic pain by stabilizing overactive nerve signals.
   • Antidepressant Medications: Tricyclic antidepressants (e.g., amitriptyline) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) can help alleviate neuropathic pain by influencing the way the brain processes pain signals.
   • Topical Analgesics: Creams or patches containing medications like lidocaine may provide relief for localized neuropathic pain.
   • Opioid Medications: In some cases, opioids may be prescribed for severe neuropathic pain, although these are typically considered after other options have been explored due to the potential for dependence and side effects.
2. Nerve Blocks and Injections: These procedures involve the injection of anesthetics, steroids, or other medications to target the specific nerves causing the pain. Nerve blocks can provide temporary relief and may be repeated as needed.
3. Physical Therapy: Exercises, stretches, and techniques can help improve nerve function, mobility, and reduce pain. Physical therapists can tailor exercise programs to the individual’s needs.
4. Spinal Cord Stimulation: This involves the implantation of a device that delivers electrical signals to the spinal cord, interfering with pain signals. It’s typically considered when other treatments have not been effective.
5. Counseling and Psychological Support: Chronic pain can take a toll on mental health. Psychotherapy, cognitive-behavioral therapy (CBT), and relaxation techniques can help individuals manage the emotional and psychological aspects of living with neuropathic pain.
6. Complementary and Alternative Therapies: Some people find relief through complementary treatments such as acupuncture, biofeedback, and meditation. These therapies can be used in conjunction with other treatments.
7. Lifestyle Modifications: Lifestyle changes, including diet, exercise, and managing underlying conditions like diabetes, can play a role in managing neuropathic pain.
8. Surgical Procedures: In some cases, surgery may be considered, such as decompression or removal of structures pressing on nerves, or dorsal root ganglion stimulation.

Medicines Commonly Prescribed for Neuropathic Pain

include anti-seizure drugs such as:

• Gabapentin (Neurontin®).
• Pregabalin (Lyrica®).
• Topiramate (Topamax®).
• Carbamazepine (Tegretol®).
• Lamotrigine (Lamictal®).

Doctors also prescribe antidepressants such as

• Amitriptyline (Elavil®).
• Nortriptyline (Pamelor®).
• Venlafaxine (Effexor®).
• Duloxetine (Cymbalta®).

Opioid Medication Listing for Chronic Pain

Opioid medications are potent pain relievers that are sometimes prescribed for the management of chronic pain. It’s important to note that opioids should only be used under the careful supervision of a healthcare provider, as they carry the risk of tolerance, dependence, and addiction. Opioid medications are typically reserved for cases of severe or debilitating pain that has not responded to other treatments. Here is a list of some common opioid medications that may be prescribed for chronic pain:

1. Morphine: Morphine is one of the oldest and most effective opioids for pain relief. It’s often used to manage severe pain, such as pain related to cancer or post-surgical recovery.
2. Oxycodone: Oxycodone is a powerful opioid available in both immediate-release and extended-release forms. It’s commonly used for chronic pain conditions.
3. Hydrocodone: Hydrocodone is often combined with acetaminophen or ibuprofen in medications like Vicodin or Norco. It’s used for moderate to severe pain.
4. Codeine: Codeine is a less potent opioid often combined with other medications, such as acetaminophen, in pain relievers.
5. Fentanyl: Fentanyl is a potent synthetic opioid available in various forms, including patches, lozenges, and injections. It’s typically reserved for severe, chronic pain, and cancer-related pain.
6. Tramadol: Tramadol is a synthetic opioid used for moderate to moderately severe pain. It also has properties that affect serotonin and norepinephrine reuptake.
7. Methadone: Methadone is a long-acting opioid that is used not only for pain management but also for the treatment of opioid addiction.
8. Buprenorphine: Buprenorphine is another opioid medication used for pain management. It has a unique profile, including partial agonist activity and antagonist properties, which can make it a safer option in some cases.
9. Oxymorphone: Oxymorphone is a potent opioid medication used for moderate to severe pain.
10. Hydromorphone: Hydromorphone is a powerful opioid medication used for severe pain. It’s often available in immediate-release and extended-release forms.

It’s important to emphasize that the use of opioid medications should be closely monitored by a healthcare provider, and they should be taken as prescribed.

How to Prevent Neuropathic Pain ?

Preventing neuropathic pain is not always possible, especially when it is caused by medical conditions or injuries that are beyond an individual’s control. However, there are steps you can take to reduce the risk of developing neuropathy or manage its progression. Here are some preventive measures:

