NERVE PAIN
PAIN IS AN ESSENTIAL PART OF LIFE. It provides crucial information about your environment that helps you avoid injury. If you touch something hot or sharp, pain gives you the immediate feedback you need to pull your hand away before damage can occur. Similarly, if you're pulling or twisting a joint or muscle beyond its capacity, pain tells you it's time to stop. And if an artery to your heart becomes clogged, intense chest pain tells you an emergency situation is occurring, one that requires swift action.
Sometimes,
however, a nerve or group of nerves that has already been injured continues
to send pain signals to the brain. Although removing the cause of the pain
might still be important - and you may in fact be in the process of doing
so - in this situation the pain itself becomes a problem.
Several medical terms are used to describe this condition, depending on the
cause and location of the pain. Neuralgia, neuropathic pain, peripheral neuropathy
and peripheral neuritis all refer to types of nerve pain. In addition, sciatica
describes leg pain; lumbago, lower back pain; and trigeminal neuralgia, facial
pain.
The cause of the original nerve damage can be any number of events. Nerves can be severed or crushed by blunt trauma, burns, lacerations or amputations, including surgical ones such as mastectomy. Nerves can be pinched from inside the body by a slipped disc, a vertebra that is out of alignment, a muscle in spasm or a cancerous growth.
Heavy metals such as mercury or lead can kill nerves. Alcoholism leads to nerve damage, as do persistent elevations in blood sugar from diabetes. Certain medications, such as those used to treat cancer or AIDS, can destroy nerves as well. When no explanation for the pain can be found, doctors refer to it as idiopathic peripheral neuropathy.
Although painkillers (analgesics) may work quite well for shortterm aches and pains, they tend to fall short of managing long-term nerve pain. That's because the effects of most painkillers tend to wear off over time. Long-term use of narcotics can create other problems: drug addiction and dependency.
There's another reason neuropathic pain resists conventional painkillers. Research has shown that an actual 'rewiring' of the brain occurs with long-term pain that causes nerve impulses to repeatedly travel back and forth in a loop. It's as if your house were hit by a lightning bolt and the circuit breaker failed to shut off, scrambling all your sensitive electronic devices.
When you are 'hit' by long periods of pain, the brain somehow starts expecting
the nerves to send pain messages. You are then dealing with the electrical
signals emitted by the damaged nerve plus the brain's heightened awareness
of those signals. You become hypersensitive to normal sensations such as
light touch, vibration and slight temperature changes, making it difficult
to tell which sensations are reactions to environmental stimuli and which
are the result of this rewiring.
With nerve pain, it's important to seek a thorough medical evaluation to
rule out any treatable cause of the pain.
DRUG TREATMENT
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Aspirin, ibuprofen, naproxen (Naprosyn, Nycopren, Synflex), ketoprofen (Orudis),
indometacin (Imbrilon, Indocid, Indomax, Rimacid), sulindac (Clinoril), others.
Function: decrease production of pain-causing chemicals. Side effects: gastrointestinal
bleeding, fluid retention, kidney damage, liver damage, allergic reactions.
Other Analgesics
Paracetamol. Function: blocks production of pain-causing chemicals.
Side effects: liver damage, allergic reactions.
Narcotics
Codeine, codeine and paracetamol (Kapake, Solpadol, Tylex), oxycodone, morphine,
hydromorphone hydrochloride (Palladone), pentazocine (Fortral). Function:
bind to receptors in the brain that control pain, turning them off. Side
effects: dependency and addiction, impaired breathing (excessive doses
can stop breathing), nausea, constipation.
Tricyclic
Antidepressants
Amitriptyline (Domical, Elavil, Lentizol, Tryptizol), nortriptyline (Allegron),
doxepin (Sinequan). Function: modify the processing of pain signals in the
brain to decrease hypersensitivity to them. Side effects: dry mouth, constipation,
lethargy, heart problems.
