Nerve pain (called neuropathic pain), is one of the more difficult and uncomfortable types of pain. Whether the pain comes from diabetes, shingles, fibromyalgia, chemotherapy, or a host of other causes, this searing, burning, electric shock kind of pain can leave you miserable. Unfortunately, most physicians are still not trained in treating nerve pain, and give anti-inflammatory medications like Motrin (which are not effective and kill over 16,500 Americans unnecessarily each year) or narcotics, which are modestly effective.
The good news is that nerve pain is very treatable. Many studies have shown that using nutritional support with lipoic acid 300 mg 2x day, Acetyl-L-Carnitine 2,000 mg a day, Inositol (500-1,000 mg a day), and vitamins B6 (50-100 mg a day) and B12 (500-5,000 mcg a day—both B vitamins and Inositol are in the Energy Revitalization System vitamin powder) can actually help heal the nerves and decrease or eliminate the pain. Nerves take time to heal, so natural remedies need to be taken for 3-12 months. In the interim, holistic pharmacies can make powerful creams combining multiple medications effective against nerve pain (available by prescription from ITC Pharmacy at 303-663-4224; called the nerve pain gel). These are rubbed over the painful areas, and can be very effective after 1-2 weeks of use. Being rubbed on the skin though, the total dose to the rest of your body is very low, making it largely side effect free! Other medications can also be very effective.
Just because doctors are not trained in pain management does not mean you have to be in pain. Want to make your nerve pain go away? You can!
What is Nerve Pain?
The term "neuropathic pain," or nerve pain, refers to a wide range of problems that cause diseases of, or injury to, the nervous system. It is a category of pain syndromes and not a single problem. Neuropathic pain can come from malfunction of nerves or the brain associated with illness (e.g., diabetes, low thyroid, etc.), infections (e.g., shingles), pinched nerves, nutritional deficiencies (e.g., vitamin B6 and B12), injury (e.g., stroke, tumors, spinal cord injury, and multiple sclerosis), and medication/treatment side effects (e.g., radiation and chemotherapy, AIDS drugs, Flagyl®). It is estimated that 50-80% of diabetics will develop some nerve injury with 30-40% of these having painful diabetic neuropathy unless preventive measures are taken such as nutritional support. Neuropathic pain affects approximately 0.6-1.5% of the U.S. population and 25-40% of cancer patients. This represents over two million Americans.
Neuropathies are characterized by pain that is burning, shooting (often to distant areas), or stabbing. It also has an "electric" quality about it. Tingling or numbness (paresthesias) and increased sensitivity with normal touch being painful (allodynia) are also commonly seen. Ongoing pain is often continually present regardless of what the patient does or does not do. In some cases, pain comes in sudden attacks without any apparent trigger. Diagnosis is made predominantly by history and physical examination, as testing often offers little benefit clinically unless the testing is looking for a treatable cause.
As with other pain problems, neuropathies are both expensive and poorly treated.
In the presence of nerve pain, it is especially important to look for treatable causes. Lab testing should include:
- A blood count (CBC) and an inflammation/sedimentation rate (ESR).
- Thyroid testing with a Free T4 and TSH.
- Vitamin B12 level.
- Screening for diabetes with a morning fasting blood sugar and a glycosylated hemoglobin (HgBA1C).
The medical history should be assessed for excess alcohol use, vitamin deficiencies, hereditary factors, or treatment with medications that can cause nerve injury. A neurological examination may also give an indication of the cause.
Nerve pain is often associated with a process called "pain central sensitization." The nerves and brain are like wires that carry information. When they become over-stimulated with chronic pain, it may make the whole system over-excitable. In these situations normal touch and other usually comfortable contact can be painful. This is called allodynia. Medications that stimulate the "calming (GABA) receptors" in the brain, such as a number of anti-seizure medications (see below), can help settle the system and further decreases pain.
Let’s begin with the most common kinds of nerve pain, and how to treat them.
Postherpetic Neuralgia (PHN)
Postherpetic Neuralgia follows a rash called herpes zoster. Often called shingles, it is caused by the same virus that causes chickenpox. The first time you get chickenpox, the virus remains in your nerve endings even after the chickenpox is gone. This usually causes no problems. If the virus re-activates in one of the nerve endings, however, it causes a rash all along the distribution of the nerve. The rash of herpes zoster is characterized by being painful and being in a line totally on one side of the body. If it extends past the midline of your body, the rash is probably coming from something else. If the pain persists after the rash is gone, continuing for weeks to years (over one year in half of elderly patients), it is called "Postherpetic Neuralgia (PHN)." The pain tends to be burning, electric, or deep and aching. PHN affects between 500,000 and 1 million Americans—most of whom are elderly. It can severely disrupt one's life, but fortunately can now be effectively treated in most cases.
Painful Diabetic Neuropathy (PDN)
This is the most common cause of neuropathy in the U.S. Alterations in sensation are common, and the feet, which are most often affected, may feel both numb and painful at the same time. There are many factors contributing to nerve injury in diabetes, including decreased circulation, accumulation of toxic byproducts, damage from elevated sugars, and nutritional deficiencies. There are also changes in NMDA and opiate receptors.
Research has shown that many people who are labeled as having diabetic neuropathy actually experience neuropathic pain caused by vitamin B6 or B12 deficiency. In addition, the nutrients inositol has been shown to improve nerve function. The nutrients lipoic acid (see Lipoic Acid for Diabetic Neuropathy) and Acetyl-L-Carnitine (see Acetyl-L-Carnitine Helps Diabetic Neuropathy) have also been shown to be very helpful for diabetic and other nerve pains, but it can take 3-12 months to begin nerve healing. So give them time to work.
Nutritional Deficiencies
Neuropathic pain can also be caused by deficiencies of vitamins B12, B1, B6, D, E and zinc (all are present in the Energy Revitalization System). A number of studies have shown that different kinds of nerve pain can improve by supplementation with high dose B vitamins. Excess vitamin B6 (over 500 mg a day for years), however, can also cause neuropathy. Vitamin D 2,000 units a day was also shown to decrease diabetic neuropathy pain by 47% after 3 months.
In patients with long-standing shingles pain, one study showed that taking 1,600 units of vitamin E (use the natural form) daily before a meal for 6 months was markedly helpful in eliminating the pain. Another study showed that taking lower doses for less than 6 months was not effective.
Hormonal Deficiencies
Hormonal deficiencies, especially an under-active thyroid, can also cause neuropathic as well as muscular pain. A therapeutic trial of thyroid hormone is reasonable for anybody who has the symptoms of low thyroid including fatigue, cold intolerance, achiness, having low body temperatures, or unexplained inappropriate weight gain.
Nerve Entrapments