1. Control Underlying Medical Conditions:
   • If you have diabetes, manage your blood sugar levels carefully through diet, exercise, and medication as prescribed by your healthcare provider.
   • Follow your healthcare provider’s recommendations for managing conditions such as high blood pressure, high cholesterol, and autoimmune diseases that can contribute to nerve damage.
2. Maintain a Healthy Lifestyle:
   • Eat a balanced diet that includes a variety of nutrients, especially B vitamins, which are important for nerve health.
   • Engage in regular physical activity to promote circulation and overall health.
   • Avoid excessive alcohol consumption, which can lead to alcoholic neuropathy.
   • Quit smoking, as it can impede blood flow and contribute to nerve damage.
3. Be Cautious with Medications:
   • Use medications as prescribed, and be aware of any potential side effects, especially those related to nerve damage.
   • Discuss medication side effects with your healthcare provider, and report any unusual symptoms promptly.
4. Manage Infections and Injuries:
   • Promptly treat infections, particularly those that can affect the nerves, such as shingles (herpes zoster).
   • Take precautions to prevent injuries that could result in nerve damage.
5. Avoid Toxins and Chemicals:
   • Be cautious when working with chemicals or toxins that may harm nerves. Follow safety guidelines and use appropriate protective measures.
6. Vaccination:
   • Get vaccinated to protect against preventable diseases that can lead to neuropathy. For example, vaccines for hepatitis and shingles can reduce the risk of neuropathic pain.
7. Regular Health Check-ups:
   • Attend regular medical check-ups to monitor your health and detect any underlying conditions or complications early.
8. Foot Care: If you have diabetes, take special care of your feet to prevent diabetic neuropathy and foot ulcers. Regularly inspect your feet, keep them clean and dry, and wear comfortable, well-fitting shoes.

It’s important to remember that neuropathic pain can still occur despite taking preventive measures, especially in cases where it is related to conditions like diabetes, autoimmune diseases, or genetic factors.

What Strategies Can Help With Nerve Pain?

Nerve pain, also known as neuropathic pain, can be challenging to manage, but there are several strategies and treatments that can help alleviate or reduce its severity. It’s important to note that the most effective approach may vary from person to person, and consulting a healthcare professional is crucial for proper diagnosis and treatment. Here are some strategies that can help with nerve pain:

Certainly! Here are more than 20 strategies for managing nerve pain in detail:

1. Prescription Medications:
   • Antidepressants: Tricyclic antidepressants (e.g., amitriptyline) and serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine) can help manage nerve pain.
   • Anticonvulsants: Medications like gabapentin and pregabalin are often used to alleviate neuropathic pain.
2. Over-the-Counter Pain Relievers:
   • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can offer mild pain relief for some individuals.
3. Opioid Medications:
   • Opioids are prescribed for severe nerve pain when other treatments are ineffective. They are typically used as a last resort due to the risk of addiction and side effects.
4. Topical Treatments:
   • Capsaicin Cream: Available over the counter, capsaicin cream can reduce pain by desensitizing nerves in the affected area.
   • Lidocaine Patches or Creams: These products provide localized numbing effects, which can alleviate pain.
5. Physical Therapy:
   • A physical therapist can design an exercise program to improve strength, flexibility, and posture, which can help manage nerve pain.
6. Nerve Blocks:
   • Injections of local anesthetics or steroids can block pain signals in specific nerves, providing temporary relief.
7. Transcutaneous Electrical Nerve Stimulation (TENS):
   • TENS devices deliver low-level electrical impulses to the skin over the painful area, interfering with nerve signals and reducing pain.
8. Acupuncture:
   • Acupuncture involves inserting thin needles into specific points on the body, which some individuals find effective in managing nerve pain.
9. Biofeedback:
   • Biofeedback therapy can teach individuals to control bodily functions, including pain perception, through mental techniques and relaxation exercises.
10. Lifestyle Modifications:
    • Managing Underlying Conditions: Treating the root cause of nerve pain, such as diabetes, can significantly improve symptoms.
    • Diet and Nutrition: Maintaining a healthy diet and managing blood sugar levels is particularly important for people with diabetic neuropathy.
    • Stress Management: Stress can exacerbate nerve pain. Relaxation techniques like meditation and deep breathing exercises can be helpful.
11. Alternative Therapies:
    • Herbal Remedies and Supplements: Some people find relief from nerve pain using supplements like alpha-lipoic acid or herbs like St. John’s Wort, but consult a healthcare provider before using them.
    • Medical Cannabis or CBD Products: These are used by some individuals for pain relief, but their efficacy can vary, and their legal status may vary by location.
12. Support Groups and Counseling:
    • Living with chronic pain can be emotionally challenging. Joining a support group or seeking counseling can help individuals cope with the emotional and psychological aspects of nerve pain.
13. Nutritional Therapy:
    • Proper nutrition can support nerve health. Ensure you get adequate B vitamins, especially B12 and folate, which are crucial for nerve function.
14. Hydrotherapy:
    • Soaking in warm water can relax muscles and relieve nerve pain. Hot or cold compresses applied to the affected area may also help.
15. Massage Therapy:
    • Therapeutic massage can reduce muscle tension, improve circulation, and alleviate nerve pain in some cases.
16. Occupational Therapy:
    • Occupational therapists can help individuals adapt to daily activities, making them more manageable despite nerve pain.
17. Mental Health Counseling:
    • Addressing anxiety, depression, and stress through counseling or therapy can indirectly improve the perception and management of nerve pain.
18. Herbal Teas:
    • Some herbal teas, such as chamomile and valerian root, have mild sedative effects that may help with pain management and sleep.
19. Mind-Body Techniques:
    • Practices like yoga, tai chi, and mindfulness meditation can promote relaxation, reduce stress, and improve overall well-being, which may help with nerve pain.
20. Acupressure:
    • Similar to acupuncture, acupressure stimulates specific points on the body, but it uses pressure instead of needles. Some individuals find it helpful for pain relief.
21. Electromagnetic Field Therapy:
    • Electromagnetic field therapy devices are designed to promote tissue healing and pain relief by stimulating electrical activity in cells. Consult a healthcare professional before using such devices.
22. Intravenous Immunoglobulin (IVIg) Therapy:
    • In certain autoimmune-related neuropathies, IVIg therapy may be considered to modulate the immune response and reduce nerve pain.
23. Nerve Decompression Surgery:
    • For certain compressive neuropathies, such as carpal tunnel syndrome, surgical procedures may be necessary to alleviate nerve pressure.
24. Radiofrequency Ablation (RFA):
    • RFA is a minimally invasive procedure that uses radiofrequency waves to disrupt nerve signals, providing relief from chronic pain.
25. Spinal Cord Stimulation (SCS):
    • SCS involves implanting a device that sends electrical signals to the spinal cord to interfere with pain signals, offering relief for some types of nerve pain.

