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Intense pain: Docs describe nerve pain, or neuropathy

As medical conditions go, "neuropathy" might sound rather innocuous. Call it by its household name -- nerve pain -- and its true nature becomes more apparent. But only by asking sufferers to describe it can you get a full picture of the intense misery that nerve pain can cause.

Here's what you need to know about neuropathy:

1. NERVE PAIN HAS A DISTINCT SENSATION

Nerves are deeply connected to feelings of physical hurt because they transmit sensations of pain in the body. But nerve pain has sensations that make it different from many other kinds of pain.

"Nerve pain is commonly described as burning, lancinating, electrical or shocking," said Dr. Brian Durkin, an anesthesiologist and director of the Center for Pain Management at Stony Brook University Hospital.

It can also be described as tingling or shooting pain, said Dr. Ronald Kanner, chairman of neurology for the North Shore-LIJ Health System in New Hyde Park. "Most of us have experienced the tingling pain when an arm or leg 'falls asleep,' " he said. "That is actually due to nerve compression."

The sensation caused by pain isn't the only clue that someone may be suffering from a nerve-related problem. "Whenever there is a severe level of pain, no obvious injury to the skin and no reason for the pain, nerve pain should be considered" as a possible cause, said Dr. Lyn Weiss, professor of physical medicine and rehabilitation at Nassau University Medical Center in East Meadow.

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Dr. Bruce Mayerson, chief of neurology at St. Catherine of Siena Medical Center in Smithtown, said it's important to realize that nerves can malfunction yet still cause pain. "People ask, 'If the nerves aren't working, how come I'm feeling pain?'" he said. "They actually send out abnormal signals when they're diseased."

2. WHO TO SEE IF YOU SUSPECT NERVE PAIN

"Whenever you have pain that impacts your daily life, you should discuss this with your primary care physician," Durkin said. "If he or she can't help you, then a board-certified pain medicine specialist should be consulted."

People with diabetes, however, might want to consult their endocrinologist, who may provide a referral to another specialist such as a neurologist, Mayerson said.

3. CAUSES CAN BE ELUSIVE

Weiss said that pain develops when nerves cause feelings of sensation, even when they're not being stimulated by something like touch. Injury to nerves or to part of the body can cause nerve pain, she said, as can specific conditions such as diabetes and shingles.

Overall, about 50 percent of people with diabetes develop nerve pain, Mayerson said. Alcoholism is another cause of nerve pain, as are a shortage of certain vitamins in the body and the presence of abnormal proteins in the blood, he said.

In 30 percent to 40 percent of people with nerve pain, however, it's not clear what the cause is, Mayerson said, and it remains a mystery whether simple aging itself could be responsible for nerve pain.

4. PAINKILLERS AND OTHER MEDICATIONS CAN BE HELPFUL

Neurologists try to first tackle the cause of nerve pain, if one can be found. If that doesn't work, medications enter the picture.

"There are several categories of medicines that are used for nerve pain," Weiss said. "Some work by calming down very irritable nerves and making them less sensitive and less likely to fire abnormally. Another group of medicines that can be helpful for nerve pain are called serotonin-norepinephrine reuptake inhibitors. While these medications are frequently used as antidepressants, they have pain-relieving effects on their own and are used at a lower dose for pain relief than for depression."

In more severe cases, doctors may turn to powerful and potentially addictive opioid medications like codeine, Vicodin and Percocet. "Nowadays, most physicians try to minimize the use of these types of medications and limit their use to short-term, if possible," Weiss said.

Durkin noted that people with nerve pain should first try antidepressants and related anti-seizure medications, and only if they don't work or cause intolerable side effects should they move on to the opioid drugs.

5. MORE DRASTIC TREATMENTS ARE AVAILABLE

"At least two-thirds of patients get some relief with the medications we use," Mayerson said. "None are a cure-all, but they take the edge off the pain."

But, if painkillers and other drugs don't work, a few other options do exist, though there's debate over whether some of them actually work. These approaches include electrical stimulation of the spinal cord and surgery designed to relieve compression of nerves.

"In rare, severe cases, electrodes may be inserted around the spinal cord to block the nerve impulses," Weiss said. "Also, in rare cases, a pump can be implanted into the spinal cord and medication delivered into the spinal cord to directly block pain sensation."

She said, however, that such procedures "are generally considered when the pain cannot be adequately controlled with medications or other measures."

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