Nerve pain is caused by damage or injury to the nerves that send messages to the brain to signal pain. Nerve injury can result from medical conditions such as shingles, diabetes, stroke and HIV.

Nerve pain is different from the pain we feel when we cut or burn ourselves (called nociceptive pain). That type of pain is usually a sharp feeling or a dull ache that goes away when the tissue is healed.

Nerve pain is often described as shooting, stabbing or burning sensations. Skin can become numb to light touch or warm objects. Sometimes, things that are not usually painful can cause pain (eg, contact with bedsheets).

Nerve pain can affect your sleep, mood and daily activities. It is important that nerve pain is diagnosed accurately by your GP. After that, you can decide together on how best to manage your condition. 

You need a GP to diagnose nerve pain. It cannot be diagnosed by a blood test, X-ray or MRI. A nerve pain diagnosis relies on the clinical judgment of your GP.

Your GP will determine whether your pain is nerve pain by:

• asking you questions about your pain
  
• physically examining your body.
  

The doctor may touch your skin with a brush or cotton wool, prick your skin with a toothpick or press a cold tube against your skin. It is important to remember that even though you are experiencing a particular type of pain, it may not be nerve pain.

After a diagnosis of nerve pain, your GP will discuss the different ways you can manage your symptoms. During these discussions, you and your GP will develop a self-management plan to meet your needs and specific goals. Over time, your needs or circumstances may change, so remember to check in with your GP on a regular basis.

Nerve pain can be difficult to treat so make sure your expectations of your treatment are realistic. Understanding how your condition is managed, and that your pain may not disappear completely, will help you to set realistic expectations around:

• making the pain ‘tolerable’
  
• improving or restoring your quality of life and functioning
  
• improving your sleep
  
• helping with depression
  
• restoring your ability to undertake social activities and work.

Medicines play a limited role in managing nerve pain but your GP may prescribe a medicine to help reduce your symptoms. Having fewer or reduced symptoms can help improve your sleep or mood and let you manage your day-to-day activities more easily. 

Because nerve pain is different from other types of pain, simple pain killers (such as paracetamol) and medicines used for inflammatory pain (such as ibuprofen) have very little effect. 

Nerve pain is treated with prescription medicines that can also be used to treat other conditions such as depression and epilepsy. The medicines most commonly prescribed for nerve pain are:

• tricyclic antidepressant (TCA) medicines (active ingredient: amitriptyline or nortriptyline)
  
• antiepileptic medicines (active ingredient: gabapentin or pregabalin)
  
• serotonin–noradrenaline reuptake inhibitors (SNRIs) (active ingredient: duloxetine or venlafaxine).
  

For more information, see:

• Amitriptyline for nerve pain
  
• Pregabalin for nerve pain

Medicines are used to reduce nerve pain to a level that allows people to resume their daily activities. They are a small piece of the puzzle when managing nerve pain but can be an important part of helping people to get back on track. 

However, less than half of patients with nerve pain achieve adequate pain relief with medicines. Coping strategies (or trying medicine-free options) should be used alongside medicines to help to improve your quality of life.

Accepting pain as part of everyday life and trying medicine-free options are important parts of learning how to ‘cope’ with nerve pain. Sometimes, the pain can affect your sleep or daily activities. Some people become depressed because of nerve pain.

Acceptance is a coping strategy that can have positive benefits for people living with nerve pain. Acceptance does not mean giving up or having no control. It is about changing the aim of treatment, from controlling the pain to having better daily function, despite still experiencing pain.

Staying active through exercise, and eating a balanced diet to maintain your physical wellbeing are good starting points to help you manage your condition. Other coping strategies include:

• setting realistic goals for managing your nerve pain
  
• joining a pain support group
  
• trying cognitive behavioural therapy (CBT)
  
• identifying triggers that impact your pain
  
• pacing physical therapies around your daily activities
  
• recognising the importance of routinely taking your medicine
  
• reviewing your management plan regularly with your GP.
  

Your GP may refer you to a psychologist, physiotherapist or other pain management services to help you with your nerve pain. Some physiotherapists, occupational therapists, nurses and psychologists specialise in managing chronic pain and may be located for referrals through pain networks such as the Australian Pain Society.

• Australian Pain Management Association
  
• NSW ACI Pain Management Network
  
• Veterans’ Mates Recovering from pain
  
• Australian Pain Society
  
• Painaustralia Neuropathic pain
  
• Find a pain service

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