Non-medicine Treatments for Nerve Pain ?

Non-medicine treatments for nerve pain, also known as neuropathic pain, can be effective in managing or alleviating symptoms. These approaches often focus on addressing the underlying causes of nerve pain and improving overall nerve health. Here are some non-medicine treatments for nerve pain:

1. Physical Therapy:
   • A physical therapist can develop a tailored exercise program to improve strength, flexibility, and posture, which can reduce nerve pain and enhance overall mobility.
2. Occupational Therapy:
   • Occupational therapists can help individuals adapt their daily routines and tasks to reduce strain on affected nerves and minimize pain.
3. Transcutaneous Electrical Nerve Stimulation (TENS):
   • TENS devices deliver low-level electrical impulses to the skin over the painful area, interfering with nerve signals and providing pain relief.
4. Acupuncture:
   • Acupuncture involves inserting fine needles into specific points on the body to stimulate natural pain-relieving mechanisms and improve nerve function.
5. Biofeedback:
   • Biofeedback therapy can teach individuals to control bodily functions, including pain perception, through mental techniques and relaxation exercises.
6. Heat and Cold Therapy:
   • Applying heat (e.g., warm compresses) or cold (e.g., ice packs) to the affected area can help reduce pain and inflammation.
7. Hydrotherapy:
   • Soaking in warm water, such as a hot bath, can relax muscles, improve circulation, and relieve nerve pain.
8. Massage Therapy:
   • Therapeutic massage can reduce muscle tension, improve circulation, and alleviate nerve pain in some cases.
9. Yoga and Tai Chi:
   • These mind-body practices can improve flexibility, balance, and posture while promoting relaxation and stress reduction, which may help with nerve pain.
10. Meditation and Mindfulness:
    • Mindfulness meditation techniques can help individuals manage pain and reduce stress, which can indirectly alleviate nerve pain.
11. Physical Exercise:
    • Regular physical activity, such as walking or swimming, can improve blood flow, enhance overall health, and reduce pain.
12. Diet and Nutrition:
    • A balanced diet rich in antioxidants, vitamins, and minerals can support nerve health. Foods containing B vitamins, magnesium, and omega-3 fatty acids may be particularly beneficial.
13. Weight Management:
    • Maintaining a healthy weight can alleviate pressure on nerves and reduce the risk of conditions like diabetic neuropathy.
14. Nerve Flossing and Gliding Exercises:
    • These exercises involve gentle stretching of the affected nerves to improve their mobility and reduce compression.
15. Cognitive Behavioral Therapy (CBT):
    • CBT can help individuals manage the emotional and psychological aspects of living with chronic pain, which often accompanies nerve pain.
16. Herbal Remedies and Supplements:
    • Some people find relief through supplements like alpha-lipoic acid, acetyl-L-carnitine, or herbs like St. John’s Wort. However, consult with a healthcare provider before using them.
17. Compression Garments:
    • In cases of peripheral neuropathy, compression stockings or gloves may help improve blood flow and reduce symptoms.
18. Magnesium Supplements:
    • Magnesium can help relax muscles and regulate nerve function. Consult a healthcare professional before taking supplements.
19. Neurofeedback:
    • This technique uses real-time monitoring of brain activity to help individuals gain better control over pain perception and management.
20. Art and Music Therapy:
    • Engaging in creative activities can provide a distraction from pain and promote emotional well-being.
21. Chiropractic Care:
    • Some individuals with nerve pain find relief through chiropractic adjustments, which can help improve spinal alignment and reduce pressure on nerves.
22. Bee Venom Therapy:
    • Some alternative therapies, like bee venom therapy, are claimed to help with nerve pain. However, their efficacy and safety can vary, and they should be used with caution and under professional guidance.

Remember that the effectiveness of these treatments can vary depending on the underlying cause of your nerve pain and your individual response.