Neuropathy and Neuritis are conditions that affect nerves. Neuropathy means a pathological change or functional disturbance of the nervous system. When the sensory system is impacted by injury or disease, the nerves within that system cannot transmit sensation to the brain. This often leads to a sense of numbness, or lack of sensation. However, in some cases when this system is injured, pain results in the affected region. Neuropathic pain does not start abruptly or resolve quickly. It is a chronic condition which leads to persistent pain symptoms. For some, the intensity of symptoms can be intermittent. Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain that occurs when someone experiences an acute injury, such as smashing a finger with a hammer or stubbing a toe when walking barefoot. This type of pain is typically short-lived and usually responsive to common pain medications, in contrast to neuropathic pain.
Although neuropathic pain is thought to be associated with peripheral extremity nerve problems, such as neuropathy caused by diabetes or spinal stenosis, injuries to the brain (encephalopathy), or spinal cord (myelopathy), can also lead to chronic neuropathic pain due to nerve fibers that become dysfunctional or lose function. This can cause a painful, burning pain due to a loss of function that progresses if the underlying process is not controlled. Other possible causes of neuropathic pain are:
- trauma (such as a herniated disc impacting a nerve)
- ischemic event when the nerve dies
- alcohol
- vitamin deficiencies
- autoimmune diseases
- cancer
- thyroid disease
- stroke
- poisons
Neuritis is inflammation of one or more nerves. Neuritis can be caused by injury, infection, or autoimmune diseases. The characteristic symptoms include pain and tenderness, impaired sensation, often with numbness or hypersensitivity, impaired strength and reflexes, abnormal circulation, and decreased ability to sweat in the distribution of the inflamed nerve or nerves. Although the term neuritis is sometimes used interchangeably with neuropathy, the latter is an often painful condition that is associated generally with nerve damage, dysfunction, or degeneration, rather than with inflammation alone. In some instances neuritis can progress to neuropathy. Symptoms depend on the nerves involved but may include pain, parethesias (pins-and-needles), paresis (weakness), hypoesthesia (numbness), anesthesia, paralysis, wasting, and disappearance of reflexes.
Remember that toothache you had? The memory of that deep, throbbing, aching pain is seared into everyone’s soul. Who among us doesn’t cringe at the very thought? Such pain occurs when the pulp inside the tooth, which holds the nerve endings, is inflamed due to trauma or infection. No one who has felt this type of pain will ever forget it, or the escalation when the root itself becomes inflamed, requiring a root canal.
Just thinking about it triggers nightmarish memories. Now think of that type of pain when a nerve is impacted by a disc, spur, stenosis, post herpetic neuralgia, or diabetes. It’s a bone-deep aching, sharp, throbbing, burning (as though on fire), intense pain exacerbated with any normal movement that stretches and further inflames the nerve. When asked what it feels like I try to tell people to imagine a horrible nonstop, throbbing toothache. Or a lancinating, knife-like pain that shoots down the arm or leg with movement. Now, think about having to live with that forever.
At times, filling a cavity, a root canal, or surgical repair of a lumbar disc can remove the inciting event and make a remarkable difference. But, for most of us there’s a residual pain that never goes away,- like a constant water drip that eventually erodes everything in its path.
The pain permeates everything we feel and do. It can’t be denied or ignored. Only when it’s honored, can the true extent of the impact be understood. When family and friends, as well as healthcare providers, appreciate that chronic pain influences every aspect of life can they begin to truly help those affected.
That’s why I write these blogs. To share with others who suffer as I do. To educate, explore, and discuss the incredible options available today. Pain can be managed. But you are the key factor in any comprehensive program you choose.
-Dr. Courtney