Burning toes, stinging fingers, shooting electric shocks up the leg nerve pain can cause agony to those suffering from the effects. And pinpointing the source isn’t always easy. It can have a number of causes. So we begin with documentation, but then what? How do we decode that information and how to move forward from there?
Nerve pain can manifest in a number of ways, but most people describe the sensations as causing burning, stabbing or electric shock-like sensations. These pains can occur when damage to either the central or peripheral nervous system causes a misinterpretation of signals in the brain or spinal cord. So it helps to start with finding clarity on what if being experienced, when, and under what conditions.
Being clear about the location and type of pain you’re experiencing could help determine its source. Diabetes is a common culprit. Other potential causes of nerve pain include stroke, compression in the spinal column, multiple sclerosis, Parkinson’s disease, and some infections. Chemotherapy, certain tumors, chronic alcoholism and toxin exposure are also common triggers. So you can see that it's not always that easy to pin down the cause. But it's important to seek care rather than relying on pain relievers all the time. Pain relievers aren't without risk and many nerve pain causes can be serious and progressive, so it's best to seek treatment.
A good way to get a more comprehensive picture of the pain is to document it in a journal. Is it constant, or are there times that are completely or relatively pain-free? Does it only hurt, or perhaps worsen, during walking, bending, sitting or laying down? Is the pain worse at night? Does it come on slowly or is it a sudden, shocking feeling? Does it come along with numbness or any other strange sensations? Is it always in the same spot, or does it radiate to the point where you can’t determine one specific source? The more information you can give your doctor, the faster they might be able to figure out what’s going on.
So start a journal and make columns. On one side put the date, then add a column for a time, and one for the name and type of the sensation, one for location on the body, and one for the duration, then one for context or circumstances. It may also help to record diet in a separate sheet in order to compare how diet and exercise may impact this pain as well. The good news is that the most popular spreadsheet programs also have phone apps so using a spreadsheet is easier than ever.
To diagnose nerve pain is a process of elimination. While it might be amazing to have them look at the pain and say definitively what's going on in one visit, that's not really how it's likely to go. A healthcare provider may want to run a few blood tests to rule out some common causes like high blood sugar, autoimmune diseases and low B12 levels. If multiple sclerosis is suspected, an MRI might be ordered to search for evidence of brain lesions, and a skin biopsy might be ordered to look for actual damage to the nerves. A doctor might also order tests to look for HIV and Lyme disease or other diseases. And in some cases, a physician may order a "nerve test" performed which will measure the performance of the nerves themselves—more on that below. A physical exam, including assessments on coordination, reflexes, and responses to various stimuli, may be helpful as well.
Doctors may be able to pinpoint the pain using tests to gauge how well the nerves are functioning. Electromyography (EMG) tests the conductivity of your nerves by comparing the electrical activity during different types of muscle movements and while at rest. Doctors must insert multiple electrodes into the muscle for this test, so it may be uncomfortable and might leave patients with a bit of temporary muscle soreness.
Another option is a nerve conduction study (NCS), which may be used alone or alongside an EMG. This test also uses electrodes, but the electrodes are attached to the skin via a sticky paste, and instead of just taking readings, this device also emits brief electric shocks. Together, the tests may be able to determine not only the location of any nerve damage but also the extent.
Nerve pain can be disruptive and disabling, and different underlying issues require different treatments—so most physicians begin with a process of elimination to help them hone in on exactly what's going on. Some causes can be progressive, and therefore treatment should be begun swiftly, but many causes are directly treatable, so don't give up hope. Relief is available—it just may take some sleuthing to figure out the best course. If nerve pain has been attacking your wellbeing, please know that there is hope and speak to professional right away. You don't have to just live with the pain.
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