Anticonvulsants
Phenytoin (Epanutin), carbamazepine (Tegretol), gabapentin (Neurontin), clonazepam
(Rivotril). Function: stabilise nerve cell membranes to prevent abnormal
electrical discharges (seizure-like activity). Side effects: lethargy, mental
grogginess, reduced white blood cell count, liver damage.
HERBAL REMEDIES
Cayenne (Capsicum annuum)
Capsaicin, an extract from cayenne and other peppers, can dramatically reduce
long-term nerve pain. Studies have proven its usefulness for arthritis, shingles,
trigeminal neuralgia and diabetic neuropathy. It appears to act by decreasing
the concentration of substance P, the primary chemical used by nerve cells
to transmit pain signals. This effect can require several weeks of regular
use. Unlike regular painkillers, however, capsaicin does not produce a tolerance
in the user. Several commercial capsaicin creams are available, usually in
concentrations of 0.025 per cent to 0.075 per cent. For maximum effectiveness,
such creams should be applied four to six times daily.
Caution: as one might expect from a pepper extract, cayenne creams can cause
an intense burning sensation, especially in people with hypersensitive nerves.
Burning does not mean that further injury is occurring, but it can take some
getting used to. It is best to start with very small amounts of the lowest
concentration cream and gradually build up to the higher strength. Some doctors
recommend first applying lignocaine cream (a prescription topical anaesthetic)
and then applying the capsaicin product once the skin is numb. Continue until
you can tolerate the capsaicin by itself.
St John's Wort (Hypericum perforatum)
Years before this herb became scientifically accepted as a depression remedy,
it was a folk medicine used for many purposes, including wound healing and
fighting off infections. Although St John's wort is not an analgesic, it
has a calming effect on the nervous system, which helps decrease the sensation
of pain. It also helps reduce the muscle tension and spasms that often accompany
nerve pain. Typical dosage: 900 to 1,200 milligrams of standardised extract
per day. Caution: may increase skin reactions to sun exposure, especially
in high doses. If you decide to try St John's wort, monitor your sun exposure
and use sunscreen, especially if you are prone to sunburn. Do not use if
you are taking a prescribed antidepressant or l.-dopa.
Corydalis (Corydalis
yanhusuo)
This tuber is a Chinese herb with potent pain-relieving properties. It is
traditionally used for neuralgia, menstrual cramps and gastrointestinal spasms.
Corydalis appears to act like codeine and other drugs in the opium family,
modifying the perception of pain by specific centres in the brain. It also
has anti-anxiety and sedative effects. Corydalis is usually prescribed by
practitioners of traditional Chinese medicine as part of a multi-herb formula
based on the patient's overall condition. Typical dosage when taken as a
single herb: % teaspoon of powdered herb two or three times daily. Caution:
may produce fatigue, constipation and occasional hcadachc.
Jamaican Dogwood
(Piscidia piscipula)
This tree grows wild in Central America and the northern parts of South America.
The bark of its root works similarly to aspirin pain relievers by blocking
an enzyme that produces inflammatory and paincausing chemicals called
prostaglandins. It also has mild sedative and anxiety-relieving properties.
Typical dosage: one or two 500-milligram capsules of powdered extract every
four to six hours as needed.
OTHER WAYS TO STOP THE PAIN
Here are a few additional healing strategies to try for nerve pain.
Acupuncture. This ancient Oriental healing art has now been accepted by many
organisations and doctors as a legitimate therapy for pain. It can sometimes
work very well for nerve pain, especially when accompanied by electrical stimulation.
Physical therapy. These treatments, including rehabilitative exercise, deep heat,
ultrasound, cold packs and manipulation or massage, can also be very helpful
for nerve pain.
Stress-management techniques. Meditation, yoga, biofeedback and other stress-management
techniques can be a central part of your approach to treating long-term pain.
Because of the role the brain plays in expecting nerve pain, it may be possible
to `rewire' your mental circuits to stop the cycle of pain or at least diminish
its effects. Your doctor might be able to refer you to classes in any of these
techniques, or you might find them advertised locally.
