Neuropathic pain: what it feels like and what actually helps

Neuropathic pain isn’t the same as a strained muscle. It comes from damaged or misfiring nerves and often feels like burning, electric shocks, pins-and-needles, or sharp stabbing. That odd mix of numbness plus pain — and sensitivity to light touch — is a big clue that nerves, not muscles, are the problem.

Want the short list? Diabetes, shingles (postherpetic neuralgia), chemotherapy, spinal compression, and nerve injuries are common causes. Even surgery or alcohol-related nerve damage can lead to chronic nerve pain. Knowing the trigger helps pick the right treatment.

How doctors diagnose nerve pain

Your doctor will start with a focused history and exam: where the pain is, how it behaves, what makes it better or worse. Simple tests like the DN4 questionnaire or bedside sensory checks can point to neuropathic pain. Sometimes nerve conduction studies, EMG, or skin biopsy are used to confirm the diagnosis or rule out other issues.

Diagnosis matters because treatments that work for ordinary back or joint pain often don’t help nerve pain. Giving the wrong medicine wastes time and causes side effects.

Real-world treatments that help

First-line medicines for neuropathic pain include gabapentin or pregabalin (they calm overactive nerves) and certain antidepressants — duloxetine or tricyclics like nortriptyline — which change how your brain processes pain. Topical options such as lidocaine patches or high-concentration capsaicin can work well for localized pain and avoid many systemic side effects.

Opioids are not the go-to choice because they give limited long-term benefit and carry big risks. For stubborn cases, nerve blocks, spinal cord stimulation, or referral to a pain clinic may be needed.

Don’t ignore non-drug tools. Gentle, regular exercise, physical therapy, pacing activities, good sleep, and cognitive behavioral therapy all reduce pain and improve function. For diabetic neuropathy, strict blood sugar control and foot care lower risks and slow progression.

Simple daily tips: wear loose clothes over sensitive areas, use a lidocaine patch for focal burning, try warm baths for stiffness (avoid extreme heat if sensation is reduced), and avoid alcohol which can worsen nerve damage. Start medicines at a low dose and increase slowly — fewer side effects that way.

When to call your doctor: sudden weakness, loss of bladder or bowel control, rapidly spreading numbness, or fever with pain. Also seek help if pain stops you from working, sleeping, or doing daily tasks — there are options to improve quality of life.

Neuropathic pain can be tough, but the right mix of treatments and everyday habits often brings meaningful relief. If you’ve been told your pain is "all in your head," get a second opinion — nerve pain has real causes and real treatments that